Risks and Role of Statins in Familial Hypercholesterolemia in the

COVID-19 era

-FH is an inherited disease characterized by chronic

elevation in plasma LDL-C concentration1

-The estimated prevalence of FH is 1:250 in the general

population and 1:125 to 1:450 in Indian urban subjects

FH patients have higher lipoprotein(a) levels compared to the general

population and may be at a higher risk of an atherothrombotic event
whilst suffering and even after recovery from COVID-19 infection1

Familial Hypercholesterolemia and COVID 19: Triggering of Increased

Sustained Cardiovascular Risk

LDL receptor variants can possibly COVID-19 might also induce long-term
modulate long-term immune lipid and glucose abnormalities in FH
response to COVID-19 in FH patients1 patients

Young subjects at increased risk of FH may have deleterious

consequences due to COVID-193

Use of Statins in the Management of FH with COVID-19

Statins are the primary “LDL cholesterol-lowering” pharmacotherapy for patients with FH which possibly
offers protection against endothelial dysfunction and acute coronary events

Advantages of using statins for FH in patients with COVID-19

-Pleiotropic effects on inflammation and oxidative stress4 Literature supports continual

-Favorable modulation of immune response4 use or even initiation of statins
-Add-on therapy for autoimmune inflammatory conditions4 as an add-on treatment for
-Lipid lowering effects preventing RNA viral entry and function3 COVID-19 patients

Statins hold promise in improving the

clinical course of FH patients with COVID-19

A 21% reduction in LDL-C levels from baseline was

observed in a trial in homozygous FH patients

Fewer drug interaction with COVID-19 treatments

and possible modest reduction in incidence of
pneumonia

Delay in cardiovascular events and prolonged

survival in patients with homozygous FH by 65%
Atorvastatin4
Aggressive LDL-C reduction accompanied by
regression of carotid IMT in FH patients

A dose dependent reduction in LDL-C and other

atherogenic lipoproteins
Pitavastatin7

Well tolerated with few drug-drug interactions

Genetic Predisposition Determines Statin Treatment Efficacy

Therapeutic efficacy of statins depend on LDL receptor function and

variation in genetic factors4

FH patients with APOE4 allele are poor responders to statin therapy compared
to APOE3 and APOE2 carriers

LOF variants in PCSK9 show up to 55% increased response

to statin therapy

Conclusion1

The potential
Patients with FH Pharmacotherapy Therapy could
advantages of
are likely to be at for severe even be intensified
intensifying lipid
increased hypercholesterolemia following recovery
-lowering therapy for
long-term risk of an in FH with COVID-19 from COVID-19
FH patients after
atherothrombotic must not be infection to
COVID-19 epidemic
event following discontinued during mitigate excess
seem promising and
COVID-19 infection risk of ASCVD
warrants further
research

APOE, apolipoprotein E; ASCVD, atherosclerotic cardiovascular disease; COVID, coronavirus disease; FH, familial hypercholesterolemia; IMT,
intima-media thickness; LDL, low-density lipoprotein; LDL-C low-density lipoprotein cholesterol; LOF, loss of function; PCSK9, Proprotein
convertase subtilisin/kexin type 9; RNA, ribonucleic acid.
References: 1. Vuorio A, et al. Familial hypercholesterolaemia and COVID-19: triggering of increased sustained cardiovascular risk. J Intern Med. 2020;287(6):746-747. 2. Gupta R,
et al. Recent trends in epidemiology of dyslipidemias in India. Indian Heart J. 2017;69(3):382-392. 3. Scicali R, et al. May statins and PCSK9 inhibitors be protective from COVID-19
in familial hypercholesterolemia subjects?. Nutr Metab Cardiovasc Dis. 2020;30(7):1068-1069. 4. Pang J, et al. The Knowns and Unknowns of Contemporary Statin Therapy for
Familial Hypercholesterolemia. Curr Atheroscler Rep. 2020;22(11):64. 5. Carswell CI, et al. Rosuvastatin. Drugs. 2002;62(14):2075-2087. 6. Rodrigues-Diez, et al. Statins: Could an old
friend help in the fight against COVID-19?. Br J Pharmacol. 2020;177(21):4873-4886. 7. Chan P, et al.. An evaluation of pitavastatin for the treatment of hypercholesterolemia. 
Expert Opin Pharmacother. 2019;20(1):103-113.