Vuorio Alpo, Strandberg Timo E, Raal Frederik, Santos Raul D, Kovanen Petri T
Mehiläinen, Airport Health Center, Vantaa, Finland.
University of Helsinki, Department of Forensic Medicine, Helsinki, Finland.
Atheroscler Plus. 2021 Sep;43:3-6. doi: 10.1016/j.athplu.2021.08.001. Epub 2021 Aug 8.
SARS-CoV-2 infection continues to cause increased morbidity and mortality, and due to the slow pace of vaccination COVID-19 will probably remain a global burden to health systems for a long time. Unfortunately, the necessary prevention and treatment strategies of COVID-19 have led to restriction measures that are hampering the routine care of common chronic metabolic conditions like hypercholesterolemia. It is of particular concern that during the acute phase of COVID-19, the control of pre-existing metabolic diseases tends to get worse which again increases the risk for complications and a poor outcome in these patients. A significant contributor to these complications is endothelial dysfunction which is associated with COVID-19. This Commentary will discuss the impact of COVID-19 on endothelial function particularly in patients with familial hypercholesterolemia (FH), a metabolic inherited disease known to in itself adversely affect endothelial function. There should be no hesitation to continue with statin therapy in severe hypercholesterolemic patients with COVID-19. We argue that in FH patients with COVID-19 the clinicians need even consider intensifying statin therapy as well as the addition of other lipid-lowering agents, such as proprotein convertase subtilisin/kexin type 9(PCSK9) inhibitors. In contrast to statins, the PCSK9 inhibitors lower lipoprotein(a) [Lp(a)] level, and, accordingly, these latter drugs need to be considered particularly in FH patients with an elevated level of Lp(a). This call applies to the in-hospital stay and also beyond. When considering that the vasculopathic effects of COVID-19 may persist, a long-term follow-up of individualized therapies in FH patients is warranted.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染持续导致发病率和死亡率上升，并且由于疫苗接种速度缓慢，新型冠状病毒肺炎（COVID-19）可能在很长一段时间内仍是卫生系统的全球负担。不幸的是，COVID-19必要的预防和治疗策略导致了限制措施，这些措施妨碍了高胆固醇血症等常见慢性代谢疾病的常规护理。特别令人担忧的是，在COVID-19急性期，已存在的代谢疾病的控制往往会恶化，这又增加了这些患者出现并发症和不良结局的风险。这些并发症的一个重要促成因素是与COVID-19相关的内皮功能障碍。本述评将讨论COVID-19对内皮功能的影响，特别是在家族性高胆固醇血症（FH）患者中，FH是一种已知本身会对内皮功能产生不利影响的代谢性遗传病。对于患有COVID-19的严重高胆固醇血症患者，应毫不犹豫地继续进行他汀类药物治疗。我们认为，对于患有COVID-19的FH患者，临床医生甚至需要考虑强化他汀类药物治疗以及添加其他降脂药物，如前蛋白转化酶枯草溶菌素/kexin 9型（PCSK9）抑制剂。与他汀类药物不同，PCSK9抑制剂可降低脂蛋白（a）[Lp（a）]水平，因此，尤其需要在Lp（a）水平升高的FH患者中考虑使用这些药物。这一呼吁适用于住院期间及出院后。考虑到COVID-19的血管病变效应可能持续存在，有必要对FH患者的个体化治疗进行长期随访。
