Vuorio Alpo, Raal Frederick, Kovanen Petri T
Mehiläinen Airport Health Centre, Vantaa.
Department of Forensic Medicine, University of Helsinki, Helsinki, Finland.
Curr Opin Lipidol. 2023 Jun 1;34(3):119-125. doi: 10.1097/MOL.0000000000000876. Epub 2023 Mar 9.
Patients with heterozygous familial hypercholesterolemia (HeFH) are at increased risk for COVID-19 cardiovascular complications in the acute phase of the infection. Elevated levels of LDL-C and often lipoprotein(a) are present from birth and lead to endothelial dysfunction, which is aggravated by a direct viral attack of the endothelial cells and their exposure to the toxic levels of circulating proinflammatory and prothrombotic mediators during the hyperinflammatory reaction typical of COVID-19.
Evidence to date shows the benefit of lipid-lowering therapy in patients with COVID-19. In HeFH patients who are at much higher cardiovascular risk, the focus should, therefore, be on the effective lowering of LDL-C levels, the root cause of the greater cardiovascular vulnerability to COVID-19 infection in these patients. The ongoing use of statins and other lipid-lowering therapies should be encouraged during the ongoing COVID pandemic to mitigate the risk of cardiovascular complications from COVID-19, particularly in HeFH patients.
Epidemiologic registry data show that the incidence of myocardial infarction is increased in SARS-CoV-2-infected HeFH patients. There is a need to study whether the risk for acute cardiovascular events is increased in the long-term and if there are changes in lipid metabolism after SARS-CoV infection(s) in patients with HeFH.
杂合子家族性高胆固醇血症（HeFH）患者在感染急性期发生COVID-19心血管并发症的风险增加。LDL-C水平升高，且脂蛋白(a)通常也升高，自出生起就存在，会导致内皮功能障碍，而在COVID-19典型的高炎症反应期间，内皮细胞受到病毒直接攻击以及暴露于循环中促炎和促血栓介质的毒性水平会使这种内皮功能障碍加重。
迄今为止的证据表明降脂治疗对COVID-19患者有益。因此，对于心血管风险高得多的HeFH患者，重点应放在有效降低LDL-C水平上，这是这些患者心血管对COVID-19感染更易受损的根本原因。在当前的COVID大流行期间，应鼓励持续使用他汀类药物和其他降脂疗法，以降低COVID-19导致心血管并发症的风险，尤其是在HeFH患者中。
流行病学登记数据显示，SARS-CoV-2感染的HeFH患者心肌梗死发病率增加。有必要研究HeFH患者长期急性心血管事件风险是否增加，以及SARS-CoV感染后脂质代谢是否有变化。
