Vuorio Alpo, Raal Frederick, Kovanen Petri T
Mehiläinen Airport Health Centre, 01530 Vantaa, Finland.
Department of Forensic Medicine, University of Helsinki, 00100 Helsinki, Finland.
Rev Cardiovasc Med. 2022 Dec 19;23(12):410. doi: 10.31083/j.rcm2312410. eCollection 2022 Dec.
Heterozygous familial hypercholesterolemia (HeFH) patients are the prime example of subjects who are at high risk for both acute myocardial infarction (AMI) and ischemic stroke during, and post, SARS-CoV-2 infection. HeFH , if left untreated, results in premature clinical atherosclerosis often presenting in the fourth or fifth decade of life. The other concern in HeFH is endothelial dysfunction which is already evident from early childhood. In untreated HeFH patients, the severe hypercholesterolemia causes endothelial dysfunction from an early age, and as a result thereof, atherosclerotic lesions develop prematurely, particularly in the coronary arteries, and result in further endothelial dysfunction and inflammation in these critical segments of the arterial tree. As the pre-existing endothelial dysfunction in HeFH patients is most likely sensitive to further direct and indirect SARS-CoV-2 virus-dependent damage, we can infer that HeFH serves as an example of a comorbidity that predicts a poorer prognosis with COVID-19 infection. Indeed, a large US national database study showed that patients diagnosed with HeFH and SARS-CoV-2 infection had significantly increased Annualized Incidence Density Rates (AIDRs) of AMI when compared to matched HeFH controls not having been diagnosed with SARS-CoV-2 infection. Effective cholesterol lowering is essential for the prevention, or at least alleviation, of the detrimental effects of SARS-CoV-2 infection among HeFH patients. Due to the pre-existing subclinical or even clinical atherosclerotic cardiovascular disease in subjects with HeFH, cholesterol-lowering treatment needs to be continued or, better still, intensified during, and for an extended period post, SARS-CoV-2 infection.
杂合子家族性高胆固醇血症（HeFH）患者是在感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）期间及之后发生急性心肌梗死（AMI）和缺血性中风高风险人群的典型例子。HeFH若不治疗，常导致临床前期动脉粥样硬化，通常在生命的第四或第五个十年出现。HeFH的另一个问题是内皮功能障碍，从幼儿期就已明显。在未经治疗的HeFH患者中，严重的高胆固醇血症从幼年起就会导致内皮功能障碍，结果动脉粥样硬化病变过早发展，特别是在冠状动脉，并导致动脉树这些关键节段进一步的内皮功能障碍和炎症。由于HeFH患者预先存在的内皮功能障碍很可能对SARS-CoV-2病毒进一步的直接和间接依赖性损伤敏感，我们可以推断HeFH是一种合并症的例子，它预示着COVID-19感染的预后较差。事实上，一项大型美国国家数据库研究表明，与未被诊断感染SARS-CoV-2的匹配HeFH对照相比，被诊断为HeFH和SARS-CoV-2感染的患者AMI的年化发病率密度率（AIDRs）显著增加。有效降低胆固醇对于预防或至少减轻HeFH患者中SARS-CoV-2感染的有害影响至关重要。由于HeFH患者预先存在亚临床甚至临床动脉粥样硬化性心血管疾病，在SARS-CoV-2感染期间及感染后的很长一段时间内，需要继续进行降胆固醇治疗，或者更好的是强化治疗。
