Familial hypercholesterolemia and statins in the COVID-19 era: Mitigating the risk of ischemic stroke

• Published in: eNeurologicalSci 2021-06, Vol.23, p.100344-100344, Article 100344
• Main Authors: Vuorio, Alpo, Kaste, Markku, Kovanen, Petri T.
• Format: Article
• Language: English
• Subjects: COVID-19; endothelial dysfunction; familial hypercholesterolemia; LDL cholesterol; Letter to the Editor; statins; stroke
• ISSN: 2405-6502; 2405-6502
• DOI: 10.1016/j.ensci.2021.100344

There is a continuing need for research about the underlying mechanisms behind ischemic strokes in COVID-19 patients. Pre-existing endothelial dysfunction, especially if it is accompanied by a viral infection of the endothelial cells may present an important mechanism behind the immunothrombotic/thromboembolic complications of the COVID-19 illness. Here we emphasize that pharmacotherapy with statins could partly counteract such pathophysiological scenarios. Accordingly, using familial hypercholesterolemia (FH) as a pertinent example of a lifelong endothelial dysfunction, we aim to make the clinicians and consulting neurologists aware of statins as a possible adjuvant therapy in the context of an increased risk of ischemic stroke in patients with COVID-19. Based on recent clinical evidence, there is a need to encourage clinicians and consulting neurologists to continue or initiate effective statin treatment to prevent an ischemic stroke, particularly when they encounter a hypercholesterolemic COVID-19 patient with FH. •In familial hypercholesterolemia (FH), serum LDL-cholesterol is markedly elevated since birth.•Elevated serum LDL-cholesterol causes endothelial dysfunction and ensuing prothrombotic state.•Ischemic stroke patients with COVID-19 seem to have worse outcomes than those without COVID-19.•Statin therapy associates with a favorable prognosis in hospitalized COVID-19 patients.•Neurologists also have to ensure that statin treatment continues in hospitalized FH patients with COVID-19.