HEART UK Offers Guidance On The Safe Use Of Lipid Lowering Therapy During COVID-19 Pandemic

Patients with atherosclerotic cardiovascular disease (ASCVD) and obesity are at increased risk of severe illness and mortality if infected with COVID-19.

In the absence of evidence from a high-quality clinical trial, a consensus statement by HEART UK, based on available evidence and experts’ opinion, provides a guide for managing hyperlipidaemia during the pandemic.

According to the charity's Medical, Scientific and Research (MSR) committee, there is no need to withhold lipid-lowering medications because of the COVID-19 pandemic. This is especially important for patients who are at high risk of cardiovascular disease, in whom stopping lipid-lowering therapy can increase the risk of an atherosclerotic vascular event; patients who are being treated for hyperlipidaemia are advised to continue with their advised diet and lifestyle measures and should not interrupt their pharmacologic treatment.

However, if the possible risks from drug-drug interaction or organ damage outweigh the benefits in patients confirmed with COVID-19, the treatment should be reviewed by the medical team and alterations should be considered.  COVID-19 causes direct liver injury or as part of the wider systemic inflammatory response syndrome. Nonetheless, it is important to recognise hepatic injury in COVID-19 patients as the majority of lipid lowering therapies are metabolised in the liver.

Handrean Soran, Chair of the HEART UK Medical, Scientific and Research Committee, said "The fatality rate as a result of (SARS-CoV-2) which causes Coronavirus Disease 2019 (COVID-19) is unpredictable but is amplified by several factors including advancing age, atherosclerotic cardiovascular disease, diabetes mellitus, hypertension and obesity. A large proportion of patients with these conditions are treated with lipid lowering medication and questions regarding the safety of continuing such medication in patients infected with COVID-19 have arisen. Some have reported an association between low circulating cholesterol levels and adverse outcomes in COVID-19 patients and suggested lipid lowering therapy may result in unfavourable outcomes in patients with COVID-19. However, a recent retrospective study reported a benefit from statin use - 28-day all-cause mortality was 5.2% in statin (a drug used to lower cholesterol) users compared to 9.4% in non-statin users. These observations, whilst encouraging, and plausible mechanistically via the anti-inflammatory and immunodulatory actions of statins, require confirmation."

Jules Payne, HEART UK's CEO says, ‘HEART UK works with world class clinicians from across the UK and the science underpins everything we do.  HEART UK’s Medical, Scientific and Research Committee produced this expert statement of care to support clinical practice.  It translates into the best treatment for patients during this pandemic and beyond.’ 

HEART UK's recommendations can be found on Atherosclerosis.

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