It is common knowledge that comorbidities such as cardiovascular conditions, diabetes, obesity, etc. are associated with increased risk of complexities surrounding COVID-19 infection.
Mortality due to cardiovascular complications and blood clots post COVID-19 infection have also been reported in about 8-12 percent of positive patients. However, the association doesn’t seem to end there. A recent study by Familial Hypercholesterolemia (FH) foundation suggests that COVID-19 recovered patients with pre-existing heart conditions should watch out.
According to the large case-control study that included patients with pre-existing atherosclerotic cardiovascular disease (ASCVD), familial hypercholesterolemia (FH) or both, the incidence of acute myocardial infarction (AMI) or heart attack is significantly higher in those infected with the SARS-CoV-2 virus.
The rate of AMI and annual incidence rate were significantly higher in patients diagnosed with FH/probable FH or ASCVD in a COVID-19 setting compared to those who didn’t have COVID-19 infection. Patients diagnosed with FH or probable FH in addition to ASCVD had a significantly enhanced AMI event in the presence of COVID-19 as against in the absence of infection.
Even amongst COVID-19 patients, the rate of AMI in those with diagnosed or probable FH was high when compared to those who did not have a pre-existing cardiac condition or event. This could be because diagnosed FH patients would already be on some kind of lipid lowering therapy. These findings emphasize the importance of diagnosis of FH, for it remains to be one of the most underdiagnosed conditions.
FH is a genetically inherited condition that causes high cholesterol and predisposes an individual to the risk of life-threatening cardiac events such as heart attack and heart disease. They have high levels of low-density lipoprotein (LDL) or ‘bad cholesterol’ in their blood that can accumulate in the walls of arteries and result in their hardening leading to a condition called atherosclerosis. This can eventually lead to heart attacks and strokes irrespective of age.
The prevalence of FH is about 1 in 250 people in India and approximately 90 percent of people with FH are estimated to be undiagnosed. The condition is a result of genetic change or mutation in genes that have a role in cholesterol clearance.
Since it is inherited, there is a 50 percent chance of a person carrying a mutation to pass it on to their children. Hence, it is important to screen all individuals with a family history of high cholesterol for the presence of FH mutations. Most genetic tests screen the most relevant genes for FH namely, LDRL, APOB and PCSK9. These genes are known to cause monogenic FH, that is, mutations in one of the genes will result in FH in an individual.
However, FH can also be caused by a combination of variations in many genes, in other words, polygenic. Hence, a comprehensive genetic test that can screen more relevant genes would be ideal in such a situation. With the advent of advanced molecular technology such as next generation sequencing (NGS), the screening of several genes in one shot is possible at an affordable cost.
Having knowledge about one’s genetic status in FH is important to not only adapt to a healthy lifestyle and seek early clinical intervention but also to protect oneself from the perils of COVID-19 infection by getting vaccinated and following COVID-19 guidelines meticulously.
The increasing rate of COVID-19 infection in the younger age group reiterates the importance of pre-symptomatic genetic diagnosis of FH in youngsters having a positive family history.
Author Dr Vedam Ramprasad is Chief Executive Officer (CEO) at MedGenome.
Views expressed are personal.
(Edited by : Kanishka Sarkar)