COVID-19 may increase risk for MI in patients with ASCVD, familial hypercholesterolemia
Adults with preexisting atherosclerotic CVD and/or familial hypercholesterolemia have increased risk for acute MI if infected with COVID-19, according to an analysis published in the American Journal of Preventive Cardiology.
“CVD, hypertension and heart failure are associated with higher rates of COVID-19-related morbidity and mortality,” Kelly D. Myers, BS, chief technology officer at the FH Foundation and CEO of Atomo Inc. in Austin, Texas, and colleagues wrote. “However, studies have documented fewer individuals presenting to hospital with acute MI during the pandemic.”
Researchers assessed laboratory data and diagnostic, procedural and prescription claims from Symphony Health from May 2012 to June 2020. In total, 55,441,462 adults who were evaluated or treated for CVD with valid demographic data and at least one record before COVID-19 and one after the pandemic were analyzed. Acute MI rates for all individuals were assessed through COVID-19 status and history.
Individuals with and without COVID-19 were then categorized into groups and matched based on the presence or lack of comorbidities before COVID-19: ASCVD (176,946 with COVID-19; 12,051,757 without COVID-19); familial hypercholesterolemia (FH; 1,216 with COVID-19; 121,396 without COVID-19); probable FH (3,369 with COVID-19; 334,724 without COVID-19); FH and ASCVD (1,399 with COVID-19; 89,396 without COVID-19); probable FH and ASCVD (3,833 with COVID-19; 253,449 without COVID-19); and no FH nor ASCVD (447,192 with COVID-19; 41,956,785 without COVID-19).
According to the researchers, there were increased rates of acute MI among individuals with COVID-19 compared with matched individuals without COVID-19 in the group with ASCVD (1.4% vs. 0.46%; P < .0002), in the group with FH (0.41% vs. 0.12%; P = .003), in the group with probable FH (0.5% vs. 0.12%; P < .0002), in the group with FH and ASCVD (1.57% vs. 0.56%; P < .0002), in the group with probable FH and ASCVD (2.09% vs. 0.5%; P < .0002) and in the group with neither disease (0.34% vs. 0.11%; P < .0002).
Among individuals with COVID-19, acute MI rates were highest in the presence of diagnosed and probable FH and ASCVD. There were higher rates of acute MI among individuals with an ASCVD history diagnosed with COVID-19 compared with individuals with COVID-19 but no ASCVD or FH (1.05%; 95% CI, 0.99-1.11; P < .0002). In addition, preexisting ASCVD plus probable FH was a critical risk factor compared with ASCVD alone (0.7%; 95% CI, 0.25-1.16; P < .0002).
According to a press release, these findings highlight the importance of diagnosing FH so these individuals can receive appropriate lipid-lowering treatment and potentially avoid putting themselves at significantly higher risk for acute MI.
“Critically, our data indicate that those with both ASCVD and FH are at very high risk of acute MI if they contract COVID-19,” the researchers wrote. “Our results suggest that individuals with ASCVD and known FH should receive a COVID-19 vaccination when offered and demonstrate another reason for making greater efforts to identify and diagnose individuals with probably undiagnosed FH.”