As the days go by we are learning more about the cardiac complications related to infection with COVID-19. One concern that has emerged is the potential increased cardiac risk for people with elevated Lipoprotein(a) levels, or Lp(a) for short. As you likely know, people with familial hypercholesterolemia (FH) frequently also have elevated Lp(a) levels.
It should be said that at this point we do not have enough evidence to know for sure if people with elevated Lp(a) are at additional risk of more serious illness if they contract COVID-19. However, we know enough to say that this is something to be aware of, to take extra precautions not to be exposed to COVID-19, and to inform your medical team of your elevated Lp(a) if you do contract COVID-19. Anyone with established cardiovascular disease is at increased risk of more serious illness from COVID-19 and should already be taking these steps.
What is Lipoprotein(a)?
Lp(a) is an LDL-like particle with an attached protein called apolipoprotein(a) Just like LDL, Lp(a) can clog arteries. Apolipoprotein(a) adds an additional, negative risk – an increased risk for clotting. The combination of "clogging arteries" and "clotting" increases the risk for heart attacks even under the best of circumstances. In the setting of infection with COVID-19 this risk may be higher.
Why would infection with COVID-19 make the risk for someone with elevated Lp(a) greater?
It turns out that infection with this virus may trigger intense systemic inflammation. One of the inflammatory proteins that increases in response to infection with COVID-19 is interleukin 6. This protein can lead to increases in already elevated Lp(a) levels and potentially increase the risk of a heart attack.
Concern for this risk has been raised by Sotirios Tsimikas, MD of the University of California, San Diego (see letter below). One of our CASCADE FH Registry investigators, Dr. Patrick Moriarty of the University of Kansas Medical Center has pointed out that Lipoprotein Apheresis not only lowers LDL and Lp(a), but also lowers a host of inflammatory proteins (including interleukin 6, interleukin 1, and TNF alpha) as well. However, we know that not everyone has access to Lipoprotein Apheresis and some centers may not be offering Lipoprotein Apheresis at this time.
How you can protect yourself
The best strategy is to follow all the CDC recommendations for COVID-19. When out in public it is now recommended that you wear a face mask. Even more important is to practice social distancing, wash your hands frequently, and avoid rubbing your eyes with your hands. If you can, especially if you have underlying cardiac disease, ask your family members to do your grocery shopping or order groceries online. It is crucial to continue all your medicines. There is reason to believe that statins may be especially helpful for you now. Statins not only lower LDL, but they are also known to improve the health of the lining (or endothelium) of blood vessels and have anti-inflammatory properties. (See our article on COVID-19 and FH treatments)
What should you do if you become ill and think you might have COVID-19?
If you have an elevated Lp(a), whether or not you have FH, and become ill, potentially with COVID-19, bring a copy of the letter below to alert medical staff of this potential increased risk. You should also have your medical history, including any diagnosis of FH, elevated Lp(a), your medications and past procedures, ready as well.
I hope that our entire FH family remains safe in these difficult times.
Mary McGowan, MD
Chief Medical Officer