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narrative_review·cardiology, epidemiology, public health, internal medicine·PMC10436799

Barriers and shortcomings in access to cardiovascular management and prevention for familial hypercholesterolemia during the COVID‐19 pandemic

Clinical Cardiology · 13 authors, 16 centres

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TL;DR

The authors conclude that continued lipid‐lowering therapy and increased resources for early identification and management are needed.

Full summary

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The review identifies multiple barriers that emerged during the pandemic, including patient fear of seeking care, financial insecurity, socioeconomic and racial disparities, and reduced physical activity during lockdowns. The paper argues that FH predisposes the vascular lining to infectious and immune attacks, increasing ASCVD risk, and that the pandemic compounded these vulnerabilities for FH patients who also have ASCVD.

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narrative_review

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cardiology

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ORIGINAL PAPER

PMC10436799

Barriers and shortcomings in access to cardiovascular management and prevention for familial hypercholesterolemia during the COVID‐19 pandemic

Clinical Cardiology

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ABSTRACT

Abstract Familial hypercholesterolemia (FH) is a hereditary condition caused by mutations in the lipid pathway. The goal in managing FH is to reduce circulating low‐density lipoprotein cholesterol and, therefore, reduce the risk of developing atherosclerotic cardiovascular disease (ASCVD). Because FH patients were considered high risk groups due to an increased susceptible for contracting COVID‐19 infection, we hypothesized whether the effects of the pandemic hindered access to cardiovascular care. In this review, we conducted a literature search in databases Pubmed/Medline and ScienceDirect. We included a comprehensive analysis of findings from articles in English related and summarized the effects of the pandemic on cardiovascular care through direct and indirect effects. During the COVID‐19 pandemic, FH patients presented with worse outcomes and prognosis, especially those that have suffered from early ASCVD. This caused avoidance in seeking care due to fear of transmission. The pandemic severely impacted consultations with lipidologists and cardiologists, causing a decline in lipid profile evaluations. Low socioeconomic communities and ethnic minorities were hit the hardest with job displacements and lacked healthcare coverage respectively, leading to treatment nonadherence. Lock‐down restrictions promoted sedentary lifestyles and intake of fatty meals, but it is unclear whether these factors attenuated cardiovascular risk in FH. To prevent early atherogenesis in FH patients, universal screening programs, telemedicine, and lifestyle interventions are important recommendations that could improve outcomes in FH patients. However, the need to research in depth on the disproportionate impact within different subgroups should be the forefront of FH research. Keywords: atherosclerotic cardiovascular disease, cholesterol, COVID‐19, familial hypercholesterolemia, genetics, mortality

CITATION EXPORT

Helen Huang, Keith S K Leung, Tulika Garg et al.. Barriers and shortcomings in access to cardiovascular management and prevention for familial hypercholesterolemia during the COVID‐19 pandemic. Clinical Cardiology. (2023). https://doi.org/10.1002/clc.24059

AUTHORS

13 · 16 CENTRES

Helen Huang, Keith S K Leung, Tulika Garg, Adele Mazzoleni, Goshen D Miteu, Farida Zakariya, Wireko A Awuah, Elaine T S Yin, Faaraea Haroon, Zarish Hussain, Narjiss Aji, Vikash Jaiswal, Gary Tse

1 Royal College of Surgeons in Ireland, Faculty of Medicine and Health Science, Dublin, Ireland
2 Aston University Medical School, Faculty of Health & Life Sciences, Aston University, Birmingham, UK
3 Epidemiology Research Unit, Cardiovascular Analytics Group, China‐UK Collaboration, Hong Kong, China
4 Government Medical College and Hospital Chandigarh, Chandigarh, India
5 Barts and The London School of Medicine and Dentistry, London, UK
6 School of Biosciences, Biotechnology, University of Nottingham, Nottingham, UK
7 Department of Biochemistry, Caleb University Lagos, Lagos, Nigeria
8 Department of Pharmaceutical Sciences, Ahmadu Bello University, Zaria, Nigeria
9 Department of Medicine, Sumy State University, Sumy, Ukraine
10 Zhejiang University School of Medicine, Hangzhou, China
11 Health Services Academy, Islamabad, Pakistan
12 Royal College of Surgeons in Ireland, Medical University of Bahrain, Busaiteen, Bahrain
13 Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
14 Department of Cardiology Research, Larkin Community Hospital, South Miami, Florida, USA
15 Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
16 Kent and Medway Medical School, Canterbury, UK