Speculation regarding poorer outcomes for those with high cholesterol and/or heart disease infected with SARS-CoV-2 are well known. This week, a real-world study published by the FH Foundation confirms COVID-19 increased heart attack rates significantly in patients with these conditions.

Familial hypercholesterolemia is a common yet severely underdiagnosed genetic condition. While those with high cholesterol are generally considered to be elevated due to age, lifestyle and diet, FH patients experience elevated LDL from birth. Researchers say only 10% of the estimated 1.3 million with FH have received a diagnosis due to lack of awareness. The condition increases the risk of cardiovascular disease by up to 20-fold due to the lifelong elevation of LDL cholesterol.

Using a machine learning process dubbed “FIND FH,” the FH Foundation analyzed a pool of over 55.4 million individuals – those with diagnosed FH, probable FH, and atherosclerotic cardiovascular disease (ASCVD) – with and without COVID-19 infection.

The study found that the “probable FH” individuals with pre-existing ASCVD infected with COVID experienced heart attacks at the highest rate, seven times greater than those who did not get the virus.

“These results are significant because these data underscore the importance of understanding if individuals have underlying cardiovascular disease or genetic high cholesterol when treating for COVID-19 infection or considering vaccination,” said Kelly Myers, study author and chief technology officer of the FH Foundation.

According to one author of the study, the “probable FH” patients are likely not to receive lipid lowering treatment. Genetic high cholesterol cannot be well-managed by diet and exercise alone.

“This study is a call to action to diagnose individuals with this deadly genetic condition who are hiding in plain sight within our healthcare system, and take particular precautions related to Covid-19 infections. FH is an untapped opportunity for heart disease prevention,” said Mary McGowan, chief medical officer for the FH Foundation.

In November, BioSpace reported on a JAMA study that proved COVID-19 is a cardiac condition as it is a respiratory disease. SARS-CoV-2 causes heart damage in 20% of people with mild or no symptoms. This damage can occur even in an otherwise healthy heart patient. Awareness and treatment for those with underlying heart conditions, like FH, is vital.

Many medications are available for the treatment of FH. The key is diagnosis. The FH Foundation hopes to leverage the results of this study and other ongoing research to raise the flag for FH as a public health concern.

Additionally, individuals with FH and ASVCD should take extra precautions to avoid contracting the novel coronavirus, which has swept our globe for well over a year. Vaccinations are readily available in many countries and spreading into those less accessible areas as well.

The CDC is planning to meet to determine if COVID-19 vaccines will require boosters to help prevent the spread of variants, some of which have mutated into more contagious and more deadly than the original strain. Particularly vulnerable communities, like those with FH and ASVCD, are vital to protect.