COVID Raises Heart Attack Risk for People With High Cholesterol

People who have genetic high cholesterol, heart disease, or both conditions were more prone to heart attacks after being infected with COVID-19, according to a new study.

The study, which was published in the American Journal of Preventive Cardiology, analyzed data from 55,412,462 people and separated them into six groups:

• Those who were diagnosed with genetic high cholesterol—also known as familial hypercholesterolemia (FH)
• Those who likely had FH
• Those who were diagnosed with a kind of heart disease called atherosclerotic cardiovascular disease (ASCVD)
• Those who were diagnosed with both FH and ASCVD
• Those who likely had both FH and ASCVD
• Those who had neither FH nor ASCVD

The groups were further broken down into patients who had COVID-19 and those who didn’t.

The overall rates of heart attacks in all of the groups were high, with heart attacks occurring at a rate of 3 to 15% annually. But there were more cases of heart attacks in those who had COVID-19. The researchers specifically found that the rates of heart attacks were highest in people who were diagnosed with COVID-19 and who were either diagnosed with genetic high cholesterol or likely had genetic high cholesterol, along with heart disease.

“We already know that people with familial hypercholesterolemia are already at a very high risk of having a cardiovascular event,” study co-author Katherine Wilemon, founder and CEO of the FH Foundation, tells Verywell. “But the data is emerging that COVID infections also increase the risk. We wanted to look at the intersection and see the impact on individuals.”

The researchers also discovered that people with undiagnosed genetic high cholesterol “are at high risk of cardiovascular events, especially when they have COVID-19,” study co-author Kelly Myers, chief technology officer of the FH Foundation, tells Verywell.

What Is Familial Hypercholesterolemia?

Familial hypercholesterolemia (FH) is a disorder that’s passed down through the family. The condition leads to high levels of low-density lipoprotein (LDL) cholesterol, known as the "bad" form of cholesterol, in the body. It starts at birth and can cause heart attacks at an early age in patients.

About one in 250 people have familial hypercholesterolemia. If the disease is untreated, people with the disease are up to 22 times more likely to have heart disease than those who don’t have FH.

People with genetic high cholesterol may have no symptoms when they’re younger. But, when symptoms do develop, they can include:

• Fatty skin deposits called xanthomas over parts of the hands, elbows, knees, ankles, and around the cornea of the eye
• Cholesterol deposits in the eyelids called xanthelasmas
• Chest pain or other signs of coronary artery disease, even from a young age
• Cramping of one or both calves when walking
• Sores on the toes that don’t heal
• Stroke-like symptoms like trouble speaking, drooping on one side of the face, weakness of an arm or leg, and loss of balance

The COVID-19 Heart Attack Connection

It’s not entirely clear why people with familial hypercholesterolemia are at a greater risk for heart attack after having COVID-19, but doctors suspect it's linked to inflammation.

The increased risk, “might have to do with inflammation in blood vessels that occurs with COVID-19,” Richard Watkins, MD, an infectious disease physician and a professor of internal medicine at the Northeast Ohio Medical University, tells Verywell.

“COVID-19 is an infection, and any infection will produce inflammation in the body—that’s how our immune system works,” Robert Greenfield, MD, a cardiologist and lipidologist at MemorialCare Heart & Vascular Institute at Orange Coast Medical Center in California, tells Verywell. People with FH already have inflammation around plaques and blockages that form in their blood vessels, and adding COVID-19 to the equation can make things worse, he says.

“COVID-19 comes along and this new insult sets up an inflammatory reaction that causes these plaques to burst or rupture like a volcano,” Greenfield explains. That causes a blockage that can lead to a heart attack.

“People with familial hypercholesterolemia are sitting on a powder keg,” he says. 

Familial Hypercholesterolemia Treatment

Treatment for genetic high cholesterol should reduce the risk of heart disease. It can include dietary changes like:

• Eating less beef, chicken, pork, and lamb
• Replacing full-fat dairy products with low-fat products
• Eliminating trans fats

Medicines like statin drugs can also help lower the risk of heart attack and stroke.

People with a severe form of FH may need to undergo a treatment called apheresis, where blood or plasma is removed from the body, filtered to remove LDL cholesterol, and then returned to the body.

How to Lower Risk of COVID-19 Complications With FH

Myers recommends that people who have either been diagnosed with FH or who have a family history of the disease “pursue COVID-19 vaccination or seriously evaluate it.”

Watkins agrees. “More research is needed to prove causality, but I encourage them to get the COVID-19 vaccine,” he says.

It's important to exercise and follow good nutrition as well. “Diets that are anti-inflammatory are good for the body,” Greenfield says, noting that it’s best to substitute whole grains for white bread and eat berries, which tend to be anti-inflammatory. “Diets we think are the most healthful tend to be anti-inflammatory, and the ones that are full of saturated fat tend to be inflammatory."

If you have FH, Myers recommends continuing to take your medication as prescribed. And, if you have symptoms of FH, see a healthcare provider. “These findings underscore the importance of diagnosis,” Myers says.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.