• This consensus statement from Hyperlipidaemia Education and Atherosclerosis Research Trust in United Kingdom (HEART UK) reviews the current evidence on the safety of lipid-lowering therapies (LLTs) in patients with coronavirus disease 2019 (COVID-19) to provide recommendations for managing hyperlipidaemia in this patient population.
• LLTs are generally safe in patients with COVID-19 and should not be interrupted because of the pandemic and during the infection.
• However, drug interactions between LLTs and COVID-19 medications should be avoided in patients with a confirmed diagnosis of COVID-19, particularly those with abnormal liver function, homozygous familial hypercholesterolaemia (HoFH) and familial chylomicronaemia syndrome (FCS).

• Patients with hyperlipidaemia should continue their recommended diet, lifestyle and medications during the COVID-19 pandemic (I, A).
• Patients with confirmed COVID-19 who are too unwell to receive medications orally can temporarily suspend LLT (I, E).
• In recovered patients, oral LLT should be reassessed and recommenced before or soon after leaving the hospital (I, B).
• In patients with COVID-19 and abnormal liver function tests, LLT should be continued until alanine transaminase (ALT) or aspartate transaminase (AST) rises to over 3 times the upper limit of normal (I, B).
• Statins should be continued in patients with COVID-19 (1, C) until ALT/AST rises (1, B), drug-drug interactions occur (1, C) or creatine kinase increases 10-fold to levels  2000 IU/mL in asymptomatic patients or at a lower level of 5-fold the upper limit of normal in symptomatic patients (1, B).
  • Drugs such as remdesivir, lopinavir and ritonavir being used for COVID-19 treatment can either compete for metabolism with some statin types or cause hepatotoxicity.
  • In such cases, switching from other statins (atorvastatin, simvastatin, pitavastatin or pravastatin) to low-dose rosuvastatin is recommended.
  • Kidney function should be evaluated if myositis occurs (1, B).
  • All statins should be temporarily discontinued with azithromycin and tocilizumab treatment.
• As ezetimibe and proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) are considered safe therapeutic options with no known drug interactions with COVID-19 medications, they should be continued in patients with COVID-19 (ezetimibe: 1, C).
  • Ezetimibe should be stopped if significant drug-drug interactions occur (1, C) or ALT and/or AST levels rise over 3 times the upper limit of normal (1, B).
  • PCSK9i should be stopped until recovery and discharge from the critical care unit in critically ill patients with COVID-19 (1, E).
• If statins, ezetimibe or PCSK9i treatments are suspended, benefit vs risk assessment to reinitiate the therapy should be considered as soon as the patient recovers (1, B).
• For patients with HoFH and FCS, lipid specialist should be consulted before making any changes to the therapy.
  • Lomitapide should be temporarily discontinued in patients who are acutely ill, on antimicrobial medications with known significant drug interactions, critically ill and/or unable to take oral medications (1, C).
  • In patients with FCS, volanesorsen should be avoided and very low-fat diet should be continued (1, C).
• Fibrates (1, C) and omega-3 fatty acids should be continued unless myopathy occurs (1, B) or the patient is critically ill (1, C), respectively.
• As cardiovascular outcome data on the use of niacin and bile acid sequestrants are limited, these agents should be temporarily discontinued in patients with COVID-19 (1, C).

MAT-BH-2100800/v1/Oct 2021