Saint Joseph University, Hotel Dieu de France, Lebanon
Covid 19 remains a novel pandemic with many controversies and
variable clinical expression and severity. Diabetes and a pre-existing
cardiovascular disease are the greatest risk factor for severe Covid 19.
The overall case fatality rate of 2.3 % in the general population
increases to 7.3 % in presence of diabetes & 10-15 % in presence of a
pre-existing cardiovascular disease (1). Age, smoking, arterial
hypertension, hypercholesterolemia, diabetes & obesity predict a severe
Covid 19.
MyD88 gene seems to be highly induced in SARS-CoV infection which
activates NFkB pathway, reduces type 1 interferon & increases
inflammation, hallmark triad of SARS-CoV infection (2,3). Modified LDL
cholesterol is absorbed via scatter receptors into cells & form
crystals that activate NLRP3 inflammasome – caspase- 1 activity
increasing the release of IL-1b & IL-18 (4). Oxidized LDL cholesterol
binds to Toll-like family receptors which activates inflammation via
MyD88 & NFkB pathway and increase transcription of inflammatory
cytokines such as IL-6, IL-12, IL-27 & TNF alpha (4).
Statins inhibit the MyD88 pathway maintaining normal levels during
hypoxia or under stress (2), and the attenuation of NFkB increased the
survival of SARS-infected transgenic mice (3). The ability of statins to
maintain MyD88 at normal levels may be protective for Covid 19 patients
as the attenuation of NFkB inflammatory pathway reduces IL-6 and other
inflammatory cytokines transcription. Furthermore, mortality was lower
in COPD & influenza patients on moderate doses of statins compared to
patients without statin therapy (5).
In our prospective cohort study, all 65 patients hospitalized for Covid
19 received Pitavastatin known for less drug interaction and muscular
toxicity and better liver tolerability. Mean age was 53,1±18,3 years and
60% were male. At database lock date, 80% of the patients were
discharged with a median length of stay of 8 days, five remained in an
isolation unit, one in ICU and only two patients were dead.
The ACE receptor seems to have also an important role in this disease.
Thus, controlling cardiovascular risk factors tightly & exploring more
the pathophysiology of Covid 19 will lead to a better comprehension of
severity and variability of this disease in order to implement a better
management.
Competing Interests’ Statement: NONE