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Statins and other lipid-lowering therapy and pregnancy outcomes in homozygous familial hypercholesterolaemia: A retrospective review of 39 pregnancies

  • Theunis C. Botha
    Correspondence
    Corresponding author.
    Affiliations
    Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Private Bag 3, WITS, 2050, Johannesburg, South Africa
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  • Gillian J. Pilcher
    Affiliations
    Carbohydrate & Lipid Metabolism Research Unit, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Private Bag 3, WITS, 2050, Johannesburg, South Africa
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  • Karen Wolmarans
    Affiliations
    Division of Lipidology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, 5th Floor Chris Barnard Building, Anzio Road Observatory, 7925, Cape Town, South Africa
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  • Dirk J. Blom
    Affiliations
    Division of Lipidology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, 5th Floor Chris Barnard Building, Anzio Road Observatory, 7925, Cape Town, South Africa
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  • Frederick J. Raal
    Affiliations
    Carbohydrate & Lipid Metabolism Research Unit, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Private Bag 3, WITS, 2050, Johannesburg, South Africa
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      Highlights

      • Statin exposure during pregnancy might not be as detrimental to the fetus as previously thought.
      • Pregnancy complications in homozygous familial hypercholesterolaemia patients did not differ from healthy woman.
      • Birth weights between statin exposed and non-exposed pregnancies was similar.
      • No severe skeletal abnormalities or developmental delay occurred in statin exposed fetusses.

      Abstract

      Background and aims

      Pregnancy in HoFH females is associated with further elevation of already markedly elevated low density lipoprotein cholesterol (LDL-C) levels, particularly if lipid-lowering therapy is discontinued, placing the mother and fetus at increased cardiovascular risk. Lipoprotein apheresis is the current recommended treatment for pregnant HoFH patients. However, this is costly, time consuming, and is not available in many countries. Alternative treatment strategies to control hypercholesterolaemia during pregnancy in HoFH patients are necessary.

      Methods

      This study was a retrospective review of 39 pregnancies from a cohort of 20 genotypically confirmed female HoFH patients.

      Results

      No maternal cardiac complications or deaths occurred during the pregnancies or during the first year postpartum. Twenty five pregnancies were exposed to lipid-lowering therapy, of which 18 were exposed to statin therapy, just prior to or during the pregnancy. Thirty three (84%) pregnancies carried to term, 3 (8%) premature deliveries and 3 (8%) miscarriages were observed. Complications associated with pregnancy in these HoFH patients, did not differ from those reported during pregnancies of otherwise healthy woman.

      Conclusions

      HoFH is a severe disease impacting significantly on life expectancy. However, for many females with HoFH, despite the high cardiovascular risk, pregnancy is not uncommon. In resource poor settings and when LA is not available, lipid lowering therapy, particularly statin therapy during pregnancy, appears to be safe for both mother and fetus and is an acceptable alternative for LDL-C reduction in these high risk patients.

      Keywords

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