The short-circuit evidence on lipid-lowering drugs use in pregnancy

The harmonized guidelines of the European Society of Cardiology (ESC) and the European Society of therosclerosis (EAS) for the management of dyslipidemia recommend that women discontinue lipidlowering drugs from pregnancy planning to the end of breastfeeding. These recommendations are cautious by necessity, mainly due to the difficulties of assessing the teratogenic risk associated with these drugs. Even though the relative lipids increase during pregnancy is similar between women with and without a history of hypercholesterolemia, women with familial hypercholesterolemia (FH) usually experience a higher absolute increase in atherogenic lipoprotein fractions than comparators. It follows that atherosclerosis dependent placental dysfunction is a matter of concerns in patients with particularly severe forms of FH, such as homozygous FH (HoFH) [4,5]. In this context, lipoprotein apheresis (LA) has been currently regarded as the most effective lipid-lowering intervention in pregnancy, being empirically able not only to reduce lipoproteins and circulating inflammatory cytokines, but also to down-regulate adhesion molecules .