Vnitr Lek 2026, 72(3):171-175 | DOI: 10.36290/vnl.2026.036

Hypolipidemic therapy in pregnancy

Pavla Jadrníčková^{1, 2}, Jan Václavík^{1, 2}, Filip Dubský^{1, 2}

¹ Interní a kardiovaskulární oddělení, Fakultní nemocnice Ostrava

² Lékařská fakulta, Ostravská univerzita, Ostrava

Pregnancy is accompanied by significant metabolic adaptations, including a physiological increase in lipid levels, particularly low-density lipoprotein cholesterol (LDL-C), a causal risk factor for cardiovascular disease. Elevated LDL-C exposure during gestation, especially in women with familial hypercholesterolemia (FH), contributes to lifelong cardiovascular risk. Although atherosclerotic coronary artery disease is rare in women of reproductive age, pregnancy in the fourth and fifth decades of life is becoming increasingly common and is associated with a higher prevalence of acute myocardial infarction during pregnancy. This review summarizes current strategies for managing dyslipidemia during pregnancy. Non-pharmacological measures, such as appropriate nutrition (e.g., Mediterranean diet) and regular physical activity, form the cornerstone of management. Pharmacotherapy is limited: bile acid sequestrants and LDL apheresis are considered safe, while ezetimibe, PCSK9 inhibitors, bempedoic acid, and volanesorsen are contraindicated due to insufficient safety data, although recent evidence supports the continuation of statins in high-risk patients. In cases of markedly elevated Lp(a), regular LDL apheresis can substantially reduce atherogenic burden. Monitoring of lipid profiles and an individualized approach, ideally within a multidisciplinary team, are essential to minimize maternal and fetal risks. This review highlights the need for further research to optimize pharmacological treatment of dyslipidemia during pregnancy and to establish safe therapeutic strategies for women at high cardiovascular risk.

Keywords: apheresis, lipid-lowering agents, pregnancy, LDL-cholesterol.

Accepted: April 23, 2026; Published: May 18, 2026  Show citation