Combined Use of Statin and PCSK9 Inhibitor in a Pregnant Woman with Possible Familial Hypercholesterolemia and Coronary Artery Stenosis.

Abstract

Although the risk of acute coronary syndrome increases during pregnancy and the postpartum period compared to the non-pregnant state, dyslipidemia-one of the key risk factors for atherosclerotic cardiovascular disease-is often undertreated in this population. Several lipid-lowering medications, including statin, have not been used due to concerns about their impact on the fetus. Herein, we report a pregnant woman with possible familial hypercholesterolemia (FH) and coronary artery stenosis, whose low-density lipoprotein cholesterol (LDL-C) level was managed by a combination of statin and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor for the secondary prevention of coronary artery disease.A 37-year-old pregnant woman with dyslipidemia was found to have severe coronary artery stenosis. She was suspected of having FH, and her lipid control was initiated with the goal of lowering LDL-C levels to ＜100 mg/dL. Although ezetimibe and colestimide were administered at 14 weeks, the target LDL-C level was not achieved. Thus, treatment with pravastatin was started at 23 weeks and evolocumab at 32 weeks of gestation. With the combination of pravastatin and evolocumab, her LDL-C levels decreased to 67 mg/dL after 35 weeks of gestation. The patient delivered vaginally at 37 weeks of gestation without any cardiac events, and her baby did not present with any abnormalities. In conclusion, the combined use of statin and PCSK9 inhibitor could effectively manage LDL-C levels, and it might be a safe option during pregnancy. Nevertheless, further research is required to assess the safety and efficacy of this combination therapy during pregnancy.