Management of Pregnancy in a Patient with Familial Hypercholesterolemia and Previous Myocardial Infarction—Treatment with LDL Apheresis: A Case Report

Familial hypercholesterolemia, a genetic disorder marked by elevated low-density lipoprotein cholesterol (LDL-C), poses significant risks for premature atherosclerosis and cardiovascular diseases, particularly during pregnancy. One of the safe methods of treating this condition in pregnancy is with...

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Published inReports (MDPI) Vol. 7; no. 2; p. 39
Main Authors Milincic, Milos, Todorovic, Jovana, Dugalic, Stefan, Novakovic, Ivana, Macura, Maja, Lalic, Katarina, Gojnic Dugalic, Miroslava
Format Journal Article
LanguageEnglish
Published Basel MDPI AG 01.06.2024
Subjects
Apheresis
Atherosclerosis
Blood
Breastfeeding & lactation
Cardiovascular disease
Case reports
Cholesterol
Contraindications
Endocrinology
familial hypercholesterolemia
Family medical history
Heart attacks
High density lipoprotein
LDL apheresis
Lipids
Low density lipoprotein
Metabolism
Postpartum period
Pregnancy
Pregnancy complications
pregnancy outcomes
Statins
Stents
Veins & arteries
Womens health
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Summary:Familial hypercholesterolemia, a genetic disorder marked by elevated low-density lipoprotein cholesterol (LDL-C), poses significant risks for premature atherosclerosis and cardiovascular diseases, particularly during pregnancy. One of the safe methods of treating this condition in pregnancy is with the use of LDL apheresis. We present a 38-year-old primigravida with homozygous Familial Hypercholesterolemia (HoFH), ischemic cardiomyopathy, and angina pectoris. Two years before conception, extremely elevated lipid levels prompted statin therapy and lifestyle changes. Stent placements followed acute myocardial infarction. When planning pregnancy, statins were discontinued, but lipid levels elevated. LDL apheresis was initiated, achieving a 60% reduction. Throughout pregnancy, 16 LDL apheresis sessions were performed every 14 days, maintaining optimal lipid profiles. A cesarean section was performed in the 38th week of gestation, delivering a healthy infant. The patient resumed statin therapy after 8 months of breastfeeding. The patient maintained cardiovascular health, demonstrating the feasibility of controlled HoFH pregnancies. This case highlights the successful management of HoFH during pregnancy using LDL apheresis, ensuring maternal and fetal well-being. Future research on novel treatments and their safety during pregnancy is essential for refining therapeutic approaches in similar cases.
ISSN:2571-841X
2571-841X
DOI:10.3390/reports7020039