Evaluating the role of statins in prevention of preeclampsia: deeper insights into maternal cardiometabolic changes

Abstract

Pregnant women with gestational hypertension and/or preeclampsia, have derangements of atherogenic lipids in early pregnancy. Changes in maternal lipids can promote atherogenesis through endothelial injury. These alterations in serum lipid levels have been linked to adverse pregnancy outcomes and maternal morbidity and mortality. Several recent studies have examined maternal atherogenic profiles in early pregnancy, and their relationships to preeclampsia and other adverse pregnancy outcomes. Given their effects on reduction of endothelial dysfunction, inflammation, and plaque stabilization, statin therapies may have utility in prevention and treatment of preeclampsia. We sought to investigate this further by examining the association between dyslipidemia and preeclampsia, as well as the potential role of statins in the prevention of preeclampsia. We discuss the pathophysiology of placental dysfunction in preeclampsia, the safety profile of statins in pregnancy, and evaluate the potential utility of statins in pregnancy, based on recent studies, specifically for women at high risk of developing preeclampsia. The lipid-lowering, immunomodulatory, anti-inflammatory, and pleiotropic effects of statins may make them promising candidates for the prevention and treatment of preeclampsia. However, it is important to note that the clinical use of statin therapy to prevent preeclampsia has no support from current research and is not justified. A reasonably large trial of pravastatin reported no effect on preeclampsia but used limited dosing with the intervention performed only in women at high-risk of term preeclampsia. Further research in randomized controlled trials extending the parameters of statin dosing is needed to help determine if preeclampsia can be effectively prevented.