Dyslipidemia Management in Pregnancy: Why Is It not Covered in the Guidelines?

Lewek, Joanna; Banach, Maciej

doi:10.1007/s11883-022-01030-w

Cited by 26 publications

(28 citation statements)

References 72 publications

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“…The estimated data collection completion time is the end of 2023 [ 94 ]. As rightly noted, inclisiran could be a very interesting option in pregnancy, as it can be used just before and immediately after pregnancy for about 9 months between injections [ 95 ]. However, as a precaution—due to a lack of adequate research, it is recommended to avoid using inclisiran during pregnancy.…”

Section: Safety and Side-effect Profilementioning

confidence: 99%

Inclisiran—Safety and Effectiveness of Small Interfering RNA in Inhibition of PCSK-9

et al. 2023

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Dyslipidemia is listed among important cardiovascular disease risk factors. Treating lipid disorders is difficult, and achieving desirable levels of LDL-cholesterol (LDL-C) is essential in both the secondary and primary prevention of cardiovascular disease. For many years, statins became the basis of lipid-lowering therapy. Nevertheless, these drugs are often insufficient due to their side effects and restrictive criteria for achieving the recommended LDL-C values. Even the addition of other drugs, i.e., ezetimibe, does not help one achieve the target LDL-C. The discovery of proprotein convertase subtilisin/kexin type 9 (PCSK9) discovery has triggered intensive research on a new class of protein-based drugs. The protein PCSK9 is located mainly in hepatocytes and is involved in the metabolism of LDL-C. In the beginning, antibodies against the PCSK9 protein, such as evolocumab, were invented. The next step was inclisiran. Inclisiran is a small interfering RNA (siRNA) that inhibits the expression of PCSK9 by binding specifically to the mRNA precursor of PCSK9 protein and causing its degradation. It has been noticed in recent years that siRNA is a powerful tool for biomedical research and drug discovery. The purpose of this work is to summarize the molecular mechanisms, pharmacokinetics, pharmacodynamics of inclisiran and to review the latest research.

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Section: Safety and Side-effect Profilementioning

confidence: 99%

Inclisiran—Safety and Effectiveness of Small Interfering RNA in Inhibition of PCSK-9

et al. 2023

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“…Its impact on TG is dose dependent. Doses of 2–4 mg daily can lower TG levels by 40% 89 . Omega‐3 is also safe during pregnancy and has multiple potential benefits, including reducing insulin resistance, preterm delivery and low birthweight.…”

Section: Management Optionsmentioning

confidence: 99%

Hyperlipidaemia and severe hypertriglyceridaemia in pregnancy

Bashir

Navti

Ahmed

et al. 2023

The Obstetric & Gynaecologis

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Lipid and triglyceride levels increase in pregnancy and do not pose problems for most women. However, pregnancy-specific factors and genetic aberrations, especially mutations, may result in supraphysiological hypercholesterolaemia (HC) and severe hypertriglyceridaemia (sHTG). HC and sHTG are associated with complications in pregnancy, including acute pancreatitis, hyperviscosity syndrome and pre-eclampsia. Abnormally high levels of lipids and triglycerides also affect fetal growth and the onset of gestational diabetes. The clinical presentation and diagnosis of HC and sHTG are varied. Management options include lifestyle and dietary restriction/ modification, omega-3, bile-acid sequestrants, fenofibrate, statins and plasmapheresis. Learning objectivesTo understand the physiological changes that occur in lipids in pregnancy and how these are modulated. To appreciate the importance of severe HC and HTG in pregnancy, including their effects on maternal morbidity and mortality. To understand the various approaches to management and the importance of multidisciplinary management. Ethical issuesShould every woman be screened for HTG and HC during pregnancy? How safe are statins and other treatments for lipid disorders in pregnancy? Should women with very severe HTG be discouraged from getting pregnant?

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“…Management of hypercholesterolemia in pregnant patients may pose challenges that have recently been expertly addressed elsewhere [81,82]. Female HoFH patients may benefit from a multidisciplinary approach that includes a lipidologist, cardiologist and gynaecologist before, during and after pregnancy [81,83].…”

Section: Pregnant Womenmentioning

confidence: 99%

New algorithms for treating homozygous familial hypercholesterolemia

Tromp

Cuchel

2022

Current Opinion in Lipidology

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Purpose of reviewWe reviewed current and future therapeutic options for patients with homozygous familial hypercholesterolemia (HoFH) and place this evidence in context of an adaptable treatment algorithm. Recent findingsLowering LDL-C levels to normal in patients with HoFH is challenging, but a combination of multiple lipidlowering therapies (LLT) is key. Patients with (near) absence of LDL receptor expression are most severely affected and frequently require regular lipoprotein apheresis on top of combined pharmacologic LLT. Therapies acting independently of the LDL receptor pathway, such as lomitapide and evinacumab, are considered game changers for many patients with HoFH, and may reduce the need for lipoprotein apheresis in future. Liver transplantation is to be considered a treatment option of last resort. Headway is being made in gene therapy strategies, either aiming to permanently replace or knock out key lipid-related genes, with first translational steps into humans being made. Cardiovascular disease risk management beyond LDL-C, such as residual Lp(a) or inflammatory risk, should be evaluated and addressed accordingly in HoFH.

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Dyslipidemia Management in Pregnancy: Why Is It not Covered in the Guidelines?

Cited by 26 publications

References 72 publications

Inclisiran—Safety and Effectiveness of Small Interfering RNA in Inhibition of PCSK-9

Inclisiran—Safety and Effectiveness of Small Interfering RNA in Inhibition of PCSK-9

Hyperlipidaemia and severe hypertriglyceridaemia in pregnancy

New algorithms for treating homozygous familial hypercholesterolemia

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