Dyslipidemia Management after Pre-eclampsia: What is the Threshold for Treatment Due to Increased Cardiovascular Risk?

Abstract

Growing evidence shows that women with a history of preeclampsia, pregnancy-induced hypertension or gestational diabetes are at increased long-term risk of cardiovascular disease (CVD).  This was incorporated in the American Heart Association’s 2011 guideline on the prevention of CVD in women and was recently reflected in the 2016 Canadian Cardiovascular Society’s guidelines, suggesting that young women who would not formerly have been considered for primary CVD prevention may benefit from screening for dyslipidemia.  However, the indications and targets for medical treatment of dyslipidemia postpartum remain unclear.  We present the case of a 31yo G1P1L2 woman with preeclampsia, preterm delivery and dyslipidemia who had active vascular risk reduction postpartum, including adjustment of antihypertensives, diet and exercise counselling for low-density lipoprotein cholesterol reduction and weight loss promotion, and consideration of an HMG-CoA reductase inhibitor, which was ultimately decided against given the improvements seen with conservative management.