72
Management
Table 20. Lipid-Lowering Therapies During Pregnancy and
Lactation
Pregnancy Lactation
Statins Should be discontinued in most
pregnancies
Can be considered in high-risk
individuals (ASCVD or FH)
Avoid use
Ezetimibe Avoid use due to insufficient data
regarding risk to fetus
Avoid use
Bile acid
sequestrants
Safe to use. No evidence of risk in
humans due to lack of systemic
absorption.
Known to interfere with absorption
of fat-soluble vitamins
High rate of gastrointestinal side
effects
Not excreted in human milk
Caution if used — associated
with malabsorption of fat-soluble
vitamins (A, D, E, and K).
Prenatal vitamins may not be
sufficient.
Niacin Avoid use due to insufficient data
regarding risk to fetus or clinical
utility for the mother
Avoid use
Fibric acid
derivatives
Can be considered (aer
the first trimester) for severe
hypertriglyceridemia only if the
potential benefit justifies the potential
risk to the fetus
Avoid use during lactation. If
taken during pregnancy, lactation
can be resumed 5 days aer last
dose of fibric acid derivatives.
Omega-3
fatty acids
Can be considered for severe
hypertriglyceridemia
Known to be excreted in human
milk. Effects on infants are
unknown.
Caution if used during lactation
Bempedoic
acid
Avoid use due to insufficient data
regarding risk to fetus
Avoid use
PCSK9
mAb
Avoid use due to insufficient data
regarding risk to fetus
Avoid use
Inclisiran Avoid use due to insufficient data
regarding risk to fetus
Avoid use
Evinacumab Avoid use due to insufficient data
regarding risk to fetus
Avoid use
Lomitapide Avoid use due to risk of embryo-fetal
toxicity
Avoid use
ASCVD indicates atherosclerotic cardiovascular disease; FH, familial hypercholesterolemia;
mAb, monoclonal antibodies; and PCSK9 proprotein convertase subtilisin/kexin type 9.
Adapted with permission from Agarwala et al. Copyright © 2024 Elsevier. Adapted with
permission from Jacobson et al. Copyright © 2015 Elsevier.
