Cardiology AdvisorStatin Discontinuation Before Pregnancy and Maternal Cardiovascular Risk

Statin discontinuation before pregnancy does not increase maternal cardiovascular risk, even in women with established atherosclerotic cardiovascular disease, per a nationwide cohort study in Circulation. Investigators analyzed 13,374 preconception statin users from South Korea’s National Health Insurance Database (2009–2023), comparing outcomes in women who continued vs discontinued statins before their last menstrual period.

🔬 Clinical Considerations

• Discontinuation showed no increased MACCE risk (HR 1.00; 95% CI, 0.72–1.37) vs continuation, including in high-risk women with established ASCVD (HR 0.83)
• Statin discontinuation associated with lower low birth weight risk (RR 0.88) and lower non-live birth risk (RR 0.89), though observational design limits causal inference
• Women with familial hypercholesterolemia history showed no significant MACCE difference between cohorts (HR 0.92; P-interaction .754)
• Findings support reassurance when patients elect statin discontinuation at conception, but residual confounding and prescription-proxy adherence measurement are key limitations

⚡ Practice Applications

• Reassure high-risk patients that statin discontinuation at conception does not appear to elevate cardiovascular event risk
• Document shared decision-making conversations when advising pregnant patients with ASCVD on statin management
• Coordinate with OB providers when managing women with familial hypercholesterolemia planning pregnancy
• Monitor cardiovascular status throughout pregnancy in women who discontinue statins, regardless of baseline risk

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