Familial hypercholesterolemia in pregnancy: A case of acute myocardial infarction treated with lipid apheresis

Familial hypercholesterolemia (FH) is an autosomal dominant disorder characterized by severely elevated low density lipoprotein cholesterol (LDL-C) leading to premature atherosclerotic cardiovascular disease. Reducing LDL-C in FH patients is critical to prevent acute coronary syndrome (ACS) events. However, traditional lipid lowering pharmacotherapies therapies have historically been contraindicated in pregnancy. While lipid apheresis has been explored as a safe and efficacious treatment for patients with FH, there is a lack of data and literature supporting its use during pregnancy. Here, we report a case of a 40 year old pregnant patient with FH and recent myocardial infarction (MI) that was treated with lipid apheresis during pregnancy. Apheresis provided substantial LDL-C reduction and ultimately a safe pregnancy without further atherosclerotic complications. Given the limited lipid lowering options for pregnant patients, this case adds to the support of lipid apheresis during pregnancy in high-risk patients.