Statins are widely used in the primary prevention of cardiovascular disease. Given that pre-eclampsia shares many risk factors with cardiovascular disease and women who have had a pregnancy complicated by pre-eclampsia are at increased risk of cardiovascular disease in later life, it has been proposed that statins might reduce the risk of pre-eclampsia or ameliorate its severity once established.
In vitro studies have supported a role for statins to suppress elaboration of sFlt-1 from cell cultures and animal studies have shown that Pravastatin prevents a pre-eclampsia-like syndrome in vulnerable animals.
In human pregnancy, case reports and small open-label case-control studies have suggested Pravastatin, a hydrophilic statin, can significantly prolong pregnancies affected by early onset pre-eclampsia. Other trials have been less supportive and other studies are underway.
Recent observational studies suggest statins are safe in the first trimester, but little is known about their safety on fetal development and longer term neonatal development when exposed in the second and third trimester.
The rationale for statins as a prophylaxis or treatment for pre-eclampsia will be discussed, their safety in pregnancy and outcomes of trials conducted so far.