ESPE Yearbook of Paediatric Endocrinology

Eur J Prev Cardiol 2022;29(5):758-65. doi: 10.1093/eurjpc/zwab152

Brief Summary: This retrospective study identified an association between high maternal cholesterol levels during pregnancy with more severe heart attacks in young adult offspring.

Comment: During pregnancy, physiological increases in total cholesterol and triglyceride (TG) levels occur due to increases in insulin resistance, and in levels of estrogens, progesterone and placental lactogen. Maternal hypercholesterolemia, either familial or transient, is associated with early lesions in the fetal aorta. This suggests a role of maternal cholesterol levels during pregnancy on the epigenetic signature in offspring. However, the current treatment of pregnant women with hyperlipidemia consists of diet modification and suspension of lipid-lowering drugs. The long-term effects of maternal hypercholesterolemia on coronary events in offspring are unknown.

This study included 310 hospitalized patients during 1991–2019. Of these, 89 were admitted with a heart attack, at a mean age of 47 years; the 221 hospitalized for other reasons served as controls. Criteria for a severe or non-severe heart attack were the presence of at least one of the following: 1) the number of coronary arteries shows >75% stenosis; 2) left ventricular ejection fraction ≤35%; 3) peak levels of creatinine kinase (CK) >1200 mg/dl and a peak in CK-MB enzymes above 200 mg/dl. Strong correlations were found between each measure of heart attack severity and maternal cholesterol during pregnancy. Further, the maternal cholesterol level was correlated with the number of cardiovascular risk factors, and with the number of cardiovascular risk factors together with clinical manifestations such as heart attack or stroke.

If the findings of this study are confirmed in a larger cohort, measurement of cholesterol levels during pregnancy should be mandatory, and interventions implemented to reduce levels. In addition, affected children should be followed and monitored early.