The role of statins in the prevention of preeclampsia

Abstract

Preeclampsia is a common hypertensive disorder of pregnancy associated with considerable neonatal and maternal morbidities and mortalities. However, the exact cause of preeclampsia remains unknown; it is generally accepted that abnormal placentation resulting in the release of soluble antiangiogenic factors, coupled with increased oxidative stress and inflammation, leads to systemic endothelial dysfunction and the clinical manifestations of the disease. Statins have been found to correct similar pathophysiological pathways that underlie the development of preeclampsia. Pravastatin, specifically, has been reported in various preclinical and clinical studies to reverse the pregnancy-specific angiogenic imbalance associated with preeclampsia, to restore global endothelial health, and to prevent oxidative and inflammatory injury. Human studies have found a favorable safety profile for pravastatin, and more recent evidence does not support the previous teratogenic concerns surrounding statins in pregnancy. With reassuring and positive findings from pilot studies and strong biological plausibility, statins should be investigated in large clinical randomized-controlled trials for the prevention of preeclampsia.

Keywords: angiogenesis; cholesterol; cholesterol synthesis; hydroxymethylglutaryl-coenzyme A reductase inhibitors; lipoprotein; low-density lipoprotein; placental growth factor; pravastatin; preeclampsia; prevention; soluble endoglin; soluble fms-like tyrosine kinase; statins; vascular endothelial growth factor.

Figure 1.

Pathophysiology of preeclampsia and effect of statins *Original figure