Women with familial hypercholesterolemia (FH) face a slightly elevated risk of pre-eclampsia during pregnancy, according to a study of over 1,400 participants in the Netherlands and Norway. Published in the European Journal of Preventive Cardiology, the research identifies a prevalence of 11 percent for the condition among women with FH, compared to 7 percent in the control group. The condition, which affects approximately 1 in 200 to 300 people, is often undiagnosed.
Pregnancy Outcomes for Women with Inherited High Cholesterol
Familial hypercholesterolemia is an inherited condition that results in lifelong high cholesterol levels, particularly elevated LDL or “bad” cholesterol, and a substantial increase in the risk of heart disease. Researchers recruited participants between 2023 and 2025, matching 484 women with FH against 968 controls based on age, smoking status, body mass index, and ethnicity. Information regarding reproductive factors and pregnancy outcomes was gathered using an online survey.
Pre-eclampsia can lead to serious and potentially life-threatening complications. The study authors emphasized that the findings do not mean that every woman with familial hypercholesterolemia will develop pre-eclampsia.
Clinical Considerations for Cardiovascular Risk Assessment
The research team suggests that reproductive health counselling should be considered as part of cardiovascular care for women with FH and potentially for women with hypercholesterolemia more broadly. Because the study was observational, researchers noted that they cannot conclude that FH or high LDL cholesterol directly causes pre-eclampsia. According to study author Janneke Mulder of Erasmus MC, University Medical Center Rotterdam, As ours was an observational study, we cannot conclude that familial hypercholesterolemia or high LDL cholesterol causes pre-eclampsia.
Researchers noted that further investigation is needed to determine if earlier or more intensive lipid-lowering treatments could potentially reduce the risk of pre-eclampsia.
Researchers Call for Larger Longitudinal Studies
While the study suggests that reproductive health and cardiovascular health are linked—noting that factors like the age of starting menstruation or menopause can impact cardiovascular risk—the team called for larger longitudinal studies to further investigate these associations.
Study author Julie van Oortmerssen, from Erasmus MC, University Medical Center Rotterdam, stated: “We would like to see larger longitudinal studies examining women with different levels of lifelong LDL cholesterol exposure, and whether hypercholesterolemia combined with pregnancy complications such as pre-eclampsia identifies women at particularly high long-term cardiovascular risk.”