How do you mitigate maternal cardiovascular risk in pregnant patients with known coronary artery disease who have discontinued statin therapy?

In patients with severe hypercholesterolemia, for example, who have HeFH, I have used a bile acid sequestrant during the pregnancy to at least lower their LDL about during this time. Having said that, I don’t know of any data supporting this. Patients with HoFH consideration for apheresis should be made during pregnancy, as their risk for an event is extremely high if untreated. Otherwise, it is not known whether statins, PCSK9 inhibitors, inclisiran, or bempedoic acid are safe during pregnancy.