Maternit Port-Royal, Cochin Hospital, AP-HP, Paris-Descartes University, Paris, France.
Drugs. 2012 Apr 16;72(6):773-88. doi: 10.2165/11632010-000000000-00000.
Cardiovascular diseases are the leading cause of mortality in industrialized countries. Treatment with statins is effective in primary prevention in patients at high cardiovascular risk. Statins are inhibitors of hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase and are classed as lipid-lowering drugs. In 2010, atorvastatin was the biggest-selling drug in the world ($US10.73 billion). Increases in the average age of pregnant women and in the prevalence of morbid obesity have inevitably led to exposure to statins in certain women during the first trimester of pregnancy. The teratogenic risk attendant upon use of statins is unclear because the available data are contradictory, but statins remain contraindicated in pregnant women. The benefits of statins in prevention of cardiovascular risk may not be solely due to their cholesterol-lowering effects: the so-called pleiotropic effects of vascular protection lead some experts to posit a potential benefit in the management of preeclampsia. In this review we evaluate the theoretical benefits and supposed risks of statins in pregnant women. After a brief overview of the pharmacodynamic properties of statins, we address the question of the teratogenic risk of statins, and then detail the rationale for the therapeutic potential of statins in preeclampsia.
心血管疾病是工业化国家死亡的主要原因。在心血管高危患者中，用他汀类药物进行一级预防治疗是有效的。他汀类药物是羟甲基戊二酰辅酶 A（HMG-CoA）还原酶的抑制剂，属于降脂药物。2010 年，阿托伐他汀是世界上销售额最大的药物（107.3 亿美元）。随着孕妇平均年龄的增加和病态肥胖的流行，孕妇在妊娠早期接触他汀类药物是不可避免的。由于可用数据相互矛盾，他汀类药物的致畸风险尚不清楚，但仍禁止孕妇使用他汀类药物。他汀类药物在预防心血管风险方面的益处可能不仅仅是由于其降低胆固醇的作用：血管保护的所谓多效性作用使一些专家假设在子痫前期的治疗中有潜在的益处。在这篇综述中，我们评估了他汀类药物在孕妇中的理论益处和假定风险。在简要概述他汀类药物的药效学特性后，我们讨论了他汀类药物的致畸风险问题，然后详细说明了他汀类药物在子痫前期治疗中的潜在治疗作用的原理。
