A Young Woman With Hypercholesterolemia Desires to Get Pregnant
History of Presenting Illness:
A 31-year-old female patient with newly diagnosed hypercholesterolemia presents to the preventive cardiology clinic for new patient consultation. Approximately six months ago, she had her lipid levels measured as part of her annual physical and her low-density lipoprotein cholesterol (LDL-C) was elevated at 318 mg/dL (on no medical therapy). She has no other medical comorbidities. She is a non-smoker, and drinks approximately two alcoholic beverages twice monthly. She remains physically active, regularly participating in belly-dancing classes twice a week without any physical limitations. She reports that her father also had markedly elevated cholesterol levels and sustained his first myocardial infarction (MI) at the age of 36.
She had an uncomplicated first pregnancy and has a healthy three-year-old daughter. She has since had two miscarriages. On physical exam her vital signs are within normal limits. Physical exam is significant only for corneal arcus. Her body mass index (BMI) is 23 kg/m2. She continues to take an oral contraceptive and for the last six months has been on rosuvastatin 20 mg daily. Her lipid panel immediately prior to her current visit and relevant laboratory studies are shown below:
- Total Cholesterol 248 mg/dL
- Triglycerides 179 mg/dL
- HDL-C 45 mg/dL
- LDL-C 162 mg/dL
- HbA1c 5.5
- AST /ALT WNL
- TSH WNL
Normal sinus rhythm, no concerning ST/T abnormalities
The patient desires to get pregnant. What is the most reasonable method to manage her lipid levels during her pregnancy?