Familial hypercholesterolemia linked to pre-eclampsia: 11% vs 7% in a Dutch-Norwegian study

Women with familial hypercholesterolemia (FH) reported pre-eclampsia more often than matched controls, according to a study in the European Journal of Preventive Cardiology published on 5 November 2026 and reported by EurekAlert. Researchers from Erasmus MC, University Medical Center Rotterdam compared 484 women with FH and 968 controls, all aged 40 and over, in the Netherlands and Norway. Pre-eclampsia was more prevalent among women with FH: 11 percent versus 7 percent in the control group eurekalert.orgEurekAlerteurekalert.orgOpen source ↗.

Study design and background

FH is an inherited condition that causes lifelong high cholesterol and substantially increases the risk of heart disease. It affects approximately 1 in 200 to 300 people, although most are undiagnosed eurekalert.orgEurekAlerteurekalert.orgOpen source ↗. Earlier studies linked the non-inherited form of hypercholesterolemia to differences in reproductive health and pregnancy outcomes. Results remained uncertain because the effects of cholesterol are hard to separate from lifestyle-related factors.

The women were recruited between 2023 and 2025. Each FH case was matched 1:2 to controls on age, smoking status, BMI and ethnicity. Data on reproductive factors and pregnancy outcomes were collected through an online survey eurekalert.orgEurekAlerteurekalert.orgOpen source ↗.

Other outcomes and limitations

Pre-eclampsia is characterised by high blood pressure in pregnancy combined with organ damage. Its complications include slower growth during pregnancy and premature birth, and in some cases they can be serious and potentially life-threatening eurekalert.orgEurekAlerteurekalert.orgOpen source ↗. The authors stress that the findings do not mean an individual woman with FH will develop pre-eclampsia.

The team did not find statistically significant differences in other aspects of reproductive health and pregnancy outcomes. Women with FH had a comparable number of pregnancies eurekalert.orgEurekAlerteurekalert.orgOpen source ↗. Because the study was observational, the authors say it cannot show that FH or high LDL cholesterol causes pre-eclampsia. They suggest that reproductive health counselling be considered as part of cardiovascular care for women with FH, and potentially for women with hypercholesterolemia more broadly.

Most women with FH in the study were on lipid-lowering therapy, but probably started it only in their 30s and 40s. Whether earlier or more intensive treatment could reduce the risk of pre-eclampsia requires further research. The study predominantly included women of European ancestry, which limits generalisability to other populations. The authors call for larger longitudinal studies of women with different levels of lifelong LDL cholesterol exposure eurekalert.orgEurekAlerteurekalert.orgOpen source ↗.