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Johnstone AM, Pudwell J, Ackerman-Banks CM, Lundsberg LS, Lipkind HS, Smith GN. High-sensitivity C-reactive protein use in cardiovascular risk screening at 6 to 12 months postpartum following hypertensive disorders of pregnancy. Am J Obstet Gynecol MFM 2023; 5:100776. [PMID: 36273813 DOI: 10.1016/j.ajogmf.2022.100776] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/30/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patients with a hypertensive disorder of pregnancy are more likely to have underlying cardiovascular risk factors and are at increased risk of future cardiovascular disease. These patients are more likely to be diagnosed with new-onset chronic hypertension and meet the criteria for metabolic syndrome postpartum. High-sensitivity C-reactive protein is a marker of general inflammation and may be used to identify increased risk for cardiovascular disease. OBJECTIVE This collaborative data-sharing study between Yale University, United States (Yale Hearts Moms study) and Queen's University, Canada (Maternal Health Clinic) aimed to study the utility of high-sensitivity C-reactive protein in postpartum cardiovascular risk screening, as determined by 30-year risk (Framingham) and metabolic syndrome 6 to 12 months postpartum. STUDY DESIGN Patients with a hypertensive disorder of pregnancy (n=478) or an uncomplicated, term pregnancy (n=90) had cardiovascular risk screening and risk scoring performed at 6 to 12 months postpartum. Patients were excluded if they had a multiple gestation or chronic hypertension, diabetes mellitus, or cardiovascular disease diagnosed before pregnancy. Patients were categorized according to high-sensitivity C-reactive protein (mg/L) into Normal (<3.0), High (3.1 to <10.0), and Acute (≥10.0) groups. The primary outcome of the study was risk for future cardiovascular events, calculated through surrogate measures such as hypertension and cholesterol. Kruskal-Wallis and chi-square tests were used to compare groups, with post hoc tests corrected using the Bonferroni method. Multivariable logistic regression was used to assess the association between high-sensitivity C-reactive protein and cardiovascular risk, adjusting for relevant medical and sociodemographic variables. Analysis was completed with IBM SPSS Statistics, version 27. RESULTS Patients in the High and Acute high-sensitivity C-reactive protein groups were more likely to have a body mass index ≥30, to have experienced a hypertensive disorder of pregnancy, to have a lower household income, and to have not breastfed or to have breastfed for <6 months, when compared with the Normal high-sensitivity C-reactive protein group (all P<.05). Patients in the High and Acute high-sensitivity C-reactive protein groups had higher 30-year cardiovascular risk scores and were more likely to have metabolic syndrome when compared with the Normal high-sensitivity C-reactive protein group (all P<.05). Patients with High high-sensitivity C-reactive protein had 2-fold odds of metabolic syndrome 6 to 12 months after delivery, compared with those in the Normal high-sensitivity C-reactive protein group (adjusted odds ratio, 2.85 [95% confidence interval, 1.66-4.91]), adjusting for hypertensive disorder of pregnancy, body mass index, clinic site, breastfeeding, income, and family history of cardiovascular disease. Those with Acute high-sensitivity C-reactive protein also seemed to have elevated odds of metabolic syndrome compared with the Normal high-sensitivity C-reactive protein group (adjusted odds ratio, 2.52 [95% confidence interval, 1.24-5.12]). The odds of chronic hypertension were significantly higher (P<.05) in the High high-sensitivity C-reactive protein group (adjusted odds ratio, 1.72 [95% confidence interval, 1.12-2.65]) compared with the Normal group. CONCLUSION Individuals with elevated postpartum high-sensitivity C-reactive protein are at increased risk of cardiovascular disease 6 to 12 months postpartum after a pregnancy complicated by a hypertensive disorder of pregnancy. Future research is critical to determine the most comprehensive and accurate method and timing of postpartum cardiovascular risk screening to decrease the incidence of preventable cardiovascular mortality among women.
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Affiliation(s)
- Ainsley M Johnstone
- From the Queen's Faculty of Health Sciences, Queen's University, Kingston, Canada (Ms Johnstone)
| | - Jessica Pudwell
- Department of Obstetrics and Gynaecology, Kingston General Hospital, Queen's University, Kingston, Canada (Ms Pudwell and Dr Smith)
| | | | - Lisbet S Lundsberg
- Yale School of Medicine, New Haven, CT (Drs Ackerman-Banks, Lundsberg, and Lipkind)
| | - Heather S Lipkind
- Yale School of Medicine, New Haven, CT (Drs Ackerman-Banks, Lundsberg, and Lipkind)
| | - Graeme N Smith
- Department of Obstetrics and Gynaecology, Kingston General Hospital, Queen's University, Kingston, Canada (Ms Pudwell and Dr Smith).
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Hamedanian L, Badehnoosh B, Razavi-Khorasani N, Mohammadpour Z, Mozaffari-Khosravi H. Evaluation of vitamin D status, parathyroid hormone, and calcium among Iranian pregnant women with preeclampsia: A case-control study. Int J Reprod Biomed 2019; 17:831-840. [PMID: 31911965 PMCID: PMC6906855 DOI: 10.18502/ijrm.v17i10.5494] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 06/18/2019] [Accepted: 07/20/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Preeclampsia is considered as a serious life-threatening condition that could affect both maternal and fetal outcome. Many studies have examined the association of nutritional factors with the incidence of preeclampsia. However, little is known about the possible role of vitamin D in the development of preeclampsia among the Iranian population. OBJECTIVE The aim of the present study was to evaluate the association between vitamin D status and preeclampsia. MATERIALS AND METHODS A total of 120 pregnant women who were referred to Kamali and Alborz General Hospital located in the Karaj City were enrolled in this study and categorized into preeclamptic and control groups (n = 60/each). The clinical details of patients such as demographic characteristics and laboratory findings were obtained from the patients. The serum levels of vitamin D, calcium, phosphorus, and parathormone were also measured. Multivariate logistic regression analysis was used to assess for independent predictors of preeclampsia. RESULTS The mean age among pregnant women with preeclampsia and control group were 31.48 ± 5.25 and 29.01 ± 5.28, respectively. The mean body mass index among the preeclamptic group was 27.92 ± 4.98, which was significantly higher compared to the control group (p < 0.001). The serum vitamin D levels were significantly lower in women with preeclampsia compared to the control subjects (p = 0.007). Moreover, no correlation between vitamin D deficiency and predisposing factors of preeclampsia was observed after adjusting for confounding factors. CONCLUSION Our study revealed that serum vitamin D level is significantly lower in among the pregnant women diagnosed with preeclampsia compared to the healthy subjects. However, no correlation was observed between the vitamin D status and the risk of preeclampsia development.
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Affiliation(s)
- Laaya Hamedanian
- International Campus, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Bita Badehnoosh
- Department of Gynecology and Obstetrics, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | | | - Zinat Mohammadpour
- Liver Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Mozaffari-Khosravi
- Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Yazd Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Groenhof TKJ, van Rijn BB, Franx A, Roeters van Lennep JE, Bots ML, Lely AT. Preventing cardiovascular disease after hypertensive disorders of pregnancy: Searching for the how and when. Eur J Prev Cardiol 2017; 24:1735-1745. [PMID: 28895439 PMCID: PMC5669282 DOI: 10.1177/2047487317730472] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Women with a history of a hypertensive disorder during pregnancy (HDP) have an increased risk of cardiovascular events. Guidelines recommend assessment of cardiovascular risk factors in these women later in life, but provide limited advice on how this follow-up should be organized. Design Systematic review and meta-regression analysis. Methods The aim of our study was to provide an overview of existing knowledge on the changes over time in three major modifiable components of cardiovascular risk assessment after HDP: blood pressure, glucose homeostasis and lipid levels. Data from 44 studies and up to 6904 women with a history of a HDP were compared with risk factor levels reported for women of corresponding age in the National Health And Nutrition Examination Survey, Estudio Epidemiólogico de la Insuficiencia Renal en España and Hong Kong cohorts (N = 27,803). Results Compared with the reference cohort, women with a HDP presented with higher mean blood pressure. Hypertension was present in a higher rate among women with a previous HDP from 15 years postpartum onwards. At 15 years postpartum (±age 45), one in five women with a history of a HDP suffer from hypertension. No differences in glucose homeostasis parameters or lipid levels were observed. Conclusions Based on our analysis, it is not possible to point out a time point to commence screening for cardiovascular risk factors in women after a HDP. We recommend redirection of future research towards the development of a stepwise approach identifying the women with the highest cardiovascular risk.
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Affiliation(s)
- T Katrien J Groenhof
- 1 Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, The Netherlands
| | - Bas B van Rijn
- 1 Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, The Netherlands.,2 Academic Unit of Human Development and Health, Institute for Life Sciences, University of Southampton, UK
| | - Arie Franx
- 1 Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, The Netherlands
| | | | - Michiel L Bots
- 4 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - A Titia Lely
- 1 Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, The Netherlands
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Long-Term Effects of Pregnancy Complications on Maternal Health: A Review. J Clin Med 2017; 6:jcm6080076. [PMID: 28749442 PMCID: PMC5575578 DOI: 10.3390/jcm6080076] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 06/26/2017] [Accepted: 07/20/2017] [Indexed: 12/17/2022] Open
Abstract
Background: Most pregnancy-related medical complications appear to resolve at delivery or shortly thereafter. Common examples are preterm labor, placental abruption, preeclampsia, and gestational diabetes. Women who developed such complications are known to be at increased risk of developing similar complications in future pregnancies. It has recently become evident that these women are at an increased risk of long term medical complications. Methods: A search through scientific publications in English regarding the association of obstetric complications and long-term maternal illness. Results: There is a clear association between various obstetric complications and long-term effects on maternal health. Conclusions: Women with a history of adverse pregnancy outcomes are at increased risk of cardiovascular and metabolic diseases later in life. Data increasingly links maternal vascular, metabolic, and inflammatory complications of pregnancy with an increased risk of vascular disease in later life.
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Mielke MM, Milic NM, Weissgerber TL, White WM, Kantarci K, Mosley TH, Windham BG, Simpson BN, Turner ST, Garovic VD. Impaired Cognition and Brain Atrophy Decades After Hypertensive Pregnancy Disorders. CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES 2016; 9:S70-6. [PMID: 26908863 DOI: 10.1161/circoutcomes.115.002461] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hypertensive pregnancy disorders have been associated with subjective cognitive complaints or brain white-matter lesions 5 to 10 years after the hypertensive pregnancy. The long-term effects of hypertensive pregnancies on brain structure and cognitive function remain unknown. METHODS AND RESULTS This study included 1279 women who participated in the Family Blood Pressure Project Genetic Epidemiology Network of Arteriopathy (GENOA) study. As part of the ancillary Genetics of Microangiopathic Brain Injury (GMBI) study, a neurocognitive battery was administered; 1075 also had a brain magnetic resonance imaging. A history of a hypertensive pregnancy disorder was obtained by a self-report using a validated questionnaire. Linear models fit with generalized estimating equations were used to assess the association between hypertensive pregnancy disorders and cognition, adjusting for age, race, education, body mass index, smoking, current hypertension, hypertension duration, and family history of hypertension. Regression models for the brain magnetic resonance imaging outcomes also were adjusted for total intracranial volume. Women with histories of hypertensive pregnancy disorders performed worse on all measures of processing speed (Digital Symbol Substitution Test [mean score, 41.2 versus 43.4; P=0.005], Trail Making Test Part A [mean seconds, 45.1 versus 42.2; P=0.035], and Stroop [mean score, 173.9 versus 181.0; P=0.002]) and had smaller brain volumes compared with women with histories of normotensive pregnancies (286 versus 297; P=0.023). CONCLUSIONS Hypertensive pregnancy disorders are associated with worse performance on tests of processing speed and smaller brain volumes decades later. Population-based studies are needed to provide critical insight as to the contribution of hypertensive pregnancies to risk of cognitive decline and dementia.
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Affiliation(s)
- Michelle M Mielke
- From the Departments of Health Sciences Research and Neurology (M.M.M.), Division of Nephrology and Hypertension (N.M.M., T.L.W., S.T.T., V.D.G.), Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (W.M.W.), and Department of Radiology (K.K.), Mayo Clinic, Rochester, MN; Department of Biostatistics, Medical Faculty, University of Belgrade, Belgrade, Serbia (N.M.M.); and Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M., B.G.W., B.N.S.)
| | - Natasa M Milic
- From the Departments of Health Sciences Research and Neurology (M.M.M.), Division of Nephrology and Hypertension (N.M.M., T.L.W., S.T.T., V.D.G.), Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (W.M.W.), and Department of Radiology (K.K.), Mayo Clinic, Rochester, MN; Department of Biostatistics, Medical Faculty, University of Belgrade, Belgrade, Serbia (N.M.M.); and Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M., B.G.W., B.N.S.)
| | - Tracey L Weissgerber
- From the Departments of Health Sciences Research and Neurology (M.M.M.), Division of Nephrology and Hypertension (N.M.M., T.L.W., S.T.T., V.D.G.), Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (W.M.W.), and Department of Radiology (K.K.), Mayo Clinic, Rochester, MN; Department of Biostatistics, Medical Faculty, University of Belgrade, Belgrade, Serbia (N.M.M.); and Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M., B.G.W., B.N.S.)
| | - Wendy M White
- From the Departments of Health Sciences Research and Neurology (M.M.M.), Division of Nephrology and Hypertension (N.M.M., T.L.W., S.T.T., V.D.G.), Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (W.M.W.), and Department of Radiology (K.K.), Mayo Clinic, Rochester, MN; Department of Biostatistics, Medical Faculty, University of Belgrade, Belgrade, Serbia (N.M.M.); and Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M., B.G.W., B.N.S.)
| | - Kejal Kantarci
- From the Departments of Health Sciences Research and Neurology (M.M.M.), Division of Nephrology and Hypertension (N.M.M., T.L.W., S.T.T., V.D.G.), Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (W.M.W.), and Department of Radiology (K.K.), Mayo Clinic, Rochester, MN; Department of Biostatistics, Medical Faculty, University of Belgrade, Belgrade, Serbia (N.M.M.); and Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M., B.G.W., B.N.S.)
| | - Thomas H Mosley
- From the Departments of Health Sciences Research and Neurology (M.M.M.), Division of Nephrology and Hypertension (N.M.M., T.L.W., S.T.T., V.D.G.), Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (W.M.W.), and Department of Radiology (K.K.), Mayo Clinic, Rochester, MN; Department of Biostatistics, Medical Faculty, University of Belgrade, Belgrade, Serbia (N.M.M.); and Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M., B.G.W., B.N.S.)
| | - B Gwen Windham
- From the Departments of Health Sciences Research and Neurology (M.M.M.), Division of Nephrology and Hypertension (N.M.M., T.L.W., S.T.T., V.D.G.), Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (W.M.W.), and Department of Radiology (K.K.), Mayo Clinic, Rochester, MN; Department of Biostatistics, Medical Faculty, University of Belgrade, Belgrade, Serbia (N.M.M.); and Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M., B.G.W., B.N.S.)
| | - Brittany N Simpson
- From the Departments of Health Sciences Research and Neurology (M.M.M.), Division of Nephrology and Hypertension (N.M.M., T.L.W., S.T.T., V.D.G.), Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (W.M.W.), and Department of Radiology (K.K.), Mayo Clinic, Rochester, MN; Department of Biostatistics, Medical Faculty, University of Belgrade, Belgrade, Serbia (N.M.M.); and Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M., B.G.W., B.N.S.)
| | - Stephen T Turner
- From the Departments of Health Sciences Research and Neurology (M.M.M.), Division of Nephrology and Hypertension (N.M.M., T.L.W., S.T.T., V.D.G.), Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (W.M.W.), and Department of Radiology (K.K.), Mayo Clinic, Rochester, MN; Department of Biostatistics, Medical Faculty, University of Belgrade, Belgrade, Serbia (N.M.M.); and Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M., B.G.W., B.N.S.)
| | - Vesna D Garovic
- From the Departments of Health Sciences Research and Neurology (M.M.M.), Division of Nephrology and Hypertension (N.M.M., T.L.W., S.T.T., V.D.G.), Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (W.M.W.), and Department of Radiology (K.K.), Mayo Clinic, Rochester, MN; Department of Biostatistics, Medical Faculty, University of Belgrade, Belgrade, Serbia (N.M.M.); and Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M., B.G.W., B.N.S.).
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Sen-yu W, Chao X. Assessment of the relationship between red blood cell distribution width and preganecy hypertension disease. J Obstet Gynaecol Res 2016; 42:1258-1262. [PMID: 27436585 DOI: 10.1111/jog.13067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 04/02/2016] [Accepted: 05/02/2016] [Indexed: 12/17/2022]
Affiliation(s)
- Wang Sen-yu
- The Nuclear Medicine Departement; The Second Affiliated Hospital of Xinjiang Medical University; Urumqi China
| | - Xu Chao
- The Clinical Laboratory Department; The 98th Hospital of Chinese PLA; Urumqi China
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A history of preeclampsia is associated with a risk for coronary artery calcification 3 decades later. Am J Obstet Gynecol 2016; 214:519.e1-519.e8. [PMID: 26874301 DOI: 10.1016/j.ajog.2016.02.003] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 01/22/2016] [Accepted: 02/04/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND A history of preeclampsia is an independent risk factor for cardiac events and stroke. Changes in vasculature structure that contribute to these associations are not well understood. OBJECTIVE The aim of this study was to quantify coronary artery calcification (CAC), a known risk factor for cardiac events, in a prospective cohort of women with and without histories of preeclampsia. STUDY DESIGN Women without prior cardiovascular events (40 with and 40 without histories of preeclampsia, matched for parity and age at index birth) were recruited from a large population-based cohort of women who were residents of Olmsted County, Minnesota, and who delivered from 1976 through 1982. Computed tomography was performed to measure CAC in Agatston units. All pregnancy histories and covariates were confirmed by review of the medical records. Current clinical variables were assessed at the time of imaging. Differences between women with and without histories of preeclampsia were examined using χ(2) tests and tests; CAC, in particular, was compared as a categorical and ordinal variable, with a χ(2) test and with Wilcoxon 2-sample tests and ordinal logistic regression, as appropriate. RESULTS Mean age (SD) at imaging was 59.5 (±4.6) years. Systolic and diastolic blood pressures, hyperlipidemia, and current diabetes status did not differ between women with and without histories of preeclampsia. However, the frequencies of having a current clinical diagnosis of hypertension (60% vs 20%, P < .001) and higher body mass index in kg/m(2) (expressed as median [25th-75th percentile], 29.8 [25.9-33.7] vs 25.3 [23.1-32.0], P = .023) were both greater in the women with histories of preeclampsia compared to those without. The frequency of a CAC score >50 Agatston units was also greater in the preeclampsia group (23% vs 0%, P = .001). Compared to women without preeclampsia, the odds of having a higher CAC score was 3.54 (confidence interval [CI], 1.39-9.02) times greater in women with prior preeclampsia without adjustment, and 2.61 (CI, 0.95-7.14) times greater after adjustment for current hypertension. After adjustment for body mass index alone, the odds of having a higher CAC based on a history of preeclampsia remained significant at 3.20 (CI, 1.21-8.49). CONCLUSION In this first prospective cohort study with confirmation of preeclampsia by medical record review, a history of preeclampsia is associated with an increased risk of CAC >30 years after affected pregnancies, even after controlling individually for traditional risk factors. A history of preeclampsia should be considered in risk assessment when initiating primary prevention strategies to reduce cardiovascular disease in women. Among women with histories of preeclampsia, the presence of CAC may be able to identify those at a particularly high cardiovascular risk, and should be the subject of future studies.
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Cardiovascular disease in women: the significance of hypertension and gestational diabetes during pregnancy. Curr Opin Cardiol 2015; 29:447-53. [PMID: 25003394 DOI: 10.1097/hco.0000000000000094] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Cardiovascular disease (CVD) remains the major killer of women around the globe. Complications during pregnancy, including hypertensive disorders of pregnancy and gestational diabetes mellitus, are now recognized as risk factors for future CVD. RECENT FINDINGS Studies of diverse populations demonstrate the links between these complications of pregnancy and a woman's future risk of CVD including atherosclerosis, hypertension, stroke, coronary artery disease, and heart failure. Markers that persist in these women following pregnancy continue to be identified and include microalbuminuria, proteinuria, elevated homocysteine levels, C-reactive protein, and salt sensitivity. Efforts are now being placed on establishing specialized clinics to monitor women beyond pregnancy to help reduce the burden of future disease. SUMMARY Pregnancy offers a unique window through which women at risk of future CVD may be identified. Clinicians have an opportunity to implement health monitoring, lifestyle modifications, and other interventions during this period, and beyond, that will help reduce the burden of CVD. Research should continue to focus on identifying and understanding the mechanisms that lead to future CVD in these women; deciphering whether pregnancy unmasks an existing predisposition to disease, compounds the risk of future disease, or is the direct cause of future disease.
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9
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Mesquita RF, Reis M, Beppler AP, Bellinazzi VR, Mattos SS, Lima-Filho JL, Cipolli JA, Coelho-Filho OR, Pio-Magalhães JA, Sposito AC, Matos-Souza JR, Nadruz W. Onset of hypertension during pregnancy is associated with long-term worse blood pressure control and adverse cardiac remodeling. ACTA ACUST UNITED AC 2014; 8:827-31. [PMID: 25455008 DOI: 10.1016/j.jash.2014.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 08/30/2014] [Accepted: 09/02/2014] [Indexed: 11/15/2022]
Abstract
Up to 20% of women with hypertensive pregnancy disorders might persist with chronic hypertension. This study compared clinical and echocardiographic features between women whose hypertension began as hypertensive pregnancy disorders (PH group) and women whose diagnosis of hypertension did not occur during pregnancy (NPH group). Fifty PH and 100 NPH women were cross-sectionally evaluated by clinical, laboratory, and echocardiography analysis, and the groups were matched by duration of hypertension. PH exhibited lower age (46.6 ± 1.4 vs. 65.3 ± 1.1 years; P < .001), but higher systolic (159.8 ± 3.9 vs. 148.0 ± 2.5 mm Hg; P = .009) and diastolic (97.1 ± 2.4 vs. 80.9 ± 1.3 mm Hg; P < .001) blood pressure than NPH, although used more antihypertensive classes (3.4 ± 0.2 vs. 2.6 ± 0.1; P < .001). Furthermore, PH showed higher left ventricular wall thickness and increased prevalence of concentric hypertrophy than NPH after adjusting for age and blood pressure. In conclusion, this study showed that PH may exhibit worse blood pressure control and adverse left ventricular remodeling compared with NPH.
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Affiliation(s)
- Roberto F Mesquita
- Department of Internal Medicine, University of Campinas, Campinas, SP, Brazil
| | - Muriel Reis
- Department of Internal Medicine, University of Campinas, Campinas, SP, Brazil
| | - Ana Paula Beppler
- Department of Internal Medicine, University of Campinas, Campinas, SP, Brazil
| | | | - Sandra S Mattos
- Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, PE, Brazil
| | - José L Lima-Filho
- Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, PE, Brazil
| | - José A Cipolli
- Department of Internal Medicine, University of Campinas, Campinas, SP, Brazil
| | | | | | - Andrei C Sposito
- Department of Internal Medicine, University of Campinas, Campinas, SP, Brazil
| | - José R Matos-Souza
- Department of Internal Medicine, University of Campinas, Campinas, SP, Brazil
| | - Wilson Nadruz
- Department of Internal Medicine, University of Campinas, Campinas, SP, Brazil; Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, PE, Brazil.
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Abstract
Heart disease is the leading cause of death in women in all countries. A history of pre-eclampsia, one of the most deadly hypertensive complications of pregnancy, increases cardiovascular risk by two to four times, which is comparable with the risk induced by smoking. Substantial epidemiological data reveal that pregnancy-related hypertensive complications are associated with a predisposition to chronic hypertension, premature heart attacks, strokes, and renal complications. In this review, we summarize clinical studies that demonstrate this relationship and also discuss the pathogenesis of these long-term complications of pre-eclampsia. Future studies should focus on strategies to prevent the progression of cardiovascular disease in women exposed to pre-eclampsia, thereby improving long-term cardiovascular health in women.
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Affiliation(s)
- Christina W Chen
- Division of Nephrology/Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN 370D, Boston, MA 02215, USA
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