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Suvakov S, Vaughan LE, Parashuram S, Butler Tobah YS, Jayachandran M, Kattah A, Chamberlain AM, Bielinski SJ, Milic N, Garovic VD. Women With a History of Preeclampsia Exhibit Accelerated Aging and Unfavorable Profiles of Senescence Markers. Hypertension 2024; 81:1550-1560. [PMID: 38690656 PMCID: PMC11168873 DOI: 10.1161/hypertensionaha.123.22250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/02/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Senescence, a mechanism of cellular aging, which is characterized by irreversible proliferation arrest and a proinflammatory secretory phenotype, has been documented in women with preeclampsia. As cellular senescence can persist and progress, we postulated that it is associated with accelerated aging phenotype and accumulation of comorbidities in women with a history of preeclampsia. METHODS We included a cohort of women with a history of preeclampsia (n=40) age- and parity-matched to a group of referent women with normotensive pregnancies (n=40). Women with prior major cardiovascular events, neurological, or autoimmune conditions were excluded. We collected urine and blood samples to study markers of aging, data on multimorbidity at the time of enrollment, and prospectively followed them for events over the course of 6 years, on average. RESULTS Women with a history of preeclampsia exhibited unfavorable aging profiles compared with referent women, including decreased urinary α-Klotho (P=0.018); increased leptin (P=0.016) and leptin/adiponectin ratio (P=0.027), and increased extracellular vesicles positive for tissue factor (P=0.025). Women with a history of preeclampsia likewise had a higher rate of comorbidities at the time of enrollment (P=0.003) and had a 4× higher risk of developing major cardiovascular events compared with referent women (P=0.003). CONCLUSIONS Our data suggest that a history of preeclampsia is associated with accelerated aging as indicated by senescence marker differences and the accumulation of multimorbidity later in life. Targeting cellular senescence may offer novel, mechanism-based approaches for the diagnosis and treatment of adverse health outcomes in women with a history of preeclampsia.
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Affiliation(s)
- Sonja Suvakov
- Division of Nephrology and Hypertension, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Lisa E. Vaughan
- Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Santosh Parashuram
- Division of Nephrology and Hypertension, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Yvonne S. Butler Tobah
- Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Muthuvel Jayachandran
- Division of Nephrology and Hypertension, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
- Division of Hematology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Andrea Kattah
- Division of Nephrology and Hypertension, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Alanna M. Chamberlain
- Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
- Department of Cardiovascular Medicine, Medical Faculty, University of Belgrade, Serbia
| | - Suzette J. Bielinski
- Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Natasa Milic
- Department of Medical Statistics & Informatics, Medical Faculty, University of Belgrade, Serbia
| | - Vesna D. Garovic
- Division of Nephrology and Hypertension, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
- Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
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Henry A, Mangos G, Roberts LM, Brown MA, Pettit F, O’Sullivan AJ, Crowley R, Youssef G, Davis GK. Preeclampsia-Associated Cardiovascular Risk Factors 6 Months and 2 Years After Pregnancy: The P4 Study. Hypertension 2024; 81:851-860. [PMID: 38288610 PMCID: PMC10956664 DOI: 10.1161/hypertensionaha.123.21890] [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: 08/05/2023] [Accepted: 01/11/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Increased cardiovascular risk following preeclampsia is well established and there are signs of early cardiovascular aging 6 months postpartum. This study assessed whether blood pressure (BP) and other cardiovascular measures are abnormal 2 years postpartum in the same cohort to determine ongoing risk markers. METHODS Six months and 2 years postpartum, BP was measured using sphygmomanometry, 24-hour ambulatory BP monitoring, and noninvasive central BP. Anthropometric measures, blood, and urine biochemistry were performed. Cross-sectional comparisons between preeclampsia and normotensive pregnancy (NP) groups and longitudinal comparisons within each group were made at 6 months and 2 years. RESULTS Two years postpartum, 129 NP, and 52 preeclampsia women were studied who also had 6 months measures. At both time points, preeclampsia group had significantly higher BP (office BP 2 years, 112±12/72±8 versus 104±9/67±7 mm Hg NP; [P<0.001]; mean ambulatory BP monitoring 116±9/73±8 versus 106±8/67±6 mm Hg NP; [P<0.001]). No significant BP changes noted 6 months to 2 years within either group. Office BP thresholds of 140 mm Hg systolic and 90 mm Hg diastolic classified 2% preeclampsia and 0% NP at 2 years. American Heart Association 2017 criteria (above normal, >120/80 mm Hg) classified 25% versus 8% (P<0.002), as did our reference range threshold of 122/79 mm Hg. American Heart Association criteria classified 60% post-preeclampsia versus 16% after NP with above-normal ambulatory BP monitoring (P<0.001). Other cardiovascular risk markers more common 2 years post-preeclampsia included higher body mass index (median 26.6 versus 23.1, P=0.003) and insulin resistance. CONCLUSIONS After preeclampsia, women have significantly higher BP 6 months and 2 years postpartum, and have higher body mass index and insulin-resistance scores, increasing their future cardiovascular risk. Regular cardiovascular risk screening should be implemented for all who have experienced preeclampsia.
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Affiliation(s)
- Amanda Henry
- School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Sydney, Australia (A.H., G.M., L.M.R., M.A.B., F.P., A.J.O., G.K.D.)
- Departments of Women’s and Children’s Health (A.H., L.M.R., G.K.D.)
| | - George Mangos
- School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Sydney, Australia (A.H., G.M., L.M.R., M.A.B., F.P., A.J.O., G.K.D.)
- Departments of Renal Medicine (G.M., M.A.B., F.P.)
| | - Lynne M. Roberts
- School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Sydney, Australia (A.H., G.M., L.M.R., M.A.B., F.P., A.J.O., G.K.D.)
- Departments of Women’s and Children’s Health (A.H., L.M.R., G.K.D.)
| | - Mark A. Brown
- School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Sydney, Australia (A.H., G.M., L.M.R., M.A.B., F.P., A.J.O., G.K.D.)
- Departments of Renal Medicine (G.M., M.A.B., F.P.)
| | - Franziska Pettit
- School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Sydney, Australia (A.H., G.M., L.M.R., M.A.B., F.P., A.J.O., G.K.D.)
- Departments of Renal Medicine (G.M., M.A.B., F.P.)
| | - Anthony J. O’Sullivan
- School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Sydney, Australia (A.H., G.M., L.M.R., M.A.B., F.P., A.J.O., G.K.D.)
- Endocrinology (A.J.O.), St George Hospital, Kogarah, Australia
| | - Rose Crowley
- Cardiology (R.C., G.Y.) St George Hospital, Sydney, Australia
| | - George Youssef
- Cardiology (R.C., G.Y.) St George Hospital, Sydney, Australia
| | - Gregory K. Davis
- School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Sydney, Australia (A.H., G.M., L.M.R., M.A.B., F.P., A.J.O., G.K.D.)
- Departments of Women’s and Children’s Health (A.H., L.M.R., G.K.D.)
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Paquin A, Wei J. Prediction of Preeclampsia: Time for the Cardiovascular Community to Be Involved. Can J Cardiol 2024; 40:431-433. [PMID: 38016542 DOI: 10.1016/j.cjca.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 11/21/2023] [Accepted: 11/23/2023] [Indexed: 11/30/2023] Open
Affiliation(s)
- Amélie Paquin
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Québec, Canada; Department of Medicine, Faculty of Medicine, Université Laval, Québec, Québec, Canada; Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
| | - Janet Wei
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Crosier R, Lopez Laporte MA, Unni RR, Coutinho T. Female-Specific Considerations in Aortic Health and Disease. CJC Open 2024; 6:391-406. [PMID: 38487044 PMCID: PMC10935703 DOI: 10.1016/j.cjco.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/06/2023] [Indexed: 03/17/2024] Open
Abstract
The aorta plays a central role in the modulation of blood flow to supply end organs and to optimize the workload of the left ventricle. The constant interaction of the arterial wall with protective and deleterious circulating factors, and the cumulative exposure to ventriculoarterial pulsatile load, with its associated intimal-medial changes, are important players in the complex process of vascular aging. Vascular aging is also modulated by biomolecular processes such as oxidative stress, genomic instability, and cellular senescence. Concomitantly with well-established cardiometabolic and sex-specific risk factors and environmental stressors, arterial stiffness is associated with cardiovascular disease, which remains the leading cause of morbidity and mortality in women worldwide. Sexual dimorphisms in aortic health and disease are increasingly recognized and explain-at least in part-some of the observable sex differences in cardiovascular disease, which will be explored in this review. Specifically, we will discuss how biological sex affects arterial health and vascular aging and the implications this has for development of certain cardiovascular diseases uniquely or predominantly affecting women. We will then expand on sex differences in thoracic and abdominal aortic aneurysms, with special considerations for aortopathies in pregnancy.
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Affiliation(s)
- Rebecca Crosier
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Rudy R. Unni
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Thais Coutinho
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Radley A, Lees JS, Stevens KI. Cardiovascular disease in older women with CKD. Clin Kidney J 2023; 16:2304-2308. [PMID: 38046012 PMCID: PMC10689181 DOI: 10.1093/ckj/sfad235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Indexed: 12/05/2023] Open
Affiliation(s)
- Alice Radley
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Jennifer S Lees
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Kate I Stevens
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
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Paquin A, Werlang A, Coutinho T. The EVA (Early Vascular Aging) Study: Association of Central Obesity With Worse Arterial Health After Preeclampsia. J Am Heart Assoc 2023; 12:e031136. [PMID: 37929708 PMCID: PMC10727383 DOI: 10.1161/jaha.123.031136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023]
Abstract
Background Women with preeclampsia have a higher risk of cardiovascular disease. This is partly explained by the worse arterial health after preeclampsia. Central obesity (CO) is a risk factor for both preeclampsia and cardiovascular disease. Whether CO contributes to further worsening of arterial health after preeclampsia remains unclear. Our objective was to evaluate the effect of CO and previous preeclampsia on arterial hemodynamics. Methods and Results We studied 40 women with previous preeclampsia (<6 years) and 40 age-matched controls with previous normotensive pregnancy in the same timeframe. We estimated arterial hemodynamics with validated techniques combining applanation tonometry and echocardiography. CO was defined as a waist-to-hip ratio ≥0.85. Differences in arterial hemodynamics across the 3 groups (preeclampsia with CO, preeclampsia without CO, and controls) were assessed with multivariable linear regression models adjusted for potential confounders. Twenty-six (65%) of the participants with preeclampsia had CO compared with 18 (45%) controls. Mean waist-to-hip ratio in patients with preeclampsia with CO, those with preeclampsia and no CO, and controls was 0.94±0.05, 0.80±0.04, and 0.83±0.07, respectively. In multivariable analyses, women with preeclampsia and CO had higher central blood pressure, arterial stiffness (carotid-femoral pulse wave velocity), steady arterial load (systemic vascular resistance), and wave reflections (reflected pressure wave amplitude, augmentation index) compared with controls (P<0.05 for each). Fewer hemodynamic domains were altered in the preeclampsia with no CO group, with higher central diastolic blood pressure, systemic vascular resistance, and wave reflections than controls (P<0.05). Conclusions Women with previous preeclampsia who also experience CO have the greatest alterations in arterial health and hemodynamics. Patients with preeclampsia with CO may represent a higher-risk subgroup who could be targeted for risk stratification and primary prevention of cardiovascular disease.
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Affiliation(s)
- Amélie Paquin
- Division of CardiologyUniversity of Ottawa Heart InstituteOttawaONCanada
- Canadian Women’s Heart Health CentreUniversity of Ottawa Heart InstituteOttawaONCanada
| | - Ana Werlang
- Department of Obstetrics and GynecologyThe Ottawa HospitalOttawaONCanada
| | - Thais Coutinho
- Division of CardiologyUniversity of Ottawa Heart InstituteOttawaONCanada
- Canadian Women’s Heart Health CentreUniversity of Ottawa Heart InstituteOttawaONCanada
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
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