Interventions to Mitigate Risk of Cardiovascular Disease After Adverse Pregnancy Outcomes

Cardiovascular events (CVEs) are prevalent in patients with systemic lupus erythematosus (SLE), and it is the young women who are disproportionately at risk. The risk factors for accelerated cardiovascular disease remain unclear, with multiple studies producing conflicting results. In this paper, we aim to address both traditional and SLE-specific risk factors postulated to drive the accelerated vascular disease in this cohort. We also discuss the more recent hypothesis that adverse pregnancy outcomes in the form of maternal–placental syndrome and resultant preterm delivery could potentially contribute to the CVEs seen in young women with SLE who have fewer traditional cardiovascular risk factors. The pathophysiology of how placental-mediated vascular insufficiency and hypoxia (with the secretion of placenta-like growth factor (PlGF) and soluble fms-tyrosine-like kinase-1 (sFlt-1), soluble endoglin (sEng) and other placental factors) work synergistically to damage the vascular endothelium is discussed. Adverse pregnancy outcomes ultimately are a small contributing factor to the complex pathophysiological process of cardiovascular disease in patients with SLE. Future collaborative studies between cardiologists, obstetricians, obstetric physicians and rheumatologists may pave the way for a better understanding of a likely multifactorial aetiological process.

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Adverse pregnancy outcomes and subsequent risk of cardiovascular disease in women with systemic lupus erythematosus

Lupus Science & Medicine ◽

10.1136/lupus-2014-000024 ◽

2014 ◽

Vol 1 (1) ◽

pp. e000024 ◽

Cited By ~ 7

Author(s):

Pin Lin ◽

Elisa Rhew ◽

Roberta B Ness ◽

Alan Peaceman ◽

Alan Dyer ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Cardiovascular Disease ◽

Lupus Erythematosus ◽

Pregnancy Outcomes ◽

Adverse Pregnancy Outcomes ◽

Systemic Lupus ◽

Cardiovascular Disease In Women ◽

Adverse Pregnancy ◽

Subsequent Risk

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Abstract 182: Adverse Pregnancy Outcomes and Cardiovascular Disease in the Mother: The Women’s Health Initiative (WHI)

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/hcq.12.suppl_1.182 ◽

2019 ◽

Vol 12 (Suppl_1) ◽

Author(s):

Marc Meller Sondergaard ◽

Mark Hlatky ◽

Marcia L. Stefanick ◽

Eric Vittinghoff ◽

Gregory Nah ◽

...

Keyword(s):

Cardiovascular Disease ◽

Women’S Health ◽

Women's Health ◽

Pregnancy Outcomes ◽

Adverse Pregnancy Outcomes ◽

Women's Health Initiative ◽

Women’S Health Initiative ◽

Health Initiative ◽

Adverse Pregnancy ◽

The Women’S Health Initiative

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Impact of heart disease on maternal, fetal and neonatal outcomes in a low-resource setting

Heart ◽

10.1136/heartjnl-2018-313810 ◽

2018 ◽

Vol 105 (10) ◽

pp. 755-760 ◽

Cited By ~ 14

Author(s):

Andrea Beaton ◽

Emmy Okello ◽

Amy Scheel ◽

Alyssa DeWyer ◽

Renny Ssembatya ◽

...

Keyword(s):

Cardiovascular Disease ◽

Heart Disease ◽

Rheumatic Heart Disease ◽

Pregnancy Outcomes ◽

Attributable Risk ◽

Case Finding ◽

Adverse Pregnancy Outcomes ◽

Active Case Finding ◽

Adverse Pregnancy ◽

Rheumatic Heart

BackgroundThe burden of pre-existing cardiovascular disease and the contribution to adverse pregnancy outcomes are not robustly quantified, particularly in low-income countries. We aimed to determine both the prevalence of maternal heart disease through active case finding and its attributable risk to adverse pregnancy outcomes.MethodsWe conducted a 24-month prospective longitudinal investigation in three Ugandan health centres, using echocardiography for active case finding during antenatal care. Women with and without heart disease were followed to 6 weeks post partum to determine pregnancy outcomes. Prevalence of heart disease was calculated. Per cent attributable risk estimates were generated for maternal, fetal and neonatal mortality.ResultsScreening echocardiography was performed in 3506 women. The prevalence of heart disease was 17 per 1000 women (95% CI 13 to 21); 15 per 1000 was rheumatic heart disease. Only 3.4% of women (2/58) had prior diagnosis. Cardiovascular complications occurred in 51% of women with heart disease, most commonly heart failure. Per cent attributable risk of heart disease on maternal mortality was 88.6% in the exposed population and 10.8% in the overall population. Population attributable risk of heart disease on fetal death was 1.1% and 6.0% for neonatal mortalityConclusionsOccult maternal heart disease may be responsible for a substantial proportion of adverse pregnancy outcomes in low-resource settings. Rheumatic heart disease is, by far, the most common condition, urging global prioritisation of this neglected cardiovascular disease.

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Periodontal Medicine: 100 Years of Progress

Journal of Dental Research ◽

10.1177/0022034519846113 ◽

2019 ◽

Vol 98 (10) ◽

pp. 1053-1062 ◽

Cited By ~ 20

Author(s):

J.D. Beck ◽

P.N. Papapanou ◽

K.H. Philips ◽

S. Offenbacher

Keyword(s):

Cardiovascular Disease ◽

Periodontal Disease ◽

Pregnancy Outcomes ◽

Adverse Pregnancy Outcomes ◽

Lessons Learned ◽

Case Definitions ◽

Medicine Research ◽

Periodontal Infection ◽

Adverse Pregnancy ◽

Periodontal Medicine

Periodontal medicine is a term used to describe how periodontal infection/inflammation may impact extraoral health. Periodontitis has been linked to over 50 systemic diseases and conditions. As part of the Journal of Dental Research’s Centennial Celebration, this narrative review discusses periodontal medicine research done over the past 100 y, with particular focus on the effects of periodontal disease on 3 pathological conditions: cardiovascular disease, diabetes mellitus, and adverse pregnancy outcomes. We selected 29 total studies that were the “first” of their kind, as they provided novel observations or contributed to shifting paradigms as well as important studies that made strong contributions to progress in understanding relationships to the systemic conditions. These studies were organized in an overview timeline and broken down into timelines by topic: cardiovascular disease ( n = 10), diabetes ( n = 12), and adverse pregnancy outcomes ( n = 7). Overall, the majority of cross-sectional, case-control, and longitudinal studies have revealed positive associations between poor periodontal status and cardiovascular disease, diabetes metabolic control, and a number of adverse pregnancy outcomes, and these associations are upheld in systematic reviews. Findings from randomized controlled trials testing the effects of periodontal therapy on systemic health outcomes were conflicting and inconsistent. While there has been a great deal of progress, we highlight lessons learned and make comments and suggestions on a number of key aspects, including the heterogeneity of case definitions of periodontal disease across studies, accounting for features of the periodontal phenotype that are most relevant to the biological link between periodontitis and systemic outcomes, the role of other comorbid inflammatory conditions, selection of study participants, and timing and intensity of the periodontal intervention.

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