scholarly journals Adverse Pregnancy Outcomes and Cardiovascular Disease Risk: Unique Opportunities for Cardiovascular Disease Prevention in Women

Circulation ◽  
2021 ◽  
Author(s):  
Nisha I. Parikh ◽  
Juan M. Gonzalez ◽  
Cheryl A.M. Anderson ◽  
Suzanne E. Judd ◽  
Kathryn M. Rexrode ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Health Care ◽  
Pregnancy Outcomes ◽  
White Women ◽  
Adverse Pregnancy Outcomes ◽  
Transitions Of Care ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Adverse Pregnancy

This statement summarizes evidence that adverse pregnancy outcomes (APOs) such as hypertensive disorders of pregnancy, preterm delivery, gestational diabetes, small-for-gestational-age delivery, placental abruption, and pregnancy loss increase a woman’s risk of developing cardiovascular disease (CVD) risk factors and of developing subsequent CVD (including fatal and nonfatal coronary heart disease, stroke, peripheral vascular disease, and heart failure). This statement highlights the importance of recognizing APOs when CVD risk is evaluated in women, although their value in reclassifying risk may not be established. A history of APOs is a prompt for more vigorous primordial prevention of CVD risk factors and primary prevention of CVD. Adopting a heart-healthy diet and increasing physical activity among women with APOs, starting in the postpartum setting and continuing across the life span, are important lifestyle interventions to decrease CVD risk. Lactation and breastfeeding may lower a woman’s later cardiometabolic risk. Black and Asian women experience a higher proportion APOs, with more severe clinical presentation and worse outcomes, than White women. More studies on APOs and CVD in non-White women are needed to better understand and address these health disparities. Future studies of aspirin, statins, and metformin may better inform our recommendations for pharmacotherapy in primary CVD prevention among women who have had an APO. Several opportunities exist for health care systems to improve transitions of care for women with APOs and to implement strategies to reduce their long-term CVD risk. One proposed strategy includes incorporation of the concept of a fourth trimester into clinical recommendations and health care policy.

Abstract 376: Adverse Pregnancy Outcomes and Cardiovascular Risks Multi-disciplinary Awareness Project

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Venkata Sai Gogineni ◽  
Ki Park ◽  
Denise Manfrini ◽  
Robert Egerman ◽  
Sharon Aroda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pregnancy Outcomes ◽  
Descriptive Analysis ◽  
Primary Objective ◽  
Adverse Pregnancy Outcomes ◽  
Cardiovascular Risks ◽  
Cvd Risk ◽  
Adverse Pregnancy ◽  
Traditional Risk Factors

Background: Cardiovascular disease (CVD) remains the number one cause of death amongst women. There has been much effort put forth over the past decade in reducing both the incidence and prevalence of this disease burden through screening and treating the traditional risk factors. Recent guidelines have shown that adverse pregnancy outcomes (APOs), including pre-eclampsia (PEC), gestational diabetes mellitus (GDM) and pre-term birth (PTB) have been associated with future maternal CVD risk. Much of the current literature focuses almost exclusively on PEC. Our investigation is more comprehensive, covering not only these other APOs but assessing whether providers of multiple specialties in our community are aware of the APO to CVD risk association. The primary objective of this study was to investigate if there exist any knowledge gaps regarding the progression from APO to CVD and if this knowledge varies by specialty. Methods: An anonymous voluntary survey through REDCap© was sent to providers in the fields of Internal medicine (IM, 21%), Family medicine (FM, 26%), Obstetrics-Gynecology (Ob-Gyn, 23%) and Cardiology (30%) who have been in practice for greater than five years in our local Gainesville community. This project was registered as a QI project and descriptive analysis was used to examine the responses. Results: A total of 53 providers responded to the survey. Despite having the majority of patients being women, Ob-Gyn was the least likely amongst all specialties to routinely screen for CV risk factors. However, when addressed, they were the most likely to ask about APOs. Cardiologists, despite declaring to be aware of the association between APOs and CV risk, were least likely to ask about APOs. All specialties recognized PEC and GDM as APOs linked to long-term maternal CV risk but failed to associate PTB as an APO. The majority of providers amongst IM, FM, and Cardiology did not ask about APOs and lacked the knowledge of how often to appropriately screen for secondary risk factors associated with APOs. Additionally, these providers outright admitted that they are not familiar with the current AHA and/or ACOG guidelines for screening and follow-up. Conclusion: Descriptive statistical analysis of our data suggests that there exists a notable knowledge gap between all four specialties investigated in our survey. Education concerning the link between APOs and future maternal CV risk is needed amongst all specialties, especially amongst the providers in Cardiology, IM, and FM. Targeted efforts at our institution to improve awareness of all APOs, their associated secondary risk factors, and appropriate screening is required in all specialties to help reduce CVD morbidity and mortality.

Do adverse pregnancy outcomes contribute to accelerated cardiovascular events seen in young women with systemic lupus erythematosus?

Lupus ◽  
2017 ◽  
Vol 26 (13) ◽  
pp. 1351-1367 ◽  
Author(s):  
M C Soh ◽  
C Nelson-Piercy ◽  
M Westgren ◽  
L McCowan ◽  
D Pasupathy
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Cardiovascular Disease ◽  
Young Women ◽  
Lupus Erythematosus ◽  
Pregnancy Outcomes ◽  
Cardiovascular Events ◽  
Adverse Pregnancy Outcomes ◽  
Systemic Lupus ◽  
Adverse Pregnancy

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.

scholarly journals Does Adding Adverse Pregnancy Outcomes Improve the Framingham Cardiovascular Risk Score in Women? Data from the Tehran Lipid and Glucose Study

2022 ◽  
Author(s):  
Marzieh Saei Ghare Naz ◽  
Ali Sheidaei ◽  
Ali Aflatounian ◽  
Fereidoun Azizi ◽  
Fahimeh Ramezani Tehrani
Keyword(s):  
Risk Factors ◽  
Risk Score ◽  
Pregnancy Outcomes ◽  
Framingham Risk Score ◽  
Adverse Pregnancy Outcomes ◽  
Proportional Hazard ◽  
Cvd Risk ◽  
C Statistic ◽  
Framingham Risk ◽  
Adverse Pregnancy

Background Limited and conflicting evidence is available regarding the predictive value of adding adverse pregnancy outcomes (APOs) to established cardiovascular disease (CVD) risk factors. Hence, the objective of this study was to determine whether adding APOs to the Framingham risk score improves the prediction of CVD events in women. Methods and Results Out of 5413 women who participated in the Tehran Lipid and Glucose Study, 4013 women met the eligibility criteria included for the present study. The exposure and the outcome variables were collected based on the standard protocol. Cox proportional hazard model was used to evaluate the association of APOs and CVDs. The variant of C‐statistic for survivals and reclassification of subjects into Framingham risk score categories after adding APOs was reported. Out of the 4013 eligible subjects, a total of 1484 (36.98%) women reported 1 APO, while 395 (9.84%) of the cases reported multiple APOs. Univariate proportional hazard Cox models showed the significant relations between CVD events and APOs. The enhanced model had a higher C‐statistic indicating more acceptable discrimination as well as a slight improvement in discrimination (C‐statistic differences: 0.0053). Moreover, we observed a greater risk of experiencing a CVD event in women with a history of multiple APOs compared with cases with only 1 APO (1 APO: hazard ratio [HR] = 1.22; 2 APOs: HR; 1.94; ≥3 APOs: HR = 2.48). Conclusions Beyond the established risk factors, re‐estimated CVDs risk by adding APOs to the Framingham risk score may improve the accurate risk estimation of CVD. Further observational studies are needed to confirm our findings.

Abstract MP71: Ten Year Predicted Cardiovascular Disease Risk in Young Women With Adverse Pregnancy Outcomes

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Janet M Catov ◽  
Becky McNeil ◽  
Philip Greenland ◽  
Noel Bairey Merz ◽  
Deborah Ehrenthal ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Young Women ◽  
Pregnancy Outcomes ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Adverse Pregnancy Outcomes ◽  
Reproductive Age ◽  
Risk Scores ◽  
Cvd Risk ◽  
Adverse Pregnancy

Introduction: Cardiovascular disease (CVD) is the leading cause of death among women. In stark contrast to mortality declines in other groups, CVD deaths to young women are increasing. CVD prediction in this group is imprecise, and how adverse pregnancy outcomes (APO) may unmask risk during the reproductive years is unknown. Hypothesis: Women with APO will have higher 10-year predicted CVD risk within 7 years following a first pregnancy compared to women with no APO. Study design: We enrolled 10,038 women at 8 sites in their first pregnancy and followed 4,500 through a CVD visit 2-7 years later. Presented here are results for the first 2,705 with lab results and no hypertension or diabetes before pregnancy. The Atherosclerotic CVD (ASCVD), American Health Association Healthy Heart, Pathobiological Determinants of Atherosclerosis in Youth (PDAY), and Reynolds risk scores were compared in women with preterm birth (PTB), preeclampsia/gestational hypertension (PE/GH), gestational diabetes (GDM), small for gestational age (SGA), and no adverse outcomes (no APO, referent). Results: As expected, 10-year predicted CVD risk was very low in women at a median age of 30, although differences at the tail of the distribution were detected based on APO history. Women with no APO had the lowest CVD risk. Women with PTB, PE/GH, GDM, or SGA had higher 10-year CVD risk as predicted by the ASCVD score compared to women with no APO (p<0.05 for PTB and PE/GH). Six to 10% of women with these APOs had ASCVD scores greater than 5%. The PDAY score that predicts risk of coronary artery calcification in young adults was also higher in women with PE/GH or GDM than in those with no APO. Risk factors perturbed after delivery in women with APOs were blood pressure, BMI, waist circumference, HDL-cholesterol, triglycerides, glucose, and HbA1c. Conclusion: While risk scores customized for women of reproductive age are needed, those with a first pregnancy complicated by PTB, PE/GH or GDM have modest but detectable predicted 10-year CVD risk as soon as 2-7 years after delivery.

scholarly journals 1430Guideline-based cardiovascular disease risk assessment among Indigenous Australians in a general practice setting

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Digsu Koye ◽  
Karen Lamb ◽  
Ping-Wen Lee ◽  
Aneta Kotevski ◽  
Javier Haurat ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Risk Assessment ◽  
Health Care ◽  
Primary Health Care ◽  
Indigenous Australians ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Indigenous Status ◽  
Primary Health

Abstract Background HealthGap is a population-based cohort study aiming to understand health inequities in cardiovascular disease (CVD) risk between Indigenous and non-Indigenous Australians. We examined guideline-based CVD risk assessment in Victoria. Methods NPS MedicineInsight, the largest Australian primary health care dataset, provided data on CVD risk factors (age, gender, smoking status, diabetes, systolic blood pressure (SBP), total and HDL cholesterol) and Aboriginal or Torres Strait Islander (Indigenous) status. The percentage of patients who had all risk factors measured was calculated and compared by Indigenous status. Results In total, 7,928 of 1,435,111 patients were classified as Indigenous. The percentage of patients with measured cholesterol was slightly lower for Indigenous (total cholesterol=31.4%, HDL=26.9%) than non-Indigenous patients (total cholesterol=35.6%, HDL=31.8%). However, more Indigenous patients had SBP measured (65.6% vs. 59.8%). Diabetes diagnosis was higher among Indigenous patients (6.2% vs. 3.6%). There was a small difference in the proportions with all risk factors measured between Indigenous and non-Indigenous patients (24.1% vs. 26.6%). Among Indigenous patients aged at least 35 years who should have had their risk assessment measured, 41.9% had all risk factors measured, while 50.7% of the non-Indigenous Australians (aged ≥45 years) had all risk factors measured. Conclusions Overall, the proportion of people with all CVD risk factors measured was smaller for Indigenous compared to non-Indigenous people. Key messages Fewer than half of Indigenous Australians have CVD risk factors captured in a primary health care setting. This has implications for health care policy and programs seeking to improve CV health outcomes among Indigenous Australians.

scholarly journals Effects of a Paleolithic Diet on Cardiovascular Disease Risk Factors: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2019 ◽  
Vol 10 (4) ◽  
pp. 634-646 ◽  
Author(s):  
Ehsan Ghaedi ◽  
Mohammad Mohammadi ◽  
Hamed Mohammadi ◽  
Nahid Ramezani-Jolfaie ◽  
Janmohamad Malekzadeh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Lipid Profile ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Cvd Risk Factors ◽  
Paleolithic Diet ◽  
Cvd Risk ◽  
Randomized Controlled

ABSTRACTThere is some evidence supporting the beneficial effects of a Paleolithic diet (PD) on cardiovascular disease (CVD) risk factors. This diet advises consuming lean meat, fish, vegetables, fruits, and nuts and avoiding intake of grains, dairy products, processed foods, and added sugar and salt. This study was performed to assess the effects of a PD on CVD risk factors including anthropometric indexes, lipid profile, blood pressure, and inflammatory markers using data from randomized controlled trials. A comprehensive search was performed in the PubMed, Scopus, ISI Web of Science, and Google Scholar databases up to August 2018. A meta-analysis was performed using a random-effects model to estimate the pooled effect size. Meta-analysis of 8 eligible studies revealed that a PD significantly reduced body weight [weighted mean difference (WMD) = −1.68 kg; 95% CI: −2.86, −0.49 kg], waist circumference (WMD = −2.72 cm; 95% CI: −4.04, −1.40 cm), BMI (in kg/m2) (WMD = −1.54; 95% CI: −2.22, −0.87), body fat percentage (WMD = −1.31%; 95% CI: −2.06%, −0.57%), systolic (WMD = −4.75 mm Hg; 95% CI: −7.54, −1.96 mm Hg) and diastolic (WMD = −3.23 mm Hg; 95% CI: −4.77, −1.69 mm Hg) blood pressure, and circulating concentrations of total cholesterol (WMD = −0.23 mmol/L; 95% CI: −0.42, −0.04 mmol/L), triglycerides (WMD = −0.30 mmol/L; 95% CI: −0.55, −0.06 mmol/L), LDL cholesterol (WMD = −0.13 mmol/L; 95% CI: −0.26, −0.01 mmol/L), and C-reactive protein (CRP) (WMD = −0.48 mg/L; 95% CI: −0.79, −0.16 mg/L) and also significantly increased HDL cholesterol (WMD = 0.06 mmol/L; 95% CI: 0.01, 0.11 mmol/L). However, sensitivity analysis revealed that the overall effects of a PD on lipid profile, systolic blood pressure, and circulating CRP concentrations were sensitive to removing some studies and to the correlation coefficients, hence the results must be interpreted with caution. Although the present meta-analysis revealed that a PD has favorable effects on CVD risk factors, the evidence is not conclusive and more well-designed trials are still needed.

scholarly journals Cardiovascular Disease Risk in Bears and Other Gay Men: A Descriptive Study from Poland

2021 ◽  
Vol 18 (3) ◽  
pp. 1044
Author(s):  
Magdalena Mijas ◽  
Karolina Koziara ◽  
Andrzej Galbarczyk ◽  
Grazyna Jasienska
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Gay Men ◽  
Disease Risk ◽  
Older Age ◽  
Analysis Of Covariance ◽  
Control Group ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Wide Range

A risk of cardiovascular disease (CVD) is increased by multiple factors including psychosocial stress and health behaviors. Sexual minority men who identify as Bears form a subculture distinguished by characteristics associated with increased CVD risk such as elevated stress and high body weight. However, none of the previous studies comprehensively investigated CVD risk in this population. Our study compared Bears (N = 31) with other gay men (N = 105) across a wide range of CVD risk factors. Logistic regression and analysis of covariance (ANCOVA) models were performed to compare both groups concerning behavioral (e.g., physical activity), medical (e.g., self-reported hypertension), and psychosocial (e.g., depressiveness) CVD risk factors. Bears were characterized by older age and higher body mass index (BMI) than the control group. We also observed higher resilience, self-esteem, as well as greater prevalence of self-reported hypertension, diabetes, and hypercholesterolemia in Bears. None of these differences remained statistically significant after adjusting for age and, in the case of self-reported diagnosis of diabetes, both age and BMI. Our study demonstrates that Bears are characterized by increased CVD risk associated predominantly with older age and higher BMI. Health promotion interventions addressed to this community should be tailored to Bears’ subcultural norms and should encourage a healthier lifestyle instead of weight loss.

scholarly journals Effect of DASH Diet Versus Healthy Dietary Advice on the Estimated Atherosclerotic Cardiovascular Disease Risk

2021 ◽  
Vol 12 ◽  
pp. 215013272098095
Author(s):  
Marwa S. Said ◽  
Inas T. El Sayed ◽  
Eman E. Ibrahim ◽  
Ghada M. Khafagy
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Dietary Advice ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Post Intervention ◽  
Dash Diet ◽  
Significant Difference ◽  
Diet Versus

Introduction: Cardiovascular disease (CVD) is the most leading cause of mortality worldwide. Changes in diet can reduce subclinical cardiac injury and inflammation in parallel with reductions of other CVD risk factors. Aim: The study aimed to evaluate the beneficial effect of the DASH diet versus usual healthy dietary advice (HDA) on the estimated risk of atherosclerotic cardiovascular disease (ASCVD). Methods: It was a prospective interventional nonrandomized controlled study, conducted on 92 participants attending Family Medicine Outpatient Clinics, Cairo University. The participants were assigned to 2 dietary groups, the DASH and HDA groups, for 12 weeks. All subjects were subjected to anthropometric measurement, assessment of lipid profile, and the estimated cardiovascular risk pre-and post-intervention. Results: The estimated cardiovascular risk was reduced significantly in both the DASH and HDA groups, with no statistically significant difference between the 2 groups regarding the risk reduction. By comparing the percent change between pre and post-intervention in both DASH and HDA groups, the following are the results: BMI dropped by 6.5% versus 2.5%, systolic blood pressure decreased by 6.9% and 4.1%, fasting blood sugar dropped by 5.5% and 3.1%, total cholesterol dropped by 5.2% and 3.1%, LDL dropped by 8.2%, and 3.1%, and HDL increased by 8.2% and 2.4%, in DASH and HDA groups, respectively. Conclusion: Both the DASH diet and HDA are associated with improvement in CVD risk factors. Although better risk factors decline with the DASH diet, there was no statistically significant difference between the 2 groups.

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