Abstract P097: Maternal Vascular Changes during Pregnancy may Persist Postpartum

Introduction: Higher parity (number of births) is associated with increased subclinical cardiovascular disease (CVD) in mid-life and older women, and with increased risk of CVD overall. In the only study of reproductive age women, common carotid artery intima-media thickness (CCA IMT) was greater after each birth. Prospective studies of arterial change throughout normal pregnancy are lacking; without them it is unclear whether unhealthy changes of the vasculature during pregnancy persist postpartum and raise women’s risk of CVD. The goal of this study was to prospectively assess normal vascular adaptation in healthy pregnant women. Hypotheses: During the course of healthy pregnancy: 1. CCA adventitial diameter (AD) will increase, then return to baseline postpartum, 2. CCA IMT will initially thin, then thicken as pregnancy progresses, then return to baseline postpartum, and 3. brachial artery distensibility will not change. Methods: We assessed 43 healthy women during each trimester of their first pregnancy and 6-8 weeks postpartum with B-mode ultrasound imaging of the CCA IMT and AD, independent predictors of CVD risk. Brachial artery distensibility, representing elasticity of the artery, was measured using the DynaPulse wave form analyzer. Linear mixed models were used to compare measures of CCA IMT, adventitial diameter, and brachial artery distensibility at each time point, after adjustment for age and pre-pregnancy BMI. Results: There were 37 women (age 28.2 ± 4.5 years, pre-pregnant BMI 24.4 ± 3.2 kg/m 2 ) with uncomplicated pregnancies. Six women with pregnancy complications were excluded from these analyses. After adjustment for age and pre-pregnancy BMI, mean (SE) CCA AD (mm) increased each trimester, from 6.38(0.08) in the 1 st trimester to 6.92(0.09) in the 3 rd trimester, and returned to baseline, 6.35 (0.07), postpartum. Pairwise comparisons were all statistically significant at p<.01. Mean (SE)CCA IMT (mm) was increased postpartum (0.567 (0.01)) compared to 1 st (0.539 (0.01)) and 2 nd trimester values (0.546 (0.01), p < .05 for each). Mean (SE) brachial artery distensibility (%/mmHg) decreased from 7.64 (0.28) 1st trimester to 6.84 (0.21) 3rd trimester (p < .01) and then remained unchanged at 6.82 (0.21) postpartum. Conclusions: As we hypothesized, in uncomplicated first pregnancies CCA AD increased throughout and returned to baseline postpartum. However, contrary to our hypotheses, CCA IMT increased postpartum, and the brachial artery stiffened during pregnancy and remained stiffer 6-8 weeks postpartum. In uncomplicated first pregnancies, some vascular changes resolved (CCA AD) and others persisted (CCA IMT and brachial artery stiffness). Whether this indicates that persistence of specific vascular effects of pregnancy may inform long term CVD risk remains to be explored.

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Abstract 85: Pre-Hypertension is a Disease Associated with Significant Structural and Functional Cardiovascular Abnormalities. It is Time to Lower the Bar.

Hypertension ◽

10.1161/hyp.60.suppl_1.a85 ◽

2012 ◽

Vol 60 (suppl_1) ◽

Author(s):

Mahfouz El Shahawy ◽

Miglena Entcheva ◽

Arjun Padalia

Keyword(s):

Intima Media Thickness ◽

Carotid Intima Media Thickness ◽

P Value ◽

Cvd Risk ◽

Structural Abnormalities ◽

Prevalent Disease ◽

Artery Stiffness ◽

Group A ◽

Group B ◽

Asymptomatic Subjects

Purpose: To examine whether pre-HTN is a risk factor for CV structural and functional abnormalities. METHODS: We screened 2233 asymptomatic subjects, age 23-80, for CVD risk using Early CVD Risk Score (ECVDRS). ECVDRS consists of 10 tests: large (C1) and small (C2) artery stiffness, BP at rest and post mild exercise (PME), Carotid Intima Media Thickness (CIMT), abdominal aorta and left ventricle ultrasound, retinal photography, microalbuminuria, ECG, and pro-BNP. Pre-HTN and normotension (NT) was defined according to the JNC VII criteria. Results: Among the subjects screened, 38% (855 of 2233) were NT; 70% (596 of 855) were not taking CV medication. 42% (942 of 2233) of subjects were pre-HTN; 55% (521 of 942) were not taking CV medication. The untreated, NT group was split into Group A 82% (491 of 596) with norm. BP rise PME and Group B 18% (105 of 596) with abn. BP rise PME. The untreated, pre-HTN group was split into Group C 61% (318 of 521) with norm. BP rise PME and Group D 39% (203 of 521) with abn. BP rise PME. The presence of structural abnormalities in the groups is shown on Table 1. Conclusions: Based on our data, pre-HTN is a prevalent disease (42%), exceeding NT (38%) in the subjects screened. Pre-HTN is associated with greater functional and structural abnormalities than the NT group. The structural abnormalities, particularly CIMT (statistically significant p value of <0.0016), may be accounted for by the greater abn. BP rise PME in the pre-HTN group (39%). Based on our data, pre-HTN justifies ECVDRS screening for appropriate risk stratification and treatment. These findings may warrant lowering the bar for the definitions of HTN and pre-HTN in future guidelines.

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Fertility preservation with successful pregnancy outcome in a patient with transplanted heart and non-Hodgkin’s lymphoma – a case report

BMC Pregnancy and Childbirth ◽

10.1186/s12884-019-2587-x ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Ana Sofia Pais ◽

Nuno Guerra ◽

Daniela Couto ◽

Ana Paula Sousa ◽

Teresa Almeida-Santos

Keyword(s):

Fertility Preservation ◽

Heart Transplant ◽

Multidisciplinary Team ◽

Normal Pregnancy ◽

Reproductive Age ◽

Pelvic Irradiation ◽

Non Hodgkin Lymphoma ◽

Increased Risk ◽

Oncologic Treatment

Abstract Background: Fertility preservation must be discussed with reproductive age women before cancer treatment. Heart transplantation raises complex issues in pregnancy. Pregnancy in a heart transplant woman after pelvic irradiation involves close multidisciplinary follow-up to avoid complications in the mother and the foetus. We report the first live birth in a heart transplant woman after pelvic irradiation, chemotherapy and fertility preservation. Case presentation: A 36-year-old heart transplant woman with pelvic non-Hodgkin lymphoma spared her fertility, with cryopreservation of oocytes and embryos, before chemotherapy and pelvic irradiation. After multidisciplinary discussion and pre-conception evaluation, pregnancy was achieved. A close follow-up by a multidisciplinary team allowed a normal pregnancy without maternal or foetal complications and the delivery of a healthy infant. Conclusions Achieving pregnancy in heart transplant women with iatrogenic ovarian failure after oncologic treatment including pelvic irradiation is possible and can be successful. Careful and close surveillance by a multidisciplinary team is mandatory due to increased risk of maternal and foetal complications.

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Abstract P197: Structural and Functional Arterial Changes in Healthy Women Following Pregnancy

Circulation ◽

10.1161/circ.133.suppl_1.p197 ◽

2016 ◽

Vol 133 (suppl_1) ◽

Author(s):

Mansi Desai ◽

Nancy Niemczyk ◽

Janet Catov ◽

Marnie Bertolet ◽

Emma Barinas-Mitchell ◽

...

Keyword(s):

Postpartum Period ◽

Post Partum ◽

Intima Media Thickness ◽

Vascular Aging ◽

Postpartum Visit ◽

Cvd Risk ◽

Vascular Effects ◽

Factors Affecting ◽

Healthy Women ◽

Early Postpartum

Background: Parity is associated with future maternal cardiovascular disease (CVD) risk in a J-shaped fashion. Markers of vascular aging and future CVD risk, such as common carotid artery intima-media thickness (CCA IMT) and inter-adventitial diameter (IAD), increase acutely during pregnancy. As reported previously, increased CCA IMT did not recede in the early postpartum period. This study aims to determine whether vascular changes during pregnancy persist beyond the initial postpartum period. Methods: This study is a follow-up to a prospective study that assessed vascular health in a cohort of 43 healthy women during a first pregnancy and at 6-8 weeks postpartum. Data on physical measures, biomarker assays, pregnancy outcomes, health history and CCA IMT and IAD via B-mode ultrasound were collected at a second post-partum visit 1-5 years following the index birth. Paired t-tests and multivariable linear regression were used to assess changes in vascular measures. Results: Sixteen participants with mean±SD age 32.4±4.4 years, BMI 25.6±3.1 kg/m 2 , cumulative breastfeeding time of 19.7±11.2 months and time from index delivery of 2.7±0.8 years completed the second postpartum visit. Eight of these women had ≥ 1 subsequent births. Compared to the third trimester, the decrease in IAD and increase in IMT observed early postpartum, persisted further out postpartum (figure). At the second postpartum visit, larger IAD was associated with higher blood pressure whereas thicker IMT was associated with less time since index birth, greater weight gain, shorter duration of breastfeeding, and lower insulin resistance (all p<0.05). Conclusions: Markers of vascular aging did not consistently improve 1 to 5 years after delivery. Persistence of pregnancy related vascular effects suggest a possible mechanism linking increased CVD risk with parity. Prolonged breastfeeding and weight management following pregnancy may be modifiable lifestyle factors affecting future maternal CVD risk.

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Abstract P115: Increased Diastolic Blood Pressure Post-mild Exercise is Associated With Early Structural and Functional Cardiovascular Abnormalities

Hypertension ◽

10.1161/hyp.70.suppl_1.p115 ◽

2017 ◽

Vol 70 (suppl_1) ◽

Author(s):

Susan Tucker ◽

Mahfouz El Shahawy

Keyword(s):

Blood Pressure ◽

Diastolic Blood Pressure ◽

Risk Score ◽

Health Care Practitioner ◽

Cvd Risk ◽

Cardiovascular Abnormalities ◽

Increased Risk ◽

Artery Stiffness ◽

Asymptomatic Subjects ◽

Retinal Photography

Background: Previous research has suggested that an increase in SBP post-mild exercise is correlated with early structural and functional cardiovascular abnormalities. Purpose: To determine if an increase in diastolic blood pressure post-mild exercise (DBP PME) is associated with early structural and functional cardiovascular abnormalities. Methods: 1416 untreated, asymptomatic subjects were screened for early indicators of cardiovascular disease using the Early CVD Risk Score (ECVDRS), also known as Rasmussen Risk Score (RRS), which consists of a panel of 10 tests; large (C1) and small (C2) artery stiffness, resting BP and post mild exercise (PME), CIMT, abdominal aorta and left ventricle ultrasounds, retinal photography, microalbumuria, ECG, and pro-BNP. 267 subjects were normotensive. Of those subjects, 12 had a increase in DBP PME, 23 had no change in DBP PME, and 232 had a decline in DBP PME. Focus was placed on the three known tests recommended for early CVD assessment; C1, C2 and CIMT. Results: As seen in Figure 1.0, a rise in diastolic blood pressure PME is statistically evident for an increased risk of early structural and functional cardiovascular abnormalities. A significant increase in abnormalities was noted with C2 and CIMT with subjects whose DBP increased PME. Conclusion: Assessment of diastolic blood pressure PME is an easy, noninvasive, inexpensive test that can be performed by any health care practitioner to evaluate the risk of CVD in patients. Any increase in diastolic blood pressure PME should warrant physicians on the urgency to further investigate and treat patients to divert the progression of CVD.

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Deletion polymorphism in the α2B-adrenergic receptor gene is associated with flow-mediated dilatation of the brachial artery

Clinical Science ◽

10.1042/cs1030517 ◽

2002 ◽

Vol 103 (5) ◽

pp. 517-524 ◽

Cited By ~ 14

Author(s):

Paula HEINONEN ◽

Laura JARTTI ◽

Mikko J. JÄRVISALO ◽

Ullamari PESONEN ◽

Jaakko A. KAPRIO ◽

...

Keyword(s):

Carotid Artery ◽

Endothelial Function ◽

Brachial Artery ◽

Adrenergic Receptor ◽

Intima Media Thickness ◽

Deletion Variant ◽

Media Thickness ◽

Increased Risk ◽

Flow Mediated Dilatation ◽

Carotid Artery Compliance

A deletion variant of the α2B-adrenergic receptor (α2B-AR) has been associated with an increased risk of acute cardiac events in middle-aged men. Our aim was to determine the possible associations between the α2B-AR gene deletion variant and indicators of subclinical atherosclerosis in the brachial and carotid arteries. A total of 148 middle-aged men participating in an epidemiological twin study on risk factors for subclinical coronary heart disease were genotyped using PCR. Flow-mediated dilatation (FMD) of the brachial artery, carotid artery compliance and carotid intima-media thickness were measured using high-resolution ultrasound. FMD was 6.2±5.0% in subjects with the I/I (insertion/insertion) genotype, 5.5±4.1% in the I/D (insertion/deletion) group and 4.1±3.8% in the D/D (deletion/deletion) group (P = 0.03 for trend). In multivariate regression analysis controlling for age, presence of hypertension, smoking, use of angiotensin-converting enzyme inhibitors and plasma levels of low-density lipoprotein cholesterol and lipoprotein (a), the association between the α2B-AR genotype and FMD remained significant (P = 0.04 for trend). The α2B-AR genotype was not associated with intima-media thickness or carotid artery compliance. These findings indicate that subjects homozygous for the deletion allele of α2B-AR appear to have an increased risk of impaired endothelial function, which may provide an explanation for the previously observed increased risk of myocardial infarction in male subjects with this genotype. It is not known whether the association of the α2B-AR polymorphism with endothelial function is direct, or is mediated via altered sympathetic activation.

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Sex-specific effects of habitual aerobic exercise on brachial artery flow-mediated dilation in middle-aged and older adults

Clinical Science ◽

10.1042/cs20100174 ◽

2010 ◽

Vol 120 (1) ◽

pp. 13-23 ◽

Cited By ~ 101

Author(s):

Gary L. Pierce ◽

Iratxe Eskurza ◽

Ashley E. Walker ◽

Tara N. Fay ◽

Douglas R. Seals

Keyword(s):

Aerobic Exercise ◽

Endurance Exercise ◽

Brachial Artery ◽

Exercise Intervention ◽

Flow Mediated Dilation ◽

Middle Aged ◽

Cvd Risk ◽

Increased Risk ◽

Menopausal Women ◽

Post Menopausal

Brachial artery FMD (flow-mediated dilation) is impaired with aging and is associated with an increased risk of CVD (cardiovascular disease). In the present study, we determined whether regular aerobic exercise improves brachial artery FMD in MA/O (middle-aged/older) men and post-menopausal women. In sedentary MA/O adults (age, 55–79 years) without CVD, 8 weeks of brisk walking (6 days/week for approx. 50 min/day; randomized controlled design) increased treadmill time approx. 20% in both MA/O men (n=11) and post-menopausal women (n=15) (P<0.01), without altering body composition or circulating CVD risk factors. Brachial artery FMD increased >50% in the MA/O men (from 4.6±0.6 to 7.1±0.6%; P<0.01), but did not change in the post-menopausal women (5.1±0.8 compared with 5.4±0.7%; P=0.50). No changes occurred in the non-exercising controls. In a separate cross-sectional study (n=167), brachial artery FMD was approx. 50% greater in endurance-exercise-trained (6.4±0.4%; n=45) compared with sedentary (4.3±0.3%; n=60) MA/O men (P<0.001), whereas there were no differences between endurance-trained (5.3±0.7%, n=20) and sedentary (5.6±0.5%, n=42) post-menopausal women (P=0.70). Brachial artery lumen diameter, peak hyperaemic shear rate and endothelium-independent dilation did not differ with exercise intervention or in the endurance exercise compared with sedentary groups. In conclusion, regular aerobic exercise is consistently associated with enhanced brachial artery FMD in MA/O men, but not in post-menopausal women. Some post-menopausal women without CVD may be less responsive to habitual aerobic exercise than MA/O men.

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Cardiovascular Complications in Patients with Turner’s Syndrome

Current Pharmaceutical Design ◽

10.2174/1381612826666200531152459 ◽

2020 ◽

Vol 26 (43) ◽

pp. 5650-5659

Author(s):

Eirini Kostopoulou ◽

Julia K. Bosdou ◽

Panagiotis Anagnostis ◽

John C. Stevenson ◽

Dimitrios G. Goulis

Keyword(s):

Risk Factors ◽

Vascular Complications ◽

Intima Media Thickness ◽

Carotid Intima Media Thickness ◽

Cardiovascular Complications ◽

Cvd Risk ◽

Increased Risk ◽

Cardiovascular Defects ◽

Exact Effect ◽

Cvd Mortality

Turner’s or Turner syndrome (TS) is the most prevalent chromosomal abnormality in live female births. Patients with TS are predisposed to an increased risk of cardiovascular diseases (CVD), mainly due to the frequently observed congenital structural cardiovascular defects, such as valvular and aortic abnormalities (coarctation, dilatation, and dissection). The increased prevalence of cardiometabolic risk factors, such as arterial hypertension, insulin resistance, diabetes mellitus, dyslipidaemia, central obesity, and increased carotid intima-media thickness, also contribute to increased morbidity and mortality in TS patients. Menopausal hormone therapy (MHT) is the treatment of choice, combined with growth hormone (GH). Although MHT may, in general, ameliorate CVD risk factors, its effect on CVD mortality in TS has not yet been established. The exact effect of GH on these parameters has not been clarified. Specific considerations should be provided in TS cases during pregnancy, due to the higher risk of CVD complications, such as aortic dissection. Optimal cardiovascular monitoring, including physical examination, electrocardiogram, CVD risk factor assessment, and transthoracic echocardiography, is recommended. Moreover, the cardiac magnetic resonance from the age of 12 years is recommended due to the high risk of aortic aneurysm and other anatomical vascular complications.

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DAPSA, carotid plaque and cardiovascular events in psoriatic arthritis: a longitudinal study

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-217595 ◽

2020 ◽

Vol 79 (10) ◽

pp. 1320-1326

Author(s):

Steven Ho Man Lam ◽

Isaac T Cheng ◽

Edmund K Li ◽

Priscilla Wong ◽

Jolie Lee ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Carotid Plaque ◽

Cohort Analysis ◽

Intima Media Thickness ◽

Carotid Intima Media Thickness ◽

Risk Scores ◽

Cvd Risk ◽

Increased Risk ◽

Cox Proportional Hazard Models ◽

Cv Disease

ObjectiveTo examine whether Disease Activity in Psoriatic Arthritis (DAPSA) reflecting the inflammatory component of psoriatic arthritis (PsA) can predict cardiovascular (CV) events independent of traditional CV risk factors and subclinical carotid atherosclerosis.MethodsA cohort analysis was performed in patients with PsA who had been followed since 2006. The outcome of interest was first CV event. Four different CV disease (CVD) risk scores and DAPSA were computed at baseline. The presence of carotid plaque (CP) and carotid intima-media thickness (CIMT) was also determined in a subgroup of patients using high-resolution ultrasound. The association between DAPSA, CVD risk scores, CP, CIMT and the occurrence of CV events was assessed using Cox proportional hazard models.Results189 patients with PsA (mean age: 48.9 years; male: 104 (55.0%)) were recruited. After a median follow-up of 9.9 years, 27 (14.3%) patients developed a CV event. Higher DAPSA was significantly associated with an increased risk of developing CV events (HR: 1.04, 95% CI (1.01 to 1.08), p=0.009). The association remained significant after adjusting for all CV risk scores in the multivariable models. In the subgroup analysis, 154 patients underwent carotid ultrasound assessment and 23 (14.9%) of them experienced a CV event. CP was associated with increased risk of developing CV events after adjusting for three CV risk scores and DAPSA, with HR ranging from 2.35 to 3.42.ConclusionHigher DAPSA and the presence of CP could independently predict CVD events in addition to traditional CV risk scores in patients with PsA.

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Association Between Uric Acid, Carotid Intima‐Media Thickness, and Cardiovascular Events: Prospective Results From the IMPROVE Study

Journal of the American Heart Association ◽

10.1161/jaha.120.020419 ◽

2021 ◽

Author(s):

Massimo R. Mannarino ◽

Matteo Pirro ◽

Bruna Gigante ◽

Kai Savonen ◽

Sudhir Kurl ◽

...

Keyword(s):

Uric Acid ◽

Carotid Atherosclerosis ◽

Elevated Serum ◽

Intima Media Thickness ◽

Carotid Intima Media Thickness ◽

Cvd Risk ◽

Vascular Events ◽

Media Thickness ◽

Hazard Ratios ◽

Increased Risk

Background The association between elevated serum uric acid (SUA), cardiovascular disease (CVD) risk, and carotid atherosclerosis has long been explored, and contrasting results have been reported. Therefore, the role of SUA as an independent risk factor for vascular events (VEs) and carotid atherosclerosis deserves further attention. We investigated the relationship between SUA, incident VEs, carotid intima‐media thickness (cIMT), and cIMT progression in subjects at moderate‐to‐high CVD risk. Methods and Results In the IMPROVE (IMT‐Progression as Predictors of VEs) study, 3686 participants (median age 64 years; 48% men) with ≥ 3 vascular risk factors, free from VEs at baseline, were grouped according to SUA quartiles (division points: 244–284–328 µmol/L in women, 295–336–385 µmol/L in men). Carotid‐IMT and its 15‐month progression, along with incident VEs, were recorded. A U‐shaped association between SUA and VEs was observed in men, with 2.4‐fold ( P = 0.004) and 2.5‐fold ( P = 0.002) increased CVD risk in the first and fourth SUA quartiles as compared with the second. Adjusted hazard ratios (HRs) for cerebro‐VEs in men were the highest (first and fourth quartile versus second: HR, 5.3, P = 0.010 and HR, 4.4, P = 0.023, respectively). SUA level was independently associated with cIMT progression in men (β = 0.068, P = 0.014). No significant association between SUA levels, CVD end points, and cIMT progression were found in women. Conclusions Both low and high SUA levels are associated with an increased risk of VEs in men at moderate‐to‐high CVD risk but not in women. Only elevated SUA levels predict cIMT progression and at a lesser but not significant extent in women.

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THYROTOXICOSIS IN PREGNANCY

Fetal and Maternal Medicine Review ◽

10.1017/s0965539513000077 ◽

2013 ◽

Vol 24 (2) ◽

pp. 108-128 ◽

Cited By ~ 1

Author(s):

H V WRIGHT ◽

D J WILLIAMS

Keyword(s):

Hyperemesis Gravidarum ◽

Type I Diabetes ◽

Normal Pregnancy ◽

Conclusive Evidence ◽

Reproductive Age ◽

Physiological Adaptation ◽

Thyroid Peroxidase ◽

Type I ◽

Increased Risk ◽

In Pregnancy

Thyrotoxicosis affects approximately 1:500 women of reproductive age. Untreated or poorly controlled thyrotoxicosis in pregnancy is associated with significant maternal and perinatal morbidity. Recognition and diagnosis of new onset thyrotoxicosis in pregnancy can be challenging as many of the symptoms can be misattributed to physiological adaptation of normal pregnancy. Women with hyperemesis gravidarum (HG) often have biochemical, but not clinical evidence of thyrotoxicosis, which does not need treatment with anti-thyroid drugs (ATDs). For women with clinical thyrotoxicosis, uncertainty regarding the risks of teratogenicity due to ATDs has led to new guideline recommendations for their use in pregnancy. Women with autoimmune diseases such as type I diabetes and who have thyroid peroxidase antibodies (TPOAb) are at an increased risk of developing postpartum thyroiditis, which can result in permanent hypothyroidism. This review summarises the management of thyrotoxicosis in pregnancy and highlights controversial areas for which conclusive evidence is still lacking.

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