Preeclampsia Emerging as a Novel Risk Factor for Cardiovascular Disease in the Offspring

Introduction: Preeclampsia is a pregnancy specific disorder which affects 2%-8% of all gestations and is associated with high maternal, fetal and neonatal morbidity and mortality worldwide. There is no “cure” for the disease except for early delivery of the fetus and placenta, however leaving preeclampsia a long term health risk both for mothers and infants. Aim: The aim of the study is to review currently available information linking preclampsia to longterm cardiovascular complications in infants and children. Results: Currently, there is evidence of predisposition to cardiovascular disease, and a higher incidence of cardiovascular risk factors among children born to preeclamptic mothers. Both in experimental models and human epidemiological studies it is now clear that the infants of pregnancies complicated by preeclampsia have an increased risk of developing high blood pressure and double the risk of stroke in later life. Preeclampsia is consistently associated with higher blood pressure and body mass index as early as 4–10 years of age. Also there is some evidence of higher cardiovascular risk in adults exposed to maternal hypertensive disorders of pregnancy. It seems that preeclampsia has an impact on the cardiovascular system independent of preterm birth and is associated with endothelial dysfunction, increased carotid intima media thickness and reductions in cardiac function that cannot be accounted for by prematurity alone. Conclusion: Taking into consideration the currently available evidence, it can now be suggested that preeclampsia is linked to adverse effects on the cardiometabolic health of the infant. Understanding the relationship between preeclampsia and cardiovascular disease will allow for implementation of early interventions to prevent or delay the onset of adverse events in this high risk population.

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Sex Differences in the Developmental Origins of Cardiovascular Disease

Physiology ◽

10.1152/physiol.00045.2013 ◽

2014 ◽

Vol 29 (2) ◽

pp. 122-132 ◽

Cited By ~ 31

Author(s):

Suttira Intapad ◽

Norma B. Ojeda ◽

John Henry Dasinger ◽

Barbara T. Alexander

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Sex Differences ◽

Cardiovascular Risk ◽

Early Life ◽

Experimental Models ◽

Developmental Origins ◽

Proof Of Concept ◽

Increased Risk ◽

Health And Disease

The Developmental Origins of Health and Disease (DOHaD) proposes that adverse events during early life program an increased risk for cardiovascular disease. Experimental models provide proof of concept but also indicate that insults during early life program sex differences in adult blood pressure and cardiovascular risk. This review will highlight the potential mechanisms that contribute to the etiology of sex differences in the developmental programming of cardiovascular disease.

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Influence of methyltestosterone postmenopausal therapy on plasma lipids, inflammatory factors, glucose metabolism and visceral fat: a randomized study

Acta Endocrinologica ◽

10.1530/eje.1.02065 ◽

2006 ◽

Vol 154 (1) ◽

pp. 131-139 ◽

Cited By ~ 18

Author(s):

Lenora M Camarate S M Leão ◽

Mônica Peres C Duarte ◽

Dalva Margareth B Silva ◽

Paulo Roberto V Bahia ◽

Cláudia Medina Coeli ◽

...

Keyword(s):

Risk Factors ◽

Insulin Resistance ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Postmenopausal Women ◽

Fat Mass ◽

Visceral Fat ◽

Increased Risk

Background: There has been a growing interest in treating postmenopausal women with androgens. However, hyperandrogenemia in females has been associated with increased risk of cardiovascular disease. Objective: We aimed to assess the effects of androgen replacement on cardiovascular risk factors. Design: Thirty-seven postmenopausal women aged 42–62 years that had undergone hysterectomy were prospectively enrolled in a double-blind protocol to receive, for 12 months, percutaneous estradiol (E2) (1 mg/day) combined with either methyltestosterone (MT) (1.25 mg/day) or placebo. Methods: Along with treatment, we evaluated serum E2, testosterone, sex hormone-binding globulin (SHBG), free androgen index, lipids, fibrinogen, and C-reactive protein; glucose tolerance; insulin resistance; blood pressure; body-mass index; and visceral and subcutaneous abdominal fat mass as assessed by computed tomography. Results: A significant reduction in SHBG (P < 0.001) and increase in free testosterone index (P < 0.05; Repeated measures analysis of variance) were seen in the MT group. Total cholesterol, triglycerides, fibrinogen, and systolic and diastolic blood pressure were significantly lowered to a similar extent by both regimens, but high-density lipoprotein cholesterol decreased only in the androgen group. MT-treated women showed a modest rise in body weight and gained visceral fat mass relative to the other group (P < 0.05), but there were no significant detrimental effects on fasting insulin levels and insulin resistance. Conclusion: This study suggests that the combination of low-dose oral MT and percutaneous E2, for 1 year, does not result in expressive increase of cardiovascular risk factors. This regimen can be recommended for symptomatic postmenopausal women, although it seems prudent to perform baseline and follow-up lipid profile and assessment of body composition, especially in those at high risk of cardiovascular disease.

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Abstract 631: Evaluation of Risk Factors for Cardiovascular Disease in Rheumatoid Arthritis

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.35.suppl_1.631 ◽

2015 ◽

Vol 35 (suppl_1) ◽

Author(s):

Vitor M Rocha ◽

Maria Guadalupe B Pippa

Keyword(s):

Rheumatoid Arthritis ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Total Cholesterol ◽

Normal Population ◽

Control Group ◽

American College Of Rheumatology ◽

Increased Risk ◽

Systemic Inflammatory Disease

Backgroung: Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease, that appear to be responsible for 50% of mortality for thrombotic events such as Myocardial Infarction (MI) and Ischemic Stroke (SI) in RA patients. Occur approximately a decade earlier in these patients compared with the normal population. Objectives: To determine the risk of developing cardiovascular disease in patients with Rheumatoid Arthritis according to the classification criteria of the American College of Rheumatology. Methods: To assess the risk of cardiovascular diseases we studied 78 patients diagnosed with Rheumatoid Arthritis. For this we used the criteria of the risk score of Acute Coronary Disease in 10 years according to the Framingham Heart Study. A control group consisted of 21 patients with osteoarthritis and fibromyalgia was also assessed using the same criteria, where age, sex, systolic blood pressure values, total cholesterol, cholesterol HDL, presence of smoking and diagnosis of diabetes, were scored. Results: Patients with rheumatoid arthritis had a mean disease duration of 12.8 years (SD=7.4), age 58.6 years (SD=10.3) and the control group 59.3 years (SD=10,0). The old values of total cholesterol, HDL, blood pressure and being with Diabetes Mellitus showed positive correlations with the Cardiovascular Risk, and Blood Pressure in the index this correlation was stronger (r=+0.593) in Rheumatoid Arthritis and age (r=+0.702) in the control group. The Global Cardiovascular Risk in each group were considered low (7,8 points to Rematoid Artrhrits and 9,3 points to the control group). Conclusion: The results showed no increased risk of cardiovascular disease when compared to control group. Remember that control group fact be constituted by a larger number of diabetics, which likely impact these results.

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Future risk of cardiovascular disease risk factors and events in women after a hypertensive disorder of pregnancy

Heart ◽

10.1136/heartjnl-2018-313453 ◽

2019 ◽

Vol 105 (16) ◽

pp. 1273-1278 ◽

Cited By ~ 19

Author(s):

Laura Benschop ◽

Johannes J Duvekot ◽

Jeanine E Roeters van Lennep

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Risk Assessment ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Hypertensive Disorder ◽

Cardiovascular Risk Assessment ◽

Increased Risk

Hypertensive disorders of pregnancy (HDP), such as gestational hypertension and pre-eclampsia, affect up to 10% of all pregnancies. These women have on average a twofold higher risk to develop cardiovascular disease (CVD) later in life as compared with women with normotensive pregnancies. This increased risk might result from an underlying predisposition to CVD, HDP itself or a combination of both. After pregnancy women with HDP show an increased risk of classical cardiovascular risk factors including chronic hypertension, renal dysfunction, dyslipidemia, diabetes and subclinical atherosclerosis. The prevalence and onset of cardiovascular risk factors depends on the severity of the HDP and the coexistence of other pregnancy complications. At present, guidelines addressing postpartum cardiovascular risk assessment for women with HDP show a wide variation in their recommendations. This makes cardiovascular follow-up of women with a previous HDP confusing and non-coherent. Some guidelines advise to initiate cardiovascular follow-up (blood pressure, weight and lifestyle assessment) 6–8 weeks after pregnancy, whereas others recommend to start 6–12 months after pregnancy. Concurrent blood pressure monitoring, lipid and glucose assessment is recommended to be repeated annually to every 5 years until the age of 50 years when women will qualify for cardiovascular risk assessment according to all international cardiovascular prevention guidelines.

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Cardiovascular risk factor documentation and management in primary care electronic medical records among people with schizophrenia in Ontario, Canada: retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2020-038013 ◽

2020 ◽

Vol 10 (10) ◽

pp. e038013

Author(s):

Braden O’Neill ◽

Sumeet Kalia ◽

Babak Aliarzadeh ◽

Frank Sullivan ◽

Rahim Moineddin ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Primary Care ◽

Cohort Study ◽

Cardiovascular Risk ◽

Electronic Medical Records ◽

Medical Records ◽

Retrospective Cohort ◽

Increased Risk

ObjectivesIn order to address the substantial increased risk of cardiovascular disease among people with schizophrenia, it is necessary to identify the factors responsible for some of that increased risk. We analysed the extent to which these risk factors were documented in primary care electronic medical records (EMR), and compared their documentation by patient and provider characteristics.DesignRetrospective cohort study.SettingEMR database of the University of Toronto Practice-Based Research Network Data Safe Haven.Participants197 129 adults between 40 and 75 years of age; 4882 with schizophrenia and 192 427 without.Primary and secondary outcome measuresDocumentation of cardiovascular disease risk factors (age, sex, smoking history, presence of diabetes, blood pressure, whether a patient is currently on medication to reduce blood pressure, total cholesterol and high-density lipoprotein cholesterol).ResultsDocumentation of cardiovascular risk factors was more complete among people with schizophrenia (74.5% of whom had blood pressure documented at least once in the last 2 years vs 67.3% of those without, p>0.0001). Smoking status was not documented in 19.8% of those with schizophrenia and 20.8% of those without (p=0.0843). Factors associated with improved documentation included older patients (OR for ages 70–75 vs 45–49=3.51, 95% CI 3.26 to 3.78), male patients (OR=1.39, 95% CI 1.33 to 1.45), patients cared for by a female provider (OR=1.52, 95% CI 1.12 to 2.07) and increased number of encounters (OR for ≥10 visits vs 3–5 visits=1.53, 95% CI 1.46 to 1.60).ConclusionsDocumentation of cardiovascular risk factors was better among people with schizophrenia than without, although overall documentation was inadequate. Efforts to improve documentation of risk factors are warranted in order to facilitate improved management.

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Comparison of the Effect of Aerobic and Resistance Training on Cardiovascular Risk Factors in Parkinson's Women

The Open Nursing Journal ◽

10.2174/1874434601913010186 ◽

2019 ◽

Vol 13 (1) ◽

pp. 186-192

Author(s):

Hamideh Yaghoobi ◽

Sahar Mohammadi ◽

Samaneh Sardashti ◽

Seddigheh Abbaspour ◽

Tahere Sarboozi Hossein-Abadi

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Heart Rate ◽

Oxygen Consumption ◽

Cardiovascular Risk ◽

Resistance Training ◽

Cardiovascular Risk Factors ◽

Maximum Oxygen Consumption ◽

Increased Risk

Background: People with low-mobility are at increased risk for cardiovascular disease. Patients with Parkinson's Disease (PD) are less interested in participating in exercise activities due to the nature of the disease. Regular exercise and physical activity can play protective roles against heart disease by reducing risk factors. This study aimed to compare the effects of aerobic and resistance training on cardiovascular risk factors in women with PD. Materials and Methods: This quasi-experimental study was carried out on 45 women with PD who were randomly assigned to one of three groups: aerobic, resistance groups, and control group. Before and after training sessions, variables of weight, Body Mass Index (BMI), heart rate at rest state, maximum oxygen consumption, blood pressure, and lipid profiles of participants were measured. Data were analyzed using SPSS software version 21 and Paired Sample t-test, ANOVA and Bonferroni post-hoc test. A significant level of P≤0.05 was considered. Results: Demographics of physiological characteristics of subjects was congruent in all three groups in the baseline. After aerobic and resistance training, levels of triglyceride, LDL, total cholesterol, fat percentage, resting heart rate, weight, BMI and systolic blood pressure were significantly decreased (p<0.05). This change was more pronounced in the aerobic group; in contrast, variables of maximum oxygen consumption and HDL were meaningfully increased in participants of both experimental groups (p<0.05). Conclusion: The results showed that both types of aerobic and resistance training can reduce the risk factors of cardiovascular disease in women with PD, while the effect of aerobic training on reducing risk factors was more than resistance training.

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The role of cardiovascular risk factors in maternal cardiovascular disease according to offspring birth characteristics in the HUNT study

Scientific Reports ◽

10.1038/s41598-021-99478-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Eirin B. Haug ◽

Amanda R. Markovitz ◽

Abigail Fraser ◽

Håvard Dalen ◽

Pål R. Romundstad ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Preterm Birth ◽

Cardiovascular Risk Factors ◽

Hazard Ratios ◽

Increased Risk ◽

Birth Characteristics ◽

History Of

AbstractA history of preterm or small (SGA) or large (LGA) for gestational age offspring is associated with smoking and unfavorable levels of BMI, blood pressure, glucose and lipids. Whether and to what extent the excess cardiovascular risk observed in women with these pregnancy complications is explained by conventional cardiovascular risk factors (CVRFs) is not known. We examined the association between a history of SGA, LGA or preterm birth and cardiovascular disease among 23,284 parous women and quantified the contribution of individual CVRFs to the excess cardiovascular risk using an inverse odds weighting approach. The hazard ratios (HR) between SGA and LGA offspring and CVD were 1.30 (95% confidence interval (CI) 1.15, 1.48) and 0.89 (95% CI 0.76, 1.03), respectively. Smoking explained 49% and blood pressure may have explained ≈12% of the excess cardiovascular risk in women with SGA offspring. Women with preterm birth had a 24% increased risk of CVD (HR 1.24, 95% CI 1.06, 1.45), but we found no evidence for CVRFs explaining any of this excess cardiovascular risk. While smoking explains a substantial proportion of excess cardiovascular risk in women with SGA offspring and blood pressure may explain a small proportion in these women, we found no evidence that conventional CVRFs explain any of the excess cardiovascular risk in women with preterm birth.

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About the Problem of Arterial Hypertension as a Risk Factor in the COVID-19 Pandemic Conditions and its Treatment (Literature Review)

Lviv clinical bulletin ◽

10.25040/lkv2021.01-02.031 ◽

2021 ◽

Vol 1-2 (33-34) ◽

pp. 31-36

Author(s):

І. Dunaieva ◽

◽

N. Kravchun ◽

Keyword(s):

Diabetes Mellitus ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Arterial Hypertension ◽

Antihypertensive Therapy ◽

Adverse Outcomes ◽

Medical Rehabilitation ◽

Sources Of Information ◽

Increased Risk

Context. In a pandemic caused by a coronavirus infection, a special risk group are the patients with cardiovascular disease, hypertension and diabetes mellitus in particular, which are the most common risk groups among the general population. The spread of coronavirus disease is particularly dangerous in terms of decompensation of chronic complications, specific damage to the cardiovascular system, especially in cases of severe infection and high risk of adverse outcomes in the above cohort of patients. The combination of coronavirus disease and cardiovascular disease poses additional difficulties in diagnosing, identifying, and prescribing appropriate therapy, including antihypertensive therapy. Therefore, it is important to address the possible risks and complications in people with hypertension and diabetes mellitus in the conditions of coronavirus disease COVID-19 and the features of the antihypertensive therapy prescription. Objective. To investigate the peculiarities of treatment of patients with arterial hypertension in the context of the COVID-19 pandemic, to analyze possible risks and complications based on the results of studying the literature. Materials and methods. Content analysis, methods of systemic and comparative results, as well as bibliosemantic evaluation of current research in the literature on the prescription of antihypertensive therapy in patients with hypertension and diabetes in the conditions of coronavirus COVID-19 were used. Sources of information were searched in scientometric medical databases, namely PubMedNCBI, Medline, Web of Science and Google Scholar, etc. by keywords: diabetes, hypertension, antihypertensive therapy, COVID-19, complications, cardiovascular risk. 174 scientific works in English, Ukrainian and Russian were analyzed and sources were selected, which contain questions about the risks of patients with hypertension and diabetes in the conditions of coronavirus disease, including those related to the appointment of antihypertensive therapy. Results. RAAS inhibitors, which provide better blood pressure control, may partially help to maintain the immune system imbalance in hypertension. In patients with hypertension during a viral infection, blood pressure levels and cardiovascular risk should be monitored. Conclusions. Constant monitoring of hemodynamic parameters, ECG and ECHO-CG – should be under the control according to the indications. The association of RAAS blockers (ACE inhibitors and ARBs) with an increased risk of infection in patients and worsening of COVID-19 has not been established so far, so patients with CVD should continue to take them. Patients who have survived coronavirus disease should be included in the medical rehabilitation programs for faster and better recovery of various systems, primarily respiratory and cardiovascular, as well as to improve quality of life and reduce the risk of disability.

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Prediction of Cardiovascular Events by Type I Central Systolic Blood Pressure

Hypertension ◽

10.1161/hypertensionaha.120.16163 ◽

2020 ◽

Author(s):

Florence Lamarche ◽

Mohsen Agharazii ◽

François Madore ◽

Rémi Goupil

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Cardiovascular Events ◽

Administrative Databases ◽

Youden Index ◽

Major Adverse Cardiovascular Events ◽

Type I ◽

Increased Risk

Compared with brachial blood pressure (BP), central systolic BP (SBP) can provide a better indication of the hemodynamic strain inflicted on target organs, but it is unclear whether this translates into improved cardiovascular risk stratification. We aimed to assess which of central or brachial BP best predicts cardiovascular risk and to identify the central SBP threshold associated with increased risk of future cardiovascular events. This study included 13 461 participants of CARTaGENE with available central BP and follow-up data from administrative databases but without cardiovascular disease or antihypertensive medication. Central BP was estimated by radial artery tonometry, calibrated for brachial SBP and diastolic BP (type I), and a generalized transfer function (SphygmoCor). The outcome was major adverse cardiovascular events. Cox proportional-hazards models, differences in areas under the curves, net reclassification indices, and integrated discrimination indices were calculated. Youden index was used to identify SBP thresholds. Over a median follow-up of 8.75 years, 1327 major adverse cardiovascular events occurred. The differences in areas under the curves, net reclassification indices, and integrated discrimination indices were of 0.2% ([95% CI, 0.1–0.3] P <0.01), 0.11 ([95% CI, 0.03–0.20] P =0.01), and 0.0004 ([95% CI, −0.0001 to 0.0014] P =0.3), all likely not clinically significant. Central and brachial SBPs of 112 mm Hg (95% CI, 111.2–114.1) and 121 mm Hg (95% CI, 120.2–121.9) were identified as optimal BP thresholds. In conclusion, central BP measured with a type I device is statistically but likely not clinically superior to brachial BP in a general population without prior cardiovascular disease. Based on the risk of major adverse cardiovascular events, the optimal type I central SBP appears to be 112 mm Hg.

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P2249Does self-reported pregnancy loss identify women at risk of an adverse cardiovascular phenotype in later life? Insights from UK biobank

European Heart Journal ◽

10.1093/eurheartj/ehz748.0727 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

E Elmahi ◽

M M Sanghvi ◽

A Jones ◽

C Y L Aye ◽

A J Lewandowski ◽

...

Keyword(s):

Cardiovascular Risk ◽

Pregnancy Loss ◽

Myocardial Strain ◽

Intima Media Thickness ◽

Later Life ◽

Self Report ◽

Uk Biobank ◽

Cross Sectional ◽

Pregnancy History ◽

Increased Risk

Abstract Introduction Cardiovascular disease (CVD) is more common in women who have had pregnancy complications such as spontaneous pregnancy loss. We used cross-sectional data from the UK Biobank Imaging Enhancement Study to determine whether pregnancy loss is associated with cardiac or vascular remodelling in later life, which might contribute to this increased risk. Methods Pregnancy history was reported by women participating in UK Biobank between 2006 and 2010 at age 40–69 years using a self-completed touch-screen questionnaire. Self-reported pregnancy loss was related to cardiovascular measures collected in those women who had participated in the Imaging Enhancement Study up to the end of 2015. Cardiac structure and function were assessed by magnetic resonance (CMR) steady-state free precession imaging at 1.5 Tesla. Three long axes cines (horizontal, vertical and LV outflow tract) and a complete short axis stack were acquired, covering both ventricles. Tagging was used to measure myocardial strain in basal, midventricular and apical short axes views. Carotid intima-media thickness (CIMT) measurements were taken for both common carotid arteries using a CardioHealth Station. Statistical associations with CMR and carotid measures were adjusted for age, BMI and other cardiovascular risk factors. Results Data were available on 2660 women of whom 113 were excluded because of pre-existing CVD and 8 had no pregnancy information available. Of the remaining 2539, 466 were nulligravid and 2073 had a history of pregnancies, of whom 622 reported at least one pregnancy loss (92% miscarriages and 8% stillbirths) and 1451 reported no pregnancy loss. No significant differences in cardiac or carotid parameters were evident in women who reported pregnancy loss compared to other groups (Table 1). CMR cardiac geometry & CIMT measurements Variable Pregnancy History Adjusted Means ± SE Effect Size (%) 95% CI P LVEDV (ml) Pregnancy Loss 122.2±1.0 0 – – No Pregnancy 124.1±1.4 1.58 (−0.83, 4.05) 0.20 Pregnancy (no loss) 122.2±0.8 0.2 (−1.42, 1.48) 0.97 LVESV (ml) Pregnancy Loss 47.8±0.6 0 – – No Pregnancy 48.0±0.8 0.45 (−3.19, 4.22) 0.81 Pregnancy (no loss) 47.3±0.5 −1.01 (−3.19, 1.22) 0.37 VEF (%) Pregnancy Loss 60.6±0.3 0 – – No Pregnancy 61.0±0.4 0.42 (−0.50, 1.35) 0.37 Pregnancy (no loss) 61.0±0.2 0.43 (−0.14, 0.99) 0.14 LVM (g) Pregnancy Loss 70.6±0.6 0 – – No Pregnancy 70.5±0.8 −0.15 (−2.68, 2.44) 0.91 Pregnancy (no loss) 70.4±0.5 −0.26 (−1.81, 1.30) 0.74 CIMT (μm) Pregnancy Loss 633.3±6.5 0 – – No Pregnancy 619.3±8.4 −2.22 (−5.04, 0.68) 0.13 Pregnancy (no loss) 627.1±4.9 −0.99 (−2.75, 0.81) 0.28 Conclusion Women who self-report pregnancy loss do not have significant differences in cardiac or carotid structure in later life to explain past epidemiological findings of increased cardiovascular risk in this population. This may be because this risk operates through other disease mechanisms or that self-report is not a sufficiently reliable way to identify pregnancy loss, and thereby allocate women into risk groups.

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