As researchers learn more about the association between pregnancy complications and CV risk, lifestyle modifications may prove key.
New data suggests that women with a history of adverse pregnancy outcomes (APO), such as gestational hypertension, gestational diabetes, and preeclampsia, can reduce their long-term risk of cardiovascular disease by maintaining optimal heart health. I understand.
Researchers measured cardiovascular health using data from the American Heart Association (AHA). necessities of life 8 (LE8) Score. It ranges from 0 to 100 based on diet, physical activity, smoking cessation, sleep, weight, cholesterol, blood sugar, and blood pressure. Researchers found that women with a history of APO who achieved or maintained good heart health (score 76 or higher) after pregnancy were as likely as women with good cardiovascular health who had never had APO. found that there is a risk of CVD in the future.
“We've known it for a long time [APOs] It has a negative effect on the birth outcome. . . But what we're finding is that women with these conditions appear to be more likely to develop cardiovascular disease later in life, up to decades later.” said Chen, MD (Boston Medical Center, Massachusetts). He told TCTMD that he presented the findings last week at the AHA's Epidemiology and Prevention | Lifestyle and Cardiometabolic Health Science Session 2024. “Until our study, I think it was largely unknown how much of this risk was potentially modifiable.”
Commenting on the study in TCTMD, Josephine Chou, MD, University of Colorado Hospital Aurora, said the findings have implications for both cardiologists and internists. “We are often uncomfortable asking about pregnancy-related complications. It's not what we're trained to do, but it's a low-hanging fruit for us to ask,” she said. Ta. “It opens the door to conversations with patients about starting cardiovascular risk assessment and prevention early.”
Lifestyle has a big impact
In this study, Qian et al. looked at 2,263 patients from the UK Biobank with a diagnosis of APO (defined as gestational hypertension, gestational diabetes, abruption placentae, small-for-gestational age, or preterm birth). , the following control groups were included: 107,260 multiparous women with no history of APO. None had a history of CVD at baseline.
Over an average of 13.5 years, APO Group reported 197 CVD incidents. The incidence of CVD events was indirectly associated with the LE8 score, with scores scored in the highest tertile (<76) significantly increasing the incidence of total CVD (HR 0.43; 95% CI 0.29-0.65), coronary The risk of heart disease (HR 0.31; 95%) was lower. CI 0.17-0.56) and atrial fibrillation (HR 0.46; 95% CI 0.23-0.91) compared with scores scored in the lowest tertile (< 67).
Additionally, researchers observed a significant interaction between APO history, LE8 score, and CVD development in the two models. The first adjusted for age and race/ethnicity, and the second further adjusted for alcohol use, education, employment status, Townsend Index of Deprivation, and family. History of CVD, age at menarche, and pregnancy.
Incident CVD risk by APO history and LE8 score: HR (95% CI)
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model 1 |
model 2 |
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History of APO |
0.95 (0.63-1.43) 1.76 (1.36-2.29) 2.69 (2.23-3.24) |
0.95 (0.63-1.43) 1.73 (1.33-2.24) |
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Score > 76 |
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Score 67-75 |
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Score < 67 |
2.48 (2.06-2.99) |
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No history of APO |
1.28 (1.21-1.35) 1.94 (1.84-2.04) |
1.25 (1.18-1.32) 1.81 (1.72-1.91) |
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Score 67-75 |
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Score < 67 |
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Finally, compared to women without APO history with a LE8 score >76, women with a history of APO and maintaining a high LE8 score had a similarly lower risk of developing CVD (HR 0.95; 95% CI 0.63-1.43). This was not the case for those with intermediate and low LE8 scores.
We need to assess the cardiovascular health status of this population in more detail. frank chen
When researchers looked closely at the various components of the LE8 score, Qian reported that there were some notable differences. “Women who had a negative pregnancy outcome were less likely to smoke and actually had better blood lipids on average,” he said. “But the main factor, and I think this may influence how we improve cardiovascular disease outcomes in these people in the clinical setting, is that their diet is worsening. They appeared to have much higher rates of suboptimal blood sugar levels, and on average, they weighed a little more.”
These factors are “levers that we can pull, ideally before a woman becomes pregnant, but certainly after she develops these adverse pregnancy outcomes,” Qian argued. “We want to target these specific risk factors more broadly.”
He called on all cardiologists to regularly ask patients about APO, even if the pregnancy occurred decades ago. Second, for people with a history of APO, “we need a more detailed assessment of cardiovascular health in this population” so that modifiable factors can be addressed, he said. said.
Qian said she would like to see future randomized studies examining the impact of lifestyle modifications on CVD in patients with a history of APO, as well as studies exploring the mechanisms associated with these symptoms. . “Inflammation and endothelial dysfunction seem to play a pretty important role here,” he says.
Chow said he would also like to see more data on how race and ethnicity play a role here. “Black women and Native American women have higher rates of pregnancy-related mortality and morbidity and are at increased risk for developing gestational hypertension and lifelong cardiovascular disease,” she said. “We want to see if modifying the lifestyle of these patients will reduce their risk to a greater extent as opposed to patients who are at lower risk from a racial or ethnic standpoint.”
