Preeclampsia (PE) is a
hypertensive pregnancy disorder complicating 1-5% of all pregnancies, and is a
major cause of maternal and fetal morbidity and mortality.
In-fact it is known as the modulator of the offspring
health, as many studies have associated it with increased incidence of
metabolic syndrome later in the life of the offspring.
A substantial number of epidemiological studies in recent
year have also documented it to be a risk factor for increased cardiovascular
and renal diseases for mother later in life.
Women who have history of preeclampsia have a 2 fold
increase in CVD and 5-12 fold in end stage renal diseases(ESRD).
A recent study by White WM
et al in the forthcoming American journal of obstetrics & gynecology concluded
that a history of preeclampsia is associated with an increased risk of coronary
artery calcification more than 30 years after affected pregnancies, even after
controlling individually for traditional risk factors.
This paper was also presented recently at the Society for Maternal and fetal Medicine (SMFM)
36th Annual pregnancy meeting at Atlanta Georgia
in February, 2016.
This study by White WM et
al is important because it is the first prospective cohort study with
confirmation of preeclampsia by medical record review.
They recruited 40 women with history of preeclampsia and 40
women without such history were recruited from a large cohort of population in Olmsted County, MN
and who delivered between 1976 and 1982.
They were matched for parity and age at the time of index
birth. Cat scan was performed to measure the coronary artery calcification in
Agatston Units. The mean age at imaging was 59.5 (± 4.6) years.
It was seen that the frequencies of being diagnosed with
hypertension (60% v. 20%, p < 0.001) and higher BMI (29.8 vs. 25.3) were
both greater in women with H/O preeclampsia.
The frequency of a CAC score > 50 Agatston units was also
greater in the preeclampsia group (23% v. 0%, p=0.001). Compared to women
without preeclampsia, the odds of having a higher coronary artery calcification
score was 3.54 (1.39 - 9.02) times greater in women with prior preeclampsia
without adjustment, and 2.61 (0.95 - 7.14) times greater after adjustment for
current hypertension.
The presence of coronary artery calcifications may be able
to identify those at a particularly high cardiovascular risk, since CAC is a strong predictor of CHD.
According to a recent Multi-Ethnic Study of Atherosclerosis
(MESA) by Joshi PM et al in the Journal Atherosclerosis showed that a high burden of
coronary artery calcium (CAC) is a strong predictor of coronary heart disease
(CHD) among persons at low risk.
Recognition of PE as a risk factor for CVD allows
identification of a young population of women at high risk of developing of cardiovascular disease.
Current guidelines recommend cardiovascular
screening and treatment for formerly preeclamptic women. However, these
recommendations are based on low levels of evidence due to a lack of studies on
screening and prevention in formerly preeclamptic women.
The American Heart association guidelines have listed
preeclampsia as an independent risk factor for CHD, as strong as a failed stress
test— but larger studies are still needed to understand the
underlying mechanism.
The current study strongly advocates the need for research
on mechanisms of late disease manifestations, and
on effective screening and therapeutic strategies aimed at reducing the late disease burden in formerly preeclamptic women. Identification
of women with CAC score > 50 carries significant potential therapeutic
implications.
References:
http://www.ncbi.nlm.nih.gov/pubmed/26792940
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