Search

Background: Angiographic evidence of the anatomy of coronary arteries and the type of coronary artery lesions in women with a history of hypertensive disorders of pregnancy (HDP) are poorly documented., Objectives: This study sought to determine the role of a history of HDP as a unique risk factor for early coronary artery disease (CAD) and type of acute coronary syndrome (ACS) (ie, atherosclerotic vs myocardial infarction with nonobstructive coronary arteries [MINOCA]) in women who underwent coronary angiography., Methods: This study used a population-based cohort of parous female patients with incident CAD who underwent coronary angiography and age-matched control subjects. The SYNTAX (Synergy between PCI [percutaneous coronary intervention] with TAXUS [Boston Scientific] and Cardiac Surgery) score was assessed to determine the complexity and degree of CAD; MINOCA was diagnosed in the presence of clinical acute myocardial infarction in the absence of obstructive coronary disease., Results: A total of 506 parous female Olmsted County, Minnesota (USA) residents had incident CAD and angiographic data from November 7, 2002 to December 31, 2016. Women with HDP were younger than normotensive women at the time of the event (median: 64.8 years vs 71.8 years; P = 0.030). There was a strong association between HDP and ACS (unadjusted P = 0.018). Women with HDP compared with women with normotensive pregnancies were more likely to have a higher SYNTAX score (OR: 2.28; 95% CI: 1.02-5.12; P = 0.046), and MINOCA (OR: 2.08; 95% CI: 1.02-4.25; P = 0.044)., Conclusions: A history of HDP is associated with CAD earlier in life and with a future risk for myocardial infarction with both obstructive and nonobstructive coronary arteries. This study underscores the need for timely detection and treatment of nonobstructive disease, in addition to traditional risk factors., Competing Interests: Funding Support and Author Disclosures This study used the resources of the Rochester Epidemiology Project (REP) medical records-linkage system, which is supported by the National Institute on Aging (grant AG 058738), by the Mayo Clinic Research Committee, and by fees paid annually by REP users. The content of this article is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health (NIH) or the Mayo Clinic. Dr Garovic has received support from NIH grant R01HL136348. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Chronic hypertension (CHT) is the main risk factor for cardiovascular diseases in women with a history of hypertensive disorders of pregnancy (HDP)., Objectives: This study sought to assess the effectiveness of peripartum screening in predicting CHT after HDP., Methods: In this longitudinal prospective study, women with HDP underwent peripartum transthoracic echocardiography and were evaluated for CHT (blood pressure ≥140/90 mm Hg or on antihypertensive medication) at least 3 months postpartum. Univariable and multivariable analyses assessed the association between clinical and transthoracic echocardiography data and a postpartum diagnosis of CHT., Results: At a median postpartum follow-up of 124 days (IQR: 103-145 days), 70 (33.2%) of 211 women remained hypertensive. Compared with normotensive women, women with CHT were older (35.5 ± 5.0 years vs 32.9 ± 5.6 years; P = 0.001), were more likely to be Afro-Caribbean (27.1% vs 7.8%; P < 0.0001), had higher body mass index (33.4 ± 5.9 kg/m 2 vs 31.2 ± 5.4 kg/m 2 ; P = 0.006), and had higher mean arterial pressure (106.5 ± 8.4 mm Hg vs 103.3 ± 7.0 mm Hg; P = 0.004). Moreover, they showed significantly higher left ventricular mass index (84.0 ± 17.9 g/m 2 vs 76.3 ± 14.8 g/m 2 ; P = 0.001), higher relative wall thickness (0.46 ± 0.10 vs 0.40 ± 0.10; P < 0.0001), and lower global longitudinal strain (-15.6% ± 2.7% vs -16.6% ± 2.2%; P = 0.006) than normotensive women. A prediction model combining clinical (maternal age and first trimester mean arterial pressure) and echocardiographic features (left ventricular mass index >75 g/m 2 , relative wall thickness >0.42, and E/e' ratio >7) showed excellent accuracy in identifying women with persistent hypertension after HDP (area under the curve: 0.85; 95% CI: 0.79-0.90)., Conclusions: This peripartum screening approach might be used to identify women at risk of CHT who would benefit from intensive blood pressure monitoring and pharmacological strategies from the early postpartum period to prevent cardiovascular disease., Competing Interests: Funding Support and Author Disclosures Dr Giorgione has received funding from the European Union's Horizon 2020 Research and Innovation Programme under the Marie Skłodowska-Curie grant agreement No 765274 (iPLACENTA project). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2022 American College of Cardiology Foundation. All rights reserved.)

Background: Hypertensive disorders of pregnancy (HDP) are associated with increased risk of cardiovascular disease (CVD) 20-30 years later; however, cardiovascular (CV) risk in the decade after HDP is less studied., Objectives: The purpose of this study was to evaluate differences in CV risk factors as well as subclinical CVD among a well-characterized group of racially diverse patients with and without a history of HDP 10 years earlier., Methods: This is a prospective study of patients with and without a diagnosis of HDP ≥10 years earlier (2005-2007) who underwent in-person visits with echocardiography, arterial tonometry, and flow-mediated dilation of the brachial artery., Results: A total of 135 patients completed assessments (84 with and 51 without a history of HDP); 85% self-identified as Black. Patients with a history of HDP had a 2.4-fold increased risk of new hypertension compared with those without HDP (56.0% vs. 23.5%; adjusted relative risk: 2.4; 95% CI: 1.39-4.14) with no differences in measures of left ventricular structure, global longitudinal strain, diastolic function, arterial stiffness, or endothelial function. Patients who developed hypertension, regardless of HDP history, had greater left ventricular remodeling, including greater relative wall thickness; worse diastolic function, including lower septal and lateral e' and E/A ratio; more abnormal longitudinal strain; and higher effective arterial elastance than patients without hypertension., Conclusions: We found a 2.4-fold increased risk of hypertension 10 years after HDP. Differences in noninvasive measures of CV risk were driven mostly by the hypertension diagnosis, regardless of HDP history, suggesting that the known long-term risk of CVD after HDP may primarily be a consequence of hypertension development., Competing Interests: Funding Support and Author Disclosures This research was supported by the National Heart, Lung, and Blood Institute 1R56HL136730 (to Dr Levine), National Institutes of Health UL1TR001878 (to Drs Levine and Ky), The American Association of Obstetricians and Gynecologists Foundation (AAOGF) Bridge Funding Award (to Dr Levine), and K23 HL153667 (to Dr Levine). Dr Chirinos is supported by National Institutes of Health grants R01-HL 121510, U01-TR003734, 3U01TR003734-01W1, U01-HL160277, R33-HL-146390, R01-HL153646, K24-AG070459, R01-AG058969, R01-HL104106, P01-HL094307, R03-HL146874, R56-HL136730, R01 HL155599, R01 HL157264, R01HL155, and 1R01HL153646-01; has recently consulted for Bayer, Sanifit, Fukuda-Denshi, Bristol Myers Squibb, Johnson and Johnson, Edwards Lifesciences, Merck, NGM Biopharmaceuticals, and the Galway-Mayo Institute of Technology; has received University of Pennsylvania research grants from National Institutes of Health, Fukuda-Denshi, Bristol Myers Squibb, Microsoft, and Abbott; is named as inventor in a University of Pennsylvania patent for the use of inorganic nitrates/nitrites for the treatment of heart failure and preserved ejection fraction and for the use of biomarkers in heart failure with preserved ejection fraction; has received payments for editorial roles from the American Heart Association, the American College of Cardiology, and Wiley; and has received research device loans from Actor Medical, Fukuda-Denshi, Uscom, Unex, NDD Medical Technologies, Microsoft, and MicroVision Medical. Dr Elovitz has served as a consultant for Mirvie; and has received support from research grants from the National Institutes of Health. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Hypertensive disorders of pregnancy (HDP), including gestational hypertension and preeclampsia, are associated with an increased risk of CVD., Objectives: The purpose of this study was to evaluate associations between HDP and long-term CVD and identify the proportion of the association mediated by established CVD risk factors., Methods: Parous participants without CVD in the Nurses' Health Study II (n = 60,379) were followed for incident CVD from first birth through 2017. Cox proportional hazards models estimated HRs and 95% CIs for the relationship between HDP and CVD, adjusting for potential confounders, including prepregnancy body mass index, smoking, and parental history of CVD. To evaluate the proportion of the association jointly accounted for by chronic hypertension, hypercholesterolemia, type 2 diabetes, and changes in body mass index, we used the difference method., Results: Women with HDP in first pregnancy had a 63% higher rate of CVD (95% CI: 1.37-1.94) compared with women with normotensive pregnancies. This association was mediated by established CVD risk factors (proportion mediated = 64%). The increased rate of CVD was higher for preeclampsia (HR: 1.72; 95% CI: 1.42-2.10) than gestational hypertension (HR: 1.41; 95% CI: 1.03-1.93). Established CVD risk factors accounted for 57% of the increased rate of CVD for preeclampsia but 84% for gestational hypertension (both P < 0.0001)., Conclusions: Established CVD risk factors arising after pregnancy explained most (84%) of the increased risk of CVD conferred by gestational hypertension and 57% of the risk among women with preeclampsia. Screening for chronic hypertension, hypercholesterolemia, type 2 diabetes, and overweight/obesity after pregnancy may be especially helpful in CVD prevention among women with a history of HDP., Competing Interests: Funding Support and Author Disclosures This research was funded by the following grants from the National Institutes of Health: U01 CA176726, R01 HL088521, R01 HL34594, and U01 HL145386. This work was supported by awards from the American Heart Association (12PRE9110014, 13GRNT17070022). Dr Stuart was supported by Training Grant T32HL098048 from the National Heart, Lung, and Blood Institute and by Training Grant T32HD060454 from the National Institute of Child Health and Human Development. Dr Tanz was supported by F31HL131222 from the National Heart, Lung, and Blood Institute under the Ruth L. Kirschstein National Research Service Award. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Hypertensive disorders of pregnancy (HDPs) are leading causes of maternal and perinatal morbidity and mortality. However, it is uncertain whether HDPs are associated with long-term risk of premature mortality (before age 70 years)., Objectives: The objective of this study was to evaluate whether HDPs were associated with premature mortality., Methods: Between 1989 and 2017, the authors followed 88,395 parous female nurses participating in the Nurses' Health Study II. The study focused on gestational hypertension and pre-eclampsia within the term HDPs. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between HDPs and premature mortality were estimated by using Cox proportional hazards models, with adjustment for relevant confounders., Results: The authors documented that 2,387 women died before age 70 years, including 1,141 cancer deaths and 212 CVD deaths. The occurrence of HDPs, either gestational hypertension or pre-eclampsia, was associated with an HR of 1.31 (95% CI: 1.18 to 1.46) for premature death during follow-up. When specific causes of death were examined, these relations were strongest for CVD-related mortality (HR: 2.26; 95% CI: 1.67 to 3.07). The association between HDPs and all-cause premature death persisted, regardless of the subsequent development of chronic hypertension (HR: 1.20 [95% CI: 1.02 to 1.40] for HDPs only and HR: 2.02 [95% CI: 1.75 to 2.33] for both HDPs and subsequent chronic hypertension)., Conclusions: An occurrence of HDPs, either gestational hypertension or pre-eclampsia, was associated with an increased risk of premature mortality, particularly CVD mortality, even in the absence of chronic hypertension., Competing Interests: Funding Support and Author Disclosures This study was supported by grants U01-HL145386, U01-CA176726, R01-HL034594, and R01-HL088521 from the National Institutes of Health. The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Hypertensive disorders of pregnancy (HDP) are associated with short-term cardiac structure and function abnormalities, but later life changes are not well studied., Objectives: This study aimed to determine if HDP history is associated with echocardiographic differences 8 to 10 years after delivery, and if subgroups with placental maternal vascular malperfusion (MVM) lesions or current hypertension may be particularly affected., Methods: Women with pregnancies delivered from 2008 to 2009 were selected from a clinical cohort with abstracted pregnancy and placental pathology data to undergo transthoracic echocardiography (2017 to 2020). Medical history, blood pressure, and weight were measured at the study visit., Results: The authors enrolled 132 women (10 ± 1 years post-delivery, age 38 ± 6 years): 102 with normotensive pregnancies and 30 with HDP: pre-eclampsia (n = 21) or gestational hypertension (n = 9). Compared with women with normotensive pregnancies, those with HDP history were more likely to have current hypertension (63% vs. 26%; p < 0.001). After adjusting for age, race, MVM lesions, body mass index, current hypertension, and hemoglobin A1c, women with HDP history had higher interventricular septal thickness (β = 0.08; p = 0.04) and relative wall thickness (β = 0.04; p = 0.04). In subgroup analyses, those with both HDP history and current hypertension had a higher proportion of left ventricular remodeling (79.0%) compared with all other groups (only HDP [36.4%; p = 0.01], only current hypertension [46.2%; p = 0.02], and neither HDP nor hypertension [38.2%; p < 0.001]), and lower mitral inflow E/A and annular e'. Accounting for placental MVM lesions did not impact results., Conclusions: Women with both HDP history and current hypertension have pronounced differences in left ventricular structure and function a decade after pregnancy, warranting continued surveillance and targeted therapies for cardiovascular disease prevention., Competing Interests: FUNDING SUPPORT AND Author Disclosures This study was funded by an AHA Go Red for Women Grant (16SFRN28930000) and a University of Pittsburgh Medical Center Heart and Vascular Institute Fellow Research Grant. Dr. Countouris was funded by the National Institutes of Health (NHLBI T32 Training Grant HL129964). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)