Physician-authored summaries and commentary on the most important medical research, provided by the NEJM Group, a division of the Massachusetts Medical Society.
© Massachusetts Medical SocietyApril 2023
Among APOs, pre-eclampsia and gestational hypertension were associated with the highest prevalence of CAD later in life.
Women with a history of adverse pregnancy outcomes (APOs) have increased risk for cardiovascular events. To evaluate the association between history of APO (pre-eclampsia, gestational hypertension, preterm delivery, small-for-gestational-age infant or gestational diabetes) and coronary artery disease (CAD) detected by coronary computed tomography angiography (CTA) screening, investigators studied a population-based cohort of 10,528 women aged 50 to 65 years in Sweden who had given birth an average of 30 years earlier.
Among these women, 18.9% had a history of an APO. The most common APO was pre-term delivery (9.5%), and the least common was gestational diabetes (1.4%). The prevalence of any coronary atherosclerosis was significantly higher in women with versus without an APO (32% vs 28%). Women with pre-eclampsia and gestational hypertension had the highest prevalences of CAD. Preterm delivery and gestational diabetes were not significantly associated with any CAD outcomes in a multivariate model including clinical predictors. The association between APOs and CAD held true among the 83% of women with a low 10-year risk for cardiovascular disease based on conventional risk factors.
Comment: This imaging study supports the previously reported association between APO and future CAD. In an accompanying editorial, the authors note that the independent risk of CAD following a hypertensive disorder of pregnancy is likely directly related to the effects of the hypertensive disorder, while the risk experienced by individuals with a history of other APOs, such as gestational diabetes, is likely mediated predominantly by conventional risk factors. These data highlight the importance of early and intensive risk-factor management in patients with history of APO.
Karol E. Watson, MD, PhD, FACC
John C. Mazziotta, MD, PhD, Term Endowed Chair and Professor of Medicine/Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, USA.
Sederholm Lawesson S, et al. Association between history of adverse pregnancy outcomes and coronary artery disease assessed by coronary computed tomography angiography. JAMA 2023; 329: 393-404.
Bello NA. Adverse pregnancy outcomes – risk enhancers whose time has finally arrived. JAMA 2023; 329: 373-375.
This summary is taken from the following Journal Watch title: Cardiology