Lipid Research Group and Vascular Immunology Research Group, Heart Research Institute, and the School of Medicine, University of Western Sydney, Australia.
Lipid Research Group and Vascular Immunology Research Group, Heart Research Institute, and the School of Medicine, University of Western Sydney, Australia.
Heart Lung Circ. 2014 Mar;23(3):203-12. doi: 10.1016/j.hlc.2013.10.087. Epub 2013 Oct 29.
It has been widely thought that the effects of hypertension in pregnancy reversed after delivery and hypertension values returned to their pre-pregnancy level as it was seen as a disease of short duration in otherwise healthy young women. However, recent studies have demonstrated that the principal underlying abnormality, endothelial dysfunction, remains in women who had preeclampsia and that it is this damage that increases the risk of developing cardiovascular disease (CVD) in later life. The contributions of hypertension and dyslipidaemia before and during the pregnancy are also important and contribute to future risk. Serum lipids are complex and change dramatically in pregnancy. In general there is an increase in most plasma lipid components, notably triglycerides, total cholesterol and the major particles of HDL and LDL. Aberrations or exaggerations in this shift (i.e. decrease HDL and a greater increase in LDL) are associated with poor outcomes of pregnancy such as preeclampsia. Long term cardiovascular disease is influenced by preeclampsia and in part potentially by the lipid changes which escalate late in disease. Whether we can influence the risk of preeclampsia by controlling cardiovascular risk factors preceding or during preeclampsia, or cardiovascular disease after preeclampsia is yet to be determined. Ultimately, strategies to control lipid concentrations will only be viable when we understand the safety to the mother at the time of the pregnancy, and to the foetus both immediately and in the very long term. Strategies to control blood pressure are well established in the non-pregnant population, and previous preeclampsia and gestational hypertension should be considered in any cardiovascular risk profile. Whether control of blood pressure in the pregnancy per se is of any longer term benefit is also yet to be determined.
人们普遍认为，妊娠高血压在分娩后会得到缓解，血压值会恢复到妊娠前水平，因为它被认为是一种在健康年轻女性中持续时间较短的疾病。然而，最近的研究表明，在患有子痫前期的女性中，主要的潜在异常，即内皮功能障碍仍然存在，正是这种损伤增加了她们在以后生活中患心血管疾病（CVD）的风险。妊娠前和妊娠期间的高血压和血脂异常也很重要，并导致未来的风险增加。血清脂质复杂，在妊娠期间会发生剧烈变化。一般来说，大多数血浆脂质成分都会增加，尤其是甘油三酯、总胆固醇以及 HDL 和 LDL 的主要颗粒。这种变化的异常或夸大（即 HDL 减少，LDL 增加更大）与妊娠不良结局有关，如子痫前期。长期心血管疾病受子痫前期的影响，部分可能受疾病晚期血脂变化的影响。我们能否通过控制子痫前期前或子痫前期期间的心血管危险因素，或子痫前期后的心血管疾病来降低子痫前期的风险，目前仍有待确定。最终，只有当我们了解妊娠期间对母亲的安全性以及对胎儿的即时和长期安全性时，控制血脂浓度的策略才可行。控制血压的策略在非孕妇群中已经得到很好的确立，以前的子痫前期和妊娠高血压应在任何心血管风险评估中考虑。控制妊娠期间的血压本身是否具有更长时间的益处，目前也尚未确定。
