Smith Graeme N
Obstetrics & Gynecology, Kingston General Hospital, Queen's University, 76 Stuart St, Kingston, ON K7L 2V7.
Semin Perinatol. 2015 Jun;39(4):316-9. doi: 10.1053/j.semperi.2015.05.012. Epub 2015 Jun 12.
Women's cardiovascular health is a national priority that should be addressed through improving cardiovascular awareness and prevention. Given the costs of treating cardiovascular disease and screening for it, novel and innovative ways to identify women who should undergo risk screening and intervention, including lifestyle modification, is critical to achieve this goal. Pregnancy is seen as a vascular stress test in that the development of common pregnancy complications has been shown to predict a woman's risk of premature cardiovascular disease and cardiovascular disease-related mortality. Therefore, pregnancy and the postpartum period provide a new early window of opportunity to identify risk factors for the majority of women to improve their long-term health. We have translated the research findings into the Maternal Health Clinic for health maintenance and disease prevention. Women who develop one of the pregnancy-related cardiovascular risk indicators are referred for screening, counseling, and lifestyle modification. We have reported that over half of the women referred to the Maternal Health Clinic, in comparison to women who have a normal pregnancy outcome, have a high lifetime cardiovascular disease risk and three times the risk to meet the criteria for the metabolic syndrome. If these women had not attended our clinic and received early screening and intervention, they may not have been identified as having underlying risk factors until much later in life. Intervening and management later in life, when there is a potentially greater burden of atherosclerosis, does not reduce cardiovascular disease risk to the same extent as maintaining favorable risk factor levels throughout adulthood. Pregnancy complications and the postpartum period are a new early window of opportunity to reliably identify women who should undergo cardiovascular risk screening, and management that may improve subsequent pregnancy outcomes and prevent cardiovascular disease.
女性心血管健康是一项国家优先事项，应通过提高心血管意识和预防来加以解决。鉴于治疗心血管疾病及其筛查的成本，采用新颖创新的方法来识别那些应接受风险筛查和干预（包括生活方式改变）的女性，对于实现这一目标至关重要。怀孕被视为一种血管应激测试，因为常见妊娠并发症的发生已被证明可预测女性患心血管疾病的风险以及与心血管疾病相关的死亡率。因此，孕期和产后时期为识别大多数女性的风险因素以改善其长期健康提供了一个新的早期机会窗口。我们已将研究结果转化应用于孕产妇健康诊所，以进行健康维护和疾病预防。出现与妊娠相关的心血管风险指标之一的女性会被转介进行筛查、咨询和生活方式改变。我们报告称，与妊娠结局正常的女性相比，被转介到孕产妇健康诊所的女性中，超过一半终生患心血管疾病的风险较高，符合代谢综合征标准的风险是其三倍。如果这些女性没有到我们诊所就诊并接受早期筛查和干预，她们可能直到生命后期才会被发现存在潜在风险因素。在生命后期进行干预和管理，此时动脉粥样硬化负担可能更大，其降低心血管疾病风险的程度不如在整个成年期维持有利的风险因素水平。妊娠并发症和产后时期是一个新的早期机会窗口，可可靠地识别那些应接受心血管风险筛查的女性，并进行可能改善后续妊娠结局和预防心血管疾病的管理。
