From the Department of Pediatrics (A.F., K.P., R.O.F., J.D., A.C., M.H., A.M.N., T.M.L.), Sainte-Justine University Hospital and Research Center, Université de Montréal, Quebec, Canada.
Department of Nutrition (J.-C.L.), Sainte-Justine University Hospital and Research Center, Université de Montréal, Quebec, Canada.
Hypertension. 2020 Mar;75(3):796-805. doi: 10.1161/HYPERTENSIONAHA.119.14335. Epub 2020 Jan 27.
Preterm birth incurs an increased risk of early cardiovascular events and death. In the general population, cardiovascular risk factors cluster in the context of inflammation and oxidative stress. Whether this also occurs in young adults born preterm is unknown. We analyzed 101 healthy young adults (ages 18-29) born preterm (≤29 weeks of gestation) and 105 full-term controls, predominantly (90%) white. They underwent a comprehensive clinical and biological evaluation, including measurement of blood pressure, lung function (spirometry), glucose metabolism (fasting glucose, glycated hemoglobin, and oral glucose tolerance test), as well as biomarkers of inflammation and oxidative stress. Individuals born preterm were at higher risk than those born full-term of stage ≥1 hypertension (adjusted odds ratio, 2.91 [95% CI, 1.51-5.75]), glucose intolerance (adjusted odds ratio, 2.22 [95% CI, 1.13-4.48]), and airflow limitation (adjusted odds ratio, 3.47 [95% CI, 1.76-7.12]). Hypertension was strongly associated with adiposity and with glucose intolerance in participants born full-term but not in those born preterm. We did not find any group difference in levels of biomarkers of inflammation and oxidative stress. In individuals born preterm, inflammation, and oxidative stress were not related to hypertension or glucose intolerance but were associated with adiposity. In those born preterm, cardiovascular risk factors were not related to each other suggesting different pathophysiological pathways leading to the development of cardiovascular risk following preterm birth. Clinicians should consider screening for these abnormalities irrespectively of other risk factors in this at-risk population. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT03261609.
早产会增加早期心血管事件和死亡的风险。在普通人群中,心血管危险因素在炎症和氧化应激的背景下聚集。早产儿是否也存在这种情况尚不清楚。我们分析了 101 名健康的年轻成年人(18-29 岁),他们早产(≤29 周妊娠),105 名足月对照组,主要(90%)为白人。他们接受了全面的临床和生物学评估,包括血压测量、肺功能(肺活量测定)、葡萄糖代谢(空腹血糖、糖化血红蛋白和口服葡萄糖耐量试验)以及炎症和氧化应激的生物标志物。与足月出生者相比,早产者发生≥1 级高血压(校正比值比,2.91[95%可信区间,1.51-5.75])、葡萄糖耐量异常(校正比值比,2.22[95%可信区间,1.13-4.48])和气流受限(校正比值比,3.47[95%可信区间,1.76-7.12])的风险更高。高血压与肥胖密切相关,与足月出生者的葡萄糖耐量异常相关,但与早产者无关。我们没有发现炎症和氧化应激生物标志物的任何组间差异。在早产者中,炎症和氧化应激与高血压或葡萄糖耐量异常无关,但与肥胖有关。在这些早产儿中,心血管危险因素彼此之间没有关联,这表明在早产出生后发展心血管风险的不同病理生理途径。临床医生应考虑在该高危人群中无论其他危险因素如何,都要对这些异常进行筛查。临床试验注册网址:http://www.clinicaltrials.gov。独特标识符:NCT03261609。