Istanbul Medeniyet University, Faculty of Medicine, Division of Cardiology, Istanbul, Turkey.
Kirklareli University, Faculty of Medicine, Department of Cardiology, Kirklareli, Turkey.
Microvasc Res. 2021 Mar;134:104104. doi: 10.1016/j.mvr.2020.104104. Epub 2020 Nov 13.
A history of preeclampsia (pPE) and gestational diabetes (pGDM) are female-specific risk markers for atherosclerosis and future cardiovascular risk. In addition to increasing the risk of established risk factors for atherosclerosis, such as hypertension or diabetes, evidence suggests that pregnancy-related complications can also directly accelerate atherosclerosis by inducing endothelial dysfunction. A combination of both conditions is seen in a subset of patients with pregnancy, though it is not known whether this combination increases the overall risk for cardiovascular events.
Present study aimed to find the impact of combined pPE/pGDM on the prevalence of coronary microvascular dysfunction (CMD).
A total of 24 patients with combined pPE/pGDM, 19 patients with isolated pPE and 63 patients with pGDM were included to the present study and a further 36 healthy women with no previous pregnancy-related complications served as controls. Coronary flow reserve was measured using echocardiography and CMD was defined as a coronary flow reserve ≤2.5.
Patients with combined pPE/pGDM had a high prevalence of CMD (91%), which was significantly higher than controls (5.6%, p < 0.001) and patients with pGDM (55%, p = 0.01). A history of pPE on top of pGDM was associated with an increased risk of CMD (HR:6.28, 95%CI:1.69-23.37, p = 0.006) after multivariate adjustment, but pGDM did not increase the odds for CMD in those with pPE.
Combined pPE/pDM is associated with a very high prevalence of CMD, which may indicate an increased risk for future cardiovascular events.
子痫前期（pPE）和妊娠糖尿病（pGDM）病史是女性动脉粥样硬化和未来心血管风险的特定风险标志物。除了增加高血压或糖尿病等动脉粥样硬化既定危险因素的风险外，有证据表明，妊娠相关并发症还可以通过诱导内皮功能障碍直接加速动脉粥样硬化。在一部分妊娠患者中可以看到这两种情况的组合，但尚不清楚这种组合是否会增加心血管事件的总体风险。
本研究旨在探讨 pPE/pGDM 联合对冠状动脉微血管功能障碍（CMD）患病率的影响。
本研究共纳入 24 例 pPE/pGDM 合并患者、19 例单纯 pPE 患者和 63 例 pGDM 患者，并纳入 36 例无既往妊娠相关并发症的健康女性作为对照组。采用超声心动图测量冠状动脉血流储备，CMD 定义为冠状动脉血流储备≤2.5。
pPE/pGDM 合并患者的 CMD 患病率很高（91%），明显高于对照组（5.6%，p<0.001）和 pGDM 患者（55%，p=0.01）。在多变量调整后，pGDM 合并 pPE 病史与 CMD 风险增加相关（HR：6.28，95%CI：1.69-23.37，p=0.006），但 pGDM 不会增加 pPE 患者发生 CMD 的几率。
pPE/pDM 合并与 CMD 患病率非常高相关，这可能表明未来心血管事件的风险增加。
