Benton Samantha J, Mery Erika E, Grynspan David, Gaudet Laura M, Smith Graeme N, Bainbridge Shannon A
Department of Health Sciences, Carleton University, Ottawa, ON K1S 5B6, Canada.
School of Interdisciplinary Health Sciences, University of Ottawa, Ottawa, ON K1H 8L1, Canada.
J Clin Med. 2022 Mar 13;11(6):1576. doi: 10.3390/jcm11061576.
Preeclampsia (PE) is associated with an increased risk of cardiovascular disease (CVD) in later life. Postpartum cardiovascular risk screening could identify patients who would benefit most from early intervention and lifestyle modification. However, there are no readily available methods to identify these high-risk women. We propose that placental lesions may be useful in this regard. Here, we determine the association between placental lesions and lifetime CVD risk assessed 6 months following PE. Placentas from 85 PE women were evaluated for histopathological lesions. At 6 months postpartum, a lifetime cardiovascular risk score was calculated. Placental lesions were compared between CVD risk groups and the association was assessed using odds ratios. Multivariable logistic regression was used to develop prediction models for CVD risk with placental pathology. Placentas from high-risk women had more severe lesions of maternal vascular malperfusion (MVM) and resulted in a 3-fold increased risk of screening as high-risk for CVD (OR 3.10 (1.20-7.92)) compared to women without these lesions. MVM lesion severity was moderately predictive of high-risk screening (AUC 0.63 (0.51, 0.75); sensitivity 71.8% (54.6, 84.4); specificity 54.7% (41.5, 67.3)). When clinical parameters were added, the model's predictive performance improved (AUC 0.73 (0.62, 0.84); sensitivity 78.4% (65.4, 87.5); specificity 51.6% (34.8, 68.0)). The results suggest that placenta pathology may provide a unique modality to identify women for cardiovascular screening.
子痫前期（PE）与日后患心血管疾病（CVD）的风险增加相关。产后心血管风险筛查可以识别出那些能从早期干预和生活方式改变中获益最大的患者。然而，目前尚无现成的方法来识别这些高危女性。我们认为胎盘病变在这方面可能有用。在此，我们确定胎盘病变与子痫前期后6个月评估的终生CVD风险之间的关联。对85例PE女性的胎盘进行组织病理学病变评估。在产后6个月，计算终生心血管风险评分。比较CVD风险组之间的胎盘病变，并使用优势比评估关联。多变量逻辑回归用于建立基于胎盘病理学的CVD风险预测模型。与没有这些病变的女性相比，高危女性的胎盘有更严重的母体血管灌注不良（MVM）病变，导致筛查为CVD高危的风险增加3倍（优势比3.10（1.20 - 7.92））。MVM病变严重程度对高危筛查有中度预测性（曲线下面积0.63（0.51, 0.75）；敏感性71.8%（54.6, 84.4）；特异性54.7%（41.5, 67.3））。当加入临床参数时，模型的预测性能有所改善（曲线下面积0.73（0.62, 0.84）；敏感性78.4%（65.4, 87.5）；特异性51.6%（34.8, 68.0））。结果表明，胎盘病理学可能为识别需要进行心血管筛查的女性提供一种独特的方式。
