Pustjens Tobias F S, Vranken Nousjka P A, Jansen Gwyneth, Winkler Patty J C, Stein Mera, Hoebers Loes, Kietselaer Bas, Spaanderman Marc E A, Rasoul Saman, Ghossein-Doha Chahinda, van 't Hof Arnoud W J
Department of Cardiology, Zuyderland Medical Center, Heerlen, Netherlands.
Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands.
Front Cardiovasc Med. 2022 Jul 15;9:932799. doi: 10.3389/fcvm.2022.932799. eCollection 2022.
Myocardial infarction with non-obstructive coronary arteries (MINOCA) predominantly affects younger females. Women with a history of gestational hypertension (GH), preeclampsia (PE), and gestational diabetes mellitus (GDM) are subjected to an elevated lifetime risk of cardiovascular disease. However, data on the potential association between these obstetric complications and MINOCA is lacking. Therefore, the current study aimed to provide insight in the prevalence of metabolic and hypertensive pregnancy disorders (MHPD) in MINOCA patients and their clinical characteristics.
In this observational cohort study conducted at the Zuyderland Medical Center and Maastricht University Medical Center in the Netherlands, patients were enrolled if they were identified as having MINOCA. Data on individual patient characteristics, laboratory results, electrocardiography as well as (non-)invasive imaging procedures were derived from the electronic health record system. Patients were asked to complete a questionnaire about prior MHPD including GDM, GH, and PE. Patients were grouped into those with MHPD and those with prior uncomplicated normotensive pregnancy (or pregnancies; NP).
After excluding patients without 1-year follow-up ( = 53), 86 female MINOCA patients remained eligible for analysis. Of the total female population, 25 (29.1%) patients had MHPD, including GH ( = 19; 22.1%), PE ( = 4; 4.7%), and GDM ( = 7; 8.1%). The MHPD patients showed higher rates of chronic hypertension (84.0 vs. 55.7%; = 0.013), hypercholesterolemia (64.0 vs. 34.4%; = 0.012), a family history of CVD (84.0 vs. 45.9%; = 0.001), gout or rheumatic arthritis (16.0 vs. 1.6%; = 0.024), and were more often non-smokers (45.8 vs. 78.3%; = 0.004), compared to the NP patients. Moreover, MHPD patients were more likely to use cardiovascular medications at baseline. A trend toward no specific cause found for the MINOCA event was observed in MHPD patients compared to the NP group (64.0 vs. 42.6%, = 0.072).
A history of metabolic and hypertensive pregnancy disorders occurred in one-third of female MINOCA patients. In these patients, conventional cardiovascular risk factors were more prevalent compared to NP patients. In most MHPD patients, the specific cause for MINOCA remained unclear.
非阻塞性冠状动脉心肌梗死(MINOCA)主要影响年轻女性。有妊娠期高血压(GH)、子痫前期(PE)和妊娠期糖尿病(GDM)病史的女性一生患心血管疾病的风险会升高。然而,关于这些产科并发症与MINOCA之间潜在关联的数据尚缺乏。因此,本研究旨在深入了解MINOCA患者中代谢和高血压妊娠疾病(MHPD)的患病率及其临床特征。
在荷兰祖德兰德医疗中心和马斯特里赫特大学医学中心进行的这项观察性队列研究中,将被确诊为MINOCA的患者纳入研究。患者个体特征、实验室检查结果、心电图以及(非)侵入性影像学检查的数据均来自电子健康记录系统。要求患者填写一份关于既往MHPD的问卷,包括GDM、GH和PE。将患者分为患有MHPD的患者和既往无并发症的血压正常妊娠(或多次妊娠;NP)的患者。
排除无1年随访的患者(=53)后,86例女性MINOCA患者仍符合分析条件。在全部女性人群中,25例(29.1%)患者患有MHPD,包括GH(=19;22.1%)、PE(=4;4.7%)和GDM(=7;8.1%)。与NP患者相比,MHPD患者的慢性高血压发生率更高(84.0%对55.7%;=0.013)、高胆固醇血症发生率更高(64.0%对34.4%;=0.012)、心血管疾病家族史更常见(84.0%对45.9%;=0.001)、痛风或风湿性关节炎更常见(16.0%对1.6%;=0.024),且更常为非吸烟者(45.8%对78.3%;=0.004)。此外,MHPD患者在基线时更可能使用心血管药物。与NP组相比,在MHPD患者中观察到MINOCA事件无特定病因的趋势(64.0%对42.6%,=0.072)。
三分之一的女性MINOCA患者有代谢和高血压妊娠疾病史。与NP患者相比,这些患者中传统心血管危险因素更普遍。在大多数MHPD患者中,MINOCA的具体病因仍不清楚。