Westmead Applied Research Centre, Faculty of Medicine and Health The University of Sydney Sydney Australia.
Department of Cardiology Cabrini Health Melbourne Australia.
J Am Heart Assoc. 2023 Sep 5;12(17):e030015. doi: 10.1161/JAHA.123.030015. Epub 2023 Aug 29.
Background Hypertensive disorders of pregnancy, gestational diabetes, and having a small-for-gestational-age baby are known to substantially increase a woman's risk of cardiovascular disease. Despite this, evidence for models of care that mitigate cardiovascular disease risk in women with these pregnancy-related conditions is lacking. Methods and Results A 6-month prospective cohort study assessed the effectiveness of a multidisciplinary Women's Heart Clinic on blood pressure and lipid control in women aged 30 to 55 years with a past pregnancy diagnosis of hypertensive disorders of pregnancy, gestational diabetes, or a small-for-gestational age baby in Melbourne, Australia. The co-primary end points were (1) blood pressure <140/90 mm Hg or <130/80 mm Hg if diabetes and (2) total cholesterol to high-density lipoprotein cholesterol ratio <4.5. The study recruited 156 women with a mean age of 41.0±4.2 years, 3.9±2.9 years from last delivery, 68.6% White, 20.5% South/East Asian, and 80.5% university-educated. The proportion meeting blood pressure target increased (69.2% to 80.5%, =0.004), with no significant change in lipid targets (80.6% to 83.7%, =0.182). Systolic blood pressure (-6.9 mm Hg [95% CI, -9.1 to -4.7], <0.001), body mass index (-0.6 kg/m [95% CI, -0.8 to -0.3], <0.001), low-density lipoprotein cholesterol (-4.2 mg/dL [95% CI, -8.2 to -0.2], =0.042), and total cholesterol (-4.6 mg/dL [95% CI, -9.1 to -0.2] =0.042) reduced. Heart-healthy lifestyle significantly improved with increased fish/olive oil (36.5% to 51.0%, =0.012), decreased fast food consumption (33.8% to 11.0%, <0.001), and increased physical activity (84.0% to 92.9%, =0.025). Conclusions Women at high risk for cardiovascular disease due to past pregnancy-related conditions experienced significant improvements in multiple cardiovascular risk factors after attending a Women's Heart Clinic, potentially improving long-term cardiovascular disease outcomes. Registration URL: https://www.anzctr.org.au; Unique identifier: ACTRN12622000646741.
妊娠高血压疾病、妊娠期糖尿病和胎儿生长受限与女性心血管疾病风险显著增加有关。尽管如此,针对这些与妊娠相关疾病的女性降低心血管疾病风险的护理模式的证据仍然缺乏。
在澳大利亚墨尔本,一项为期 6 个月的前瞻性队列研究评估了多学科女性心脏诊所对过去妊娠诊断为妊娠高血压疾病、妊娠期糖尿病或胎儿生长受限的 30 至 55 岁女性的血压和血脂控制的有效性。主要终点为(1)血压<140/90mmHg 或糖尿病患者<130/80mmHg;(2)总胆固醇与高密度脂蛋白胆固醇比值<4.5。该研究招募了 156 名女性,平均年龄为 41.0±4.2 岁,距上次分娩 3.9±2.9 年,37.1%为白人,20.5%为东南亚裔,80.5%受过大学教育。血压达标率升高(69.2%至 80.5%,=0.004),血脂目标无显著变化(80.6%至 83.7%,=0.182)。收缩压下降了 6.9mmHg(95%CI,-9.1 至-4.7mmHg,<0.001),体重指数下降了 0.6kg/m(95%CI,-0.8 至-0.3kg/m,<0.001),低密度脂蛋白胆固醇下降了 4.2mg/dL(95%CI,-8.2 至-0.2mg/dL,=0.042),总胆固醇下降了 4.6mg/dL(95%CI,-9.1 至-0.2mg/dL,=0.042)。心脏健康的生活方式显著改善,鱼类/橄榄油摄入量增加(36.5%至 51.0%,=0.012),快餐摄入量减少(33.8%至 11.0%,<0.001),体力活动增加(84.0%至 92.9%,=0.025)。
由于过去与妊娠相关的疾病,患有心血管疾病高危因素的女性在参加女性心脏诊所后,其多种心血管风险因素显著改善,这可能改善长期心血管疾病结局。