Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA.
Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
Am Heart J. 2024 Jun;272:96-105. doi: 10.1016/j.ahj.2024.03.004. Epub 2024 Mar 12.
Preeclampsia is associated with a two-fold increase in a woman's lifetime risk of developing atherosclerotic cardiovascular disease (ASCVD), but the reasons for this association are uncertain. The objective of this study was to examine the associations between vascular health and a hypertensive disorder of pregnancy among women ≥ 2 years postpartum.
Pre-menopausal women with a history of either a hypertensive disorder of pregnancy (cases: preeclampsia or gestational hypertension) or a normotensive pregnancy (controls) were enrolled. Participants were assessed for standard ASCVD risk factors and underwent vascular testing, including measurements of blood pressure, endothelial function, and carotid artery ultrasound. The primary outcomes were blood pressure, ASCVD risk, reactive hyperemia index measured by EndoPAT and carotid intima-medial thickness. The secondary outcomes were augmentation index normalized to 75 beats per minute and pulse wave amplitude measured by EndoPAT, and carotid elastic modulus and carotid beta-stiffness measured by carotid ultrasound.
Participants had a mean age of 40.7 years and were 5.7 years since their last pregnancy. In bivariate analyses, cases (N = 68) were more likely than controls (N = 71) to have hypertension (18% vs 4%, P = .034), higher calculated ASCVD risk (0.6 vs 0.4, P = .02), higher blood pressures (systolic: 118.5 vs 111.6 mm Hg, P = .0004; diastolic: 75.2 vs 69.8 mm Hg, P = .0004), and higher augmentation index values (7.7 vs 2.3, P = .03). They did not, however, differ significantly in carotid intima-media thickness (0.5 vs 0.5, P = .29) or reactive hyperemia index (2.1 vs 2.1, P = .93), nor in pulse wave amplitude (416 vs 326, P = .11), carotid elastic modulus (445 vs 426, P = .36), or carotid beta stiffness (2.8 vs 2.8, P = .86).
Women with a prior hypertensive disorder of pregnancy had higher ASCVD risk and blood pressures several years postpartum, but did not have more endothelial dysfunction or subclinical atherosclerosis.
子痫前期会使女性终生罹患动脉粥样硬化性心血管疾病（ASCVD）的风险增加一倍，但这种关联的原因尚不清楚。本研究的目的是探讨产后 2 年以上的女性血管健康与妊娠期高血压疾病之间的关系。
纳入既往有妊娠期高血压疾病（病例：子痫前期或妊娠期高血压）或正常妊娠（对照组）的绝经前妇女。评估参与者的 ASCVD 标准风险因素，并进行血管检查，包括血压、内皮功能和颈动脉超声检查。主要结局为血压、ASCVD 风险、用 EndoPAT 测量的反应性充血指数和颈动脉内膜中层厚度。次要结局为用 EndoPAT 测量的归一化至 75 次/分的增强指数和脉搏波幅度，以及用颈动脉超声测量的颈动脉弹性模量和颈动脉β硬度。
参与者的平均年龄为 40.7 岁，距上次妊娠时间为 5.7 年。在单变量分析中，病例组（n = 68）比对照组（n = 71）更有可能患有高血压（18% vs. 4%，P =.034），ASCVD 风险更高（0.6 vs. 0.4，P =.02），血压更高（收缩压：118.5 vs. 111.6 mmHg，P =.0004；舒张压：75.2 vs. 69.8 mmHg，P =.0004），增强指数值更高（7.7 vs. 2.3，P =.03）。然而，两组间颈动脉内膜中层厚度（0.5 vs. 0.5，P =.29）或反应性充血指数（2.1 vs. 2.1，P =.93）无显著差异，脉搏波幅度（416 vs. 326，P =.11）、颈动脉弹性模量（445 vs. 426，P =.36）或颈动脉β硬度（2.8 vs. 2.8，P =.86）也无差异。
产后多年患有妊娠期高血压疾病的女性 ASCVD 风险和血压更高，但内皮功能障碍或亚临床动脉粥样硬化程度并不更严重。
