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Vascular health years after a hypertensive disorder of pregnancy: The EPOCH study.
Miller, Hayley E; Tierney, Seda; Stefanick, Marcia L; Mayo, Jonathan A; Sedan, Oshra; Rosas, Lisa G; Melbye, Mads; Boyd, Heather A; Stevenson, David K; Shaw, Gary M; Winn, Virginia D; Hlatky, Mark A.
Afiliação
  • Miller HE; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA.
  • Tierney S; Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
  • Stefanick ML; Department of Medicine, Stanford University School of Medicine, Stanford, CA; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA.
  • Mayo JA; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA; Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
  • Sedan O; Department of Health Policy, Stanford University School of Medicine, Stanford, CA.
  • Rosas LG; Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA; Department of Medicine, Stanford University School of Medicine, Stanford, CA.
  • Melbye M; Danish Cancer Institute, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
  • Boyd HA; Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
  • Stevenson DK; Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
  • Shaw GM; Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
  • Winn VD; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA.
  • Hlatky MA; Department of Health Policy, Stanford University School of Medicine, Stanford, CA; Department of Medicine, Stanford University School of Medicine, Stanford, CA. Electronic address: hlatky@stanford.edu.
Am Heart J ; 272: 96-105, 2024 06.
Article em En | MEDLINE | ID: mdl-38484963
ABSTRACT

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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).

CONCLUSION:

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.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Hipertensão Induzida pela Gravidez / Espessura Intima-Media Carotídea / Rigidez Vascular Limite: Adult / Female / Humans / Pregnancy Idioma: En Revista: Am Heart J Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Hipertensão Induzida pela Gravidez / Espessura Intima-Media Carotídea / Rigidez Vascular Limite: Adult / Female / Humans / Pregnancy Idioma: En Revista: Am Heart J Ano de publicação: 2024 Tipo de documento: Article