Combined past preeclampsia and gestational diabetes is associated with a very high frequency of coronary microvascular dysfunction.

BACKGROUND: A history of preeclampsia (pPE) and gestational diabetes (pGDM) are female-specific risk markers for atherosclerosis and future cardiovascular risk. In addition to increasing the risk of established risk factors for atherosclerosis, such as hypertension or diabetes, evidence suggests that pregnancy-related complications can also directly accelerate atherosclerosis by inducing endothelial dysfunction. A combination of both conditions is seen in a subset of patients with pregnancy, though it is not known whether this combination increases the overall risk for cardiovascular events. AIMS: Present study aimed to find the impact of combined pPE/pGDM on the prevalence of coronary microvascular dysfunction (CMD). METHODS: A total of 24 patients with combined pPE/pGDM, 19 patients with isolated pPE and 63 patients with pGDM were included to the present study and a further 36 healthy women with no previous pregnancy-related complications served as controls. Coronary flow reserve was measured using echocardiography and CMD was defined as a coronary flow reserve ≤2.5. RESULTS: Patients with combined pPE/pGDM had a high prevalence of CMD (91%), which was significantly higher than controls (5.6%, p < 0.001) and patients with pGDM (55%, p = 0.01). A history of pPE on top of pGDM was associated with an increased risk of CMD (HR:6.28, 95%CI:1.69-23.37, p = 0.006) after multivariate adjustment, but pGDM did not increase the odds for CMD in those with pPE. CONCLUSIONS: Combined pPE/pDM is associated with a very high prevalence of CMD, which may indicate an increased risk for future cardiovascular events.

Does mild preeclampsia cause arterial stiffness and ventricular remodeling through inflammation?

BACKGROUND: A link between preeclampsia (PE) and excessive maternal morbidity and mortality is a commonly recognized fact. Moreover it has been suggested that chronic inflammatory state connected with PE contributes to accelerated atherosclerosis. There is also an association between PE and maternal cardiac remodeling and biventricular diastolic dysfunction. The aim of the study was to investigate the presence of impaired myocardial performance and increased arterial stiffness in patients who experienced a mild case of PE five years previously. METHODS: The study included forty PE patients (40 women; mean age 33.75 +/- 7.95) and 27 healthy volunteers (27 women; mean age 36.44 +/- 10.45)Transthoracic echocardiography including Doppler echocardiography combined with tissue Doppler imaging (TDI), and aortic stiffness index (AoSI), aortic distensibility (AoD), and aortic elastic modulus (AoEM) values were measured in each study participant. RESULTS: There was a statistically significant increase in hsCRR aortic stiffness index, and aortic elastic modulus in PE patients as compared to controls (2.43 +/- 1.91 vs. 3.80 +/- 2.06, p=0.007; 3.09 +/- 2.41 vs. 7.32 +/- 6.89, p=0.001; 2.89 +/- 2.11 vs. 7.00 +/- 6.83, p=0.001), while a significant decrease was observed in the aortic strain and distensibility (respectively 22.35 +/- 15.99 vs. 12.24 +/- 9.22, p=0.005; 11.17 +/- 9.68 vs. 6.13 +/- 4.99, p=0.018). No differences between the two groups were observed with regard to the left ventricular myocardial performance index (MPI) (0.55 +/- 0.16 vs. 0.53 +/-0.19, p=0.630). CONCLUSIONS: To the best of our knowledge, this has been the first study to demonstrate impaired aortic elasticity and unaffected myocardial performance index in patients with mild PE. Moreover, these effects turned out to be significantly correlated with inflammation.

The effect of metformin treatment on ovarian stromal blood flow in women with polycystic ovary syndrome.

OBJECTIVE: To evaluate the effects of metformin on the ovarian stromal blood perfusion in the patients with polycystic ovary syndrome (PCOS). METHODS: Twenty-five women with PCOS who underwent a Doppler examination of the ovarian stroma was evaluated; hormonal, anthropometric, and biochemical parameters of patients were determined. After the patients were treated with 850 mg metformin twice a day for 6 months, the same parameters were evaluated in the same patients. RESULTS: After metformin treatment, although pulsatility index (PI) was increased from 1.80 +/- 1.23, 1.84 +/- 1.28 to 2.20 +/- 1.10, 2.19 +/- 0.83 in the right and left ovary, respectively, and resistance index was increased from 0.84 +/- 0.25, 0.83 +/- 0.23 to 1.16 +/- 0.37, 1.10 +/- 0.26 in the right and left ovary respectively (P < 0.05), peak systolic velocity (PSV) was decreased from 12.30 +/- 1.72, 12.34 +/- 1.55 to 10.25 +/- 0.97, 10.53 +/- 1.33 in the right and left ovary respectively (P < 0.05). PI and RI did not show any difference between the homeostatic model assessment insulin resistance index (HOMA-IR) >or= 2.38 and HOMA-IR < 2.38 groups before and after metformin treatment (P > 0.05). However, PSV was decreased significantly from 13.05 +/- 1.35, 12.82 +/- 2.02 to 11.03 +/- 0.71, 10.25 +/- 0.42 in HOMA-IR >or= 2.38 group in the right and left ovary, respectively, and PSV was decreased from 11.50 +/- 2.67, 11.28 +/- 0.26 to 9.10 +/- 0.58, 9.28 +/- 0.25 in HOMA-IR < 2.38 group in the right and left ovary, respectively, before and after metformin treatment (P < 0.05). PSV for both ovaries were positively correlated with HOMA scores before and after metformin treatment [(r = 0.713, P = 0.000; r = 0.617, P = 0.04 and r = 0.635, P= 0.03; r = 0.483, P = 0.031 respectively]. CONCLUSION: Metformin treatment affected ovarian stromal blood flow in PCOS patients.

Previous gestational diabetes history is associated with impaired coronary flow reserve.

BACKGROUND: Gestational diabetes mellitus (GDM) is a prediabetic state that is known to increase the risk of cardiovascular diseases. We have investigated coronary flow velocity reserve (CFVR) and epicardial fat thickness (EFT), and left ventricular diastolic function in patients with a history of previous GDM (p-GDM). METHODS: Ninety-three women with GDM history and 95 healthy women without GDM history were recruited. We used transthoracic Doppler echocardiography to assess CFVR, EFT, and left ventricular diastolic function. Insulin resistance of each subject was assessed with homeostasis model assessment insulin resistance (HOMA-IR). Hemoglobin A1c and high-sensitivity C-reactive protein (hsCRP) were also measured in all patients. RESULTS: CFVR values were significantly lower (2.34 ± 0.39 versus 2.80 ± 0.24, p < 0.001) and EFT values were significantly higher in patients with p-GDM than the control group (5.5 ± 1.3 versus 4.3 ± 1.1, p < 0.001). E/E' ratio (7.21 ± 1.77 versus 6.53 ± 1.38, p = 0.003), hemoglobin A1c (5.2 ± 0.4 and 5.0 ± 0.3, p = 0.001), HOMA-IR (2.8 ± 1.4 versus 1.7 ± 0.9, p = 0.04), and hsCRP levels were significantly higher in the p-GDM group than the control group. Multivariate analysis revealed that gestational diabetes history is independently associated with CFVR. CONCLUSION: Women with a GDM history may be at more risk regarding coronary microvascular dysfunction compared to the healthy ones.

Diagnosis of gestational diabetes mellitus by use of the homeostasis model assessment-insulin resistance index in the first trimester.

OBJECTIVE: Gestational diabetes mellitus (GDM) affects 2-10% of all pregnant women, causing increased morbidity and mortality, and is tested for in the second trimester of pregnancy. The purpose of the present study was to predict GDM in the first trimester. DESIGN AND METHODS: The study included 271 patients who were between the 10th and 14th week of gestation. Fasting glucose and insulin were measured in the first trimester and the homeostasis model assessment-insulin resistance index (HOMA-IR) was calculated for each patient. These values were compared with the results of the second-trimester glucose tolerance test. RESULTS: HOMA-IR values were higher in women with GDM. A cut-off value of 2.60 for HOMA-IR was calculated at the end of the study. CONCLUSION: Accepting patients whose HOMA-IR value is higher than 2.60 in the first trimester seems to be a good method to predict GDM.