Hypertension during Pregnancy is Associated with Coronary Artery Calcium Independent of Renal Function

Cassidy‐Bushrow, Andrea E.; Bielak, Lawrence F.; Rule, Andrew D.; Sheedy, Patrick F.; Turner, Stephen T.; Garovic, Vesna D.; Peyser, Patricia A.

doi:10.1089/jwh.2008.1285

Cited by 28 publications

(14 citation statements)

References 61 publications

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“…Yuan et al [29] show that the most relevant cardiac structural changes observed in pregnancy-associated hypertension are the increase in left atrial and ventricular diameters as well as in the thickness of the inter-ventricular septum with impaired left ventricular diastolic function and sustained systolic function. These results are in agreement with some previous data [18,20,30] as well as with our findings in patients with PEC in whom we observed a preserved systolic function resulting from an increase in both LV end-systolic and end-diastolic volumes. Conversely, we did not observe significant abnormalities in the LV structure of patients with G-PIH, and this is in agreement with the observations of De Conti et al [31] while others [32] have reached different conclusions starting from a lesser systematic classification of hypertension complicating pregnancy.…”

Section: Discussionsupporting

confidence: 94%

“…In patients with CH, the hemodynamic profile is comparable to that observed in non-pregnant hypertensive patients with limited additional changes of LV structure and function. These data are largely in agreement with the epidemiological evidence demonstrating an increased relative risk of major cardiovascular complications in patients affected by pre-eclampsia or chronic hypertension in pregnancy [20][21][22][23], and support a possible prognostic role for the changes in the hemodynamic and humoral profile of hypertensive pregnancy in addition and beyond blood pressure elevation. Previous studies have evaluated the changes in left ventricular structure and function in pregnant women, and report divergent results [24][25][26][27].…”

Section: Discussionsupporting

confidence: 88%

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Hemodynamic and neurohumoral profile in patients with different types of hypertension in pregnancy

et al. 2010

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Hypertension in pregnancy is a frequent disorder that includes a spectrum of conditions. We aimed at comparatively evaluating the hemodynamic, echocardiographic and biohumoral profile of a sample of pregnant Caucasian women with different form of pregnancy-related hypertension. We enrolled 39 non-hypertensive pregnant women (NP), 26 with Chronic HBP in pregnancy (CH), 24 with gestational hypertension (G-PIH), and 33 with pre-eclampsia. We recorded and compared blood pressure (BP), echocardiographic parameters, resting plasma renin activity (PRA) and plasma aldosterone (PA), Plasma levels of atrial (ANP) and brain natriuretic peptide (BNP). PE patients had a significantly higher BP than either G-PIH or NP patients. PE patients had also significantly lower cardiac output than NP, G-PIH and CH. In comparison to NP patients, the total peripheral vascular resistance was 61% higher in PE women and 38% higher in CH patients. All echographic parameters were significantly more altered in PE patients when compared with NP, in respect to any other form of hypertension. Either ANP (+35%) and BNP (+40%) were significantly higher in PE patients than in controls. The PRA was reduced in PE and CH patients when compared either with NP (-38 and -35%, respectively) or G-PIH (-47 and -43%, respectively). On the basis of our data, we can conclude that PE is the gestation associated hypertension with the largest anatomical, functional and biohumoral involvement, and so it has to be involved in a more intensive monitoring and evaluation.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 88%

Hemodynamic and neurohumoral profile in patients with different types of hypertension in pregnancy

et al. 2010

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“…[46,48,[68][69][70][71][72][73] Two retrospective cohort studies have evaluated CACS in women with a history of hypertensive pregnancy disorders, and both found a positive association between CACS and self-reported hypertension in pregnancy. [74,75] There are no published prospective studies yet to evaluate CACS in previous preeclamptic patients. Although CACS is a non-invasive measurement, holds great promise as a CVD risk marker, and provides the most direct evidence for cardiovascular damage, radiation dose and costs should be taken into account when considering CACS for risk assessment.…”

Section: Coronary Artery Calcium Scorementioning

confidence: 99%

Determinants of future cardiovascular health in women with a history of preeclampsia

et al. 2015

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Please cite this article as: Zoet Gerbrand A, Koster Maria PH, Velthuis Birgitta K, de Groot Christianne JM, Maas Angela HEM, Fauser Bart CJM, Franx Arie, Rijn Bas B.van.Determinants of future cardiovascular health in women with a history of preeclampsia.Maturitas http://dx.doi.org/10.1016/j.maturitas. 2015.07.004 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Keywords:Preeclampsia, cardiovascular disease, risk assessment, screening, prevention Highlights  Female-specific risk factors, among which preeclampsia, may have additional value in cardiovascular screening.  Non-invasive imaging techniques can be helpful to detect early-stage cardiovascular lesions as a sign of subclinical atherosclerotic disease.  Preliminary studies show positive effects of short-term lifestyle interventions following preeclampsia.  There is a need for clinical practice guidelines that provide long-term strategies in women after preeclampsia in pregnancy to improve cardiovascular health. AbstractWomen who develop preeclampsia have an increased risk of cardiovascular disease (CVD) later in life.However, current guidelines on cardiovascular risk assessment and prevention are unclear on how and when to screen these women postpartum, and about the role of a positive history of preeclampsia in later-life CVD risk management. The aim of this review is to discuss the present knowledge on commonly used cardiovascular screening modalities available to women with a history of preeclampsia, and to discuss recent developments in early detection of CVD using cardiovascular imaging.Furthermore, we explore how female-specific risk factors may have additional value in cardiovascular screening, in particular in relatively young women, although their implementation in clinical practice is challenged by inconsistent results and lack of long-term outcome data. Non-invasive imaging techniques, e.g. coronary artery intima-media thickness (CIMT), can be helpful to detect subclinical atherosclerotic disease, and coronary artery calcium scoring (CACS) has shown to be effective in early detection of cardiovascular damage. However, whilst more short-term and long-term follow-up studies are becoming available, few studies have investigated women with a history of preeclampsia in the fourth and fifth decade of life, when early signs of premature CVD are most likely to become apparent.Further studies are needed to inform new and improved clinical practice guidelines, and provide longterm strategies to effectively prevent CVD, specifically targeted at women with a history of preeclampsia. Additionally, evaluation of feasibility, cost-effectiveness ...

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“…32 Normal functioning of angiogenic factors, such as VEGF, are critical for maintenance of a healthy, intact endothelium, as demonstrated in animal studies where the lack of one VEGF allele in renal podocytes resulted in characteristic renal lesions seen in preeclampsia. 58 and clinical CVD outcomes. 45,55,57,59,60 In addition, early-onset preeclampsia (before 34 gestational weeks) has been associated with a hazard ratio of 9.5 for CVD death 59 and recurrent disease (ie, in >1 pregnancy) was associated with a 6-fold increase in risk for subsequent hypertension 55 ( Table 2).…”

Section: Pathophysiologic Mechanisms Of Preeclampsia and Vascular Effmentioning

confidence: 99%

Preeclampsia and Hypertensive Disease in Pregnancy: Their Contributions to Cardiovascular Risk

Valdiviezo

Garovic

Ouyang

2012

Clinical Cardiology

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More women than men die each year of cardiovascular disease, which remains the leading cause of death in the United States. Sex-specific factors, including pregnancy-related disorders, should be considered when assessing cardiovascular (CV) risk in women. Hypertensive disorders of pregnancy have been associated with CV risk later in life and may identify women in whom earlier primary prevention may reduce their risk. This article reviews the physiologic changes in blood pressure during pregnancy, current definitions of hypertensive diseases of pregnancy and preeclampsia, and postulated pathophysiologic mechanisms leading to preeclampsia that might contribute to later CV risk. Also summarized are studies providing evidence on the association between hypertensive diseases of pregnancy and future CV risk. IntroductionCardiovascular disease (CVD) continues to be the leading cause of death in the United States. More women than men die each year of heart disease. Despite efforts to improve prevention, diagnosis, and treatment of CVD over recent years that have resulted in an overall reduction of cardiovascular (CV) death rates, CVD death rates are on the rise for women age <55 years.1 This is in part due to genderrelated differences in risk factors, symptoms, and treatment. Traditional risk factors and risk-stratification tools fail to take sex-specific risk factors for women into consideration. Gestational hypertension, diabetes mellitus (DM), and preeclampsia-eclampsia may be associated with increased risk of CVD later in life. Identification of these higher-risk women would provide the opportunity for closer surveillance and preventive programs to reduce CV risk. This article reviews the physiologic changes in blood pressure (BP) during pregnancy, current definitions of hypertensive disease of pregnancy and preeclampsia, postulated pathophysiologic mechanisms leading to preeclampsia that might contribute to later CV risk, and the evidence on the association between hypertensive diseases of pregnancy and future CV risk.Two meta-analyses of the literature were published in 2007. 2,3 To provide current data on the association between

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Hypertension during Pregnancy is Associated with Coronary Artery Calcium Independent of Renal Function

Cited by 28 publications

References 61 publications

Hemodynamic and neurohumoral profile in patients with different types of hypertension in pregnancy

Hemodynamic and neurohumoral profile in patients with different types of hypertension in pregnancy

Determinants of future cardiovascular health in women with a history of preeclampsia

Preeclampsia and Hypertensive Disease in Pregnancy: Their Contributions to Cardiovascular Risk

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