Preeclampsia, lactation duration affect CV risk in women
ORLANDO, Fla. — Two new studies presented at the American College of Cardiology Scientific Session highlight differences in CV risk related to preeclampsia history and lactation duration.
The data in women highlight a need for increased awareness and research on women during pregnancy and postpartum.
“This is an exciting and interesting topic within women’s cardiovascular health,” Karlee Hoffman, DO, second-year cardiology fellow at Allegheny Health Network in Pittsburgh, told Cardiology Today. “With education among providers and patients along with a multidisciplinary approach with our OB-GYN colleagues, we can capture these patients and really make a difference with their risk for long-term cardiovascular disease.”
Preeclampsia and CV risk
In one study, women with a history of preeclampsia had increased risk for diabetes, hypertension and hyperlipidemia at 5 years’ follow-up after delivery compared with women who did not have preeclampsia.
Hoffman and colleagues analyzed obstetrical, demographic and CV risk factor data from 658 women who either had preeclampsia (n = 329; mean age at diagnosis, 30 years) or were an age- and race-matched control (n = 329) in 2012. Women were followed up for 5 years for the incidence of hyperlipidemia, hypertension and diabetes.
Women with preeclampsia were more likely to have babies of low birth weight (P < .001), obesity (P = .002), postdelivery complications (P < .001) and preterm pregnancy (P < .001) compared with the control group.
The majority of women (77%) followed up with their primary care physician or gynecologist. At 5 years, compared with the control group, more women with preeclampsia had hypertension (32.8% vs. 0.3%; P < .001), new-onset diabetes (21% vs. 0%; P < .001) and hyperlipidemia (3% vs. 0%; P < .001).
Metabolic syndrome was seen more often in women with a history of preeclampsia vs. the control group (12 women vs. none).
The most significant predictors of future hypertension were African-American race, age at diagnosis and a history of diabetes in a multivariate logistic regression analysis of women with a history of preeclampsia.
“Preeclampsia can be a very early marker for patients who are at risk for developing long-term cardiovascular disease, and we can intervene early with aggressive lifestyle modifications and follow these patients closely,” Hoffman said in an interview.
Lactation and CV risk
In another study, Malamo Countouris, MD, second-year chief cardiology fellow at the University of Pittsburgh, and colleagues found that women who had a history of a long duration of lactation exhibited an improved cardiometabolic profile and had decreased risk for vascular changes that were linked to CVD compared with women who never breast-fed.
The researchers reviewed data from 678 women who delivered a single pregnancy. Follow-up was conducted for 7 to 15 years after delivery. During follow-up, information on BP, physical measurements, biomarkers of lipid metabolism, carotid intima-media thickness and reproductive history were collected.
Women were categorized based on lactation history: never lactated, less than 6 months per pregnancy, or at least 6 months per pregnancy.
Women who never lactated had lower HDL (51.1 mg/dL vs. 58.8 mg/dL) higher systolic BP (117 mm Hg vs. 111 mm Hg), higher diastolic BP (77.3 mm Hg vs. 72.7 mm Hg) and higher triglycerides (124 mg/dL vs. 96.7 mg/dL) compared with women who lactated for at least 6 months per pregnancy (P < .05 for all). These women also had higher overall mean carotid intima-media thickness (0.6 mm vs. 0.58 mm) and carotid artery adventitial diameter (6.72 mm vs. 6.52 mm; P for all < .05). The associations were only seen in women with prior normotensive pregnancies and not in those with prior hypertensive pregnancies.
Women with normotensive pregnancies who lactated for at least 6 months had lower triglycerides, higher HDL and lower mean carotid intima-media thickness vs. those who never lactated after adjusting for race, age, socioeconomic status, time from last pregnancy, BMI and total lifetime parity.
“We can further educate women that longer duration of lactation is beneficial both for infants as well as the mothers,” Countouris told Cardiology Today. “In particular, lactation may reduce risk for subclinical CVD with thinner carotid intima-media thickness and improve lipid profile among women normotensive during pregnancy.”
Countouris recommended that future research “should involve larger studies including women with a history of hypertensive disorders of pregnancy that would clarify the association of lactation and cardiometabolic profile in these women.” – by Darlene Dobkowski
Countouris M, et al. Abstract 1169-401.
Hoffman K, et al. Abstract 1260-408. Both presented at: American College of Cardiology Scientific Session; March 10-12, 2018; Orlando, Fla.
Disclosures: Countouris and Hoffman report no relevant financial disclosures.