LAS VEGAS — Physicians can help reduce a woman's risk of cardiovascular disease by taking into account her pregnancy history, according to an expert here at the Cardiometabolic Risk Summit.
Margo B. Minissian,
PhDc, ACNP, CLS, AACC, FAHA, a scientist and cardiology nurse practitioner at the Women's Heart Center at Cedars-Sinai Heart Institute, said that pregnancy is "the first physiologic stress test."
There are various hemodynamic changes that occur during pregnancy and can last after pregnancy ends, she said, such as stroke volume, heart rate, blood volume and cardiac output. Further, there are adverse pregnancy outcomes that can increase lifetime cardiovascular disease (CVD) risk.
Margo B. Minissian
"It's important to identify women who would most benefit from primary prevention efforts to reduce the risk of CVD," she said.
Minissian continued: "If we are able to target screening, lifestyle modification and implement early treatment strategies that we already know about, we can ultimately reduce overall risk and threshold for potential cardiovascular and metabolic dysfunction."
Approximately 30% of women experience adverse pregnancy outcomes such as gestational diabetes, gestational hypertension, preeclampsia or preterm delivery, Minissian said. About 25% of women carry a predictor of their future CVD risk.
She said that women with gestational diabetes, which affects around 5% of pregnancies, have a 7-fold increase in risk of later type 2 diabetes and an increased CVD risk as well.
Gestational hypertension, present in up to 14% of pregnancies, is associated with later development of chronic hypertension, increased ischemic heart disease, increased stroke mortality, higher BMI, higher blood pressure and an unfavorable lipid panel, Minissian said.
Preeclampsia, which affects 2% to 5% of all births and about 25% of preterm births, leads to a 4-fold higher incidence of hypertension, 3-fold higher incidence of type 2 diabetes and a 2-fold elevated risk of CVD death, according to Minissian.
"Preeclampsia does not go away after the placenta is delivered," she said. "It's a very important risk factor to pay attention to."
Preterm delivery, defined as gestation less than 37 weeks, affects 6% to 12% of births in the developed world. Compared with term births, women who delivery early have a hazard ratio for CVD of 1.3 to 2.6, she reported.
Minissian urged primary care providers to become more involved.
"I work in a specialty program, but you don't need to be a specialist to do good cardiac risk prevention," she said. "I really feel that it's all of our responsibilities to be able to identify these women. Most of them are only in OBGYN clinics. OBGYNs are terrified of hypertension and they're terrified of lipids oftentimes. And so it's the primary care community that really needs to embrace these young women and make sure that they get properly screened, and if they're complicated, make sure that they get properly referred."
Minissian said that encouraging high-risk women to lead a healthy lifestyle and treating known heart disease risk markers like cholesterol and blood pressure can reduce a woman's risk. She pressed the audience to utilize pregnancy history to make some of these decisions.
"Pregnancy can tell us about a woman's future," Minissian concluded. "It's not as good as a crystal ball, but I think it could be. And a detailed history and physical examination, including [adverse pregnancy outcomes] in your detailed history, are important in stratifying the risk of heart disease. Women with adverse pregnancy outcomes are at higher risk — somewhere between two to eight times more likely to develop heart disease later in life." – by Chelsea Frajerman Pardes
Disclosures: Minissian is a consultant for Sanofi Regeneron and receives grant and/or research support from the American Heart Association, NIH and the National Lipid Foundation.
Minissian MB. Cardiometabolic risk prevention in women. Presented at: Cardiometabolic Risk Summit Fall; Oct. 14, 2016; Las Vegas.