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Biwer LA, Man JJ, Camarda ND, Carvajal BV, Karumanchi SA, Jaffe IZ. Prior Exposure to Experimental Preeclampsia Increases Atherosclerotic Plaque Inflammation in Atherogenic Mice-Brief Report. Arterioscler Thromb Vasc Biol 2024; 44:946-953. [PMID: 38450510 PMCID: PMC10978246 DOI: 10.1161/atvbaha.123.320474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/21/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Women with a history of preeclampsia have evidence of premature atherosclerosis and increased risk of myocardial infarction and stroke compared with women who had a normotensive pregnancy. Whether this is due to common risk factors or a direct impact of prior preeclampsia exposure has never been tested in a mouse atherosclerosis model. METHODS Pregnant LDLR-KO (low-density lipoprotein receptor knockout; n=35) female mice were randomized in midgestation to sFlt1 (soluble fms-like tyrosine kinase 1)-expressing adenovirus or identical control adenovirus. Postpartum, mice were fed high-fat diet for 8 weeks to induce atherogenesis. Comparison between the control and preeclampsia models was made for metabolic parameters, atherosclerosis burden and composition by histology, plaque inflammation by flow cytometry, and aortic cytokines and inflammatory markers using a cytokine array. RESULTS In pregnant LDLR-KO mice, sFlt1 adenovirus significantly induced serum sFlt1, blood pressure, renal endotheliosis, and decreased pup viability. After 8 weeks of postpartum high fat feeding, body weight, fasting glucose, plasma cholesterol, HDL (high-density lipoprotein), and LDL (low-density lipoprotein) were not significantly different between groups with no change in aortic root plaque size, lipid content, or necrotic core area. Flow cytometry demonstrated significantly increased CD45+ aortic arch leukocytes and CD3+T cells and aortic lysate contained more CCL (CC motif chemokine ligand) 22 and fetuin A and decreased expression of IGFBP6 (insulin-like growth factor-binding protein 6) and CCL21 in preeclampsia-exposed mice compared with controls. CONCLUSIONS In atherogenic LDLR-KO mice, exposure to sFlt1-induced preeclampsia during pregnancy increases future atherosclerotic plaque inflammation, supporting the concept that preeclampsia directly exacerbates atherosclerotic inflammation independent of preexisting risk factors. This mechanism may contribute to ischemic vascular disease in women after preeclampsia pregnancy.
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Affiliation(s)
- Lauren A. Biwer
- Molecular Cardiology Research Center, Tufts Medical Center, Boston MA
- Department of Comparative Medicine, Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT
| | - Joshua J. Man
- Molecular Cardiology Research Center, Tufts Medical Center, Boston MA
| | | | | | | | - Iris Z. Jaffe
- Molecular Cardiology Research Center, Tufts Medical Center, Boston MA
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2
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Björkman S, Lilliecreutz C, Bladh M, Strömberg T, Östgren CJ, Mahmoud A, Kafashian A, Bergstrand S, Sederholm Lawesson S. Microvascular dysfunction in women with a history of hypertensive disorders of pregnancy: A population-based retrospective cohort study. BJOG 2024; 131:433-443. [PMID: 37732494 DOI: 10.1111/1471-0528.17665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/04/2023] [Accepted: 08/31/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE To evaluate microvascular function in women with previous hypertensive disorders of pregnancy (HDP). DESIGN Retrospective population-based cohort study. SETTING Linköping, Sweden. POPULATION Women aged 50-65 years, participating in the Swedish CArdioPulmonary bioImage Study (SCAPIS) at one site (Linköping) 2016-18, who underwent microcirculatory assessment (N = 1222). METHODS Forearm skin comprehensive microcirculatory assessment was performed with a PeriFlux PF6000 EPOS (Enhanced Perfusion and Oxygen Saturation) system measuring oxygen saturation and total speed resolved perfusion. Obstetric records were reviewed to identify women with previous HDP. Data on cardiovascular risk factors, comorbidities, medication, lifestyle, anthropometric data, and biochemical analyses were obtained from SCAPIS. The microcirculatory data were compared between women with and without previous HDP. MAIN OUTCOME MEASURES Skin microcirculatory oxygen saturation and total speed resolved perfusion at baseline and post-ischaemic peak. RESULTS Women with previous pre-eclampsia displayed impaired post-ischaemic peak oxygen saturation compared with women with normotensive pregnancies (88%, interquartile range [IQR] 84-89% vs 91%, IQR 87-94%, p = 0.001) 6-30 years after pregnancy. The difference remained after multivariable adjustment (β -2.69, 95% CI -4.93 to -0.45). CONCLUSIONS The findings reveal microvascular dysfunction at long-term follow up in women with previous pre-eclampsia and strengthen the possible role of endothelial dysfunction as a link to the increased risk of cardiovascular disease in women with HDP.
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Affiliation(s)
- Stina Björkman
- Department of Obstetrics and Gynaecology in Norrköping, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Caroline Lilliecreutz
- Department of Obstetrics and Gynaecology in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Marie Bladh
- Department of Obstetrics and Gynaecology in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Tomas Strömberg
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Carl Johan Östgren
- Department of Health, Medicine and Caring Sciences, and CMIV Centre of Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | | | | | - Sara Bergstrand
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Sofia Sederholm Lawesson
- Department of Cardiology, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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3
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Sayed M, Rashed M, Abbas AM, Youssef A, Abdel Ghany M. Postpartum Detection of Diastolic Dysfunction and Nondipping Blood Pressure Profile in Women With Preeclampsia. Tex Heart Inst J 2023; 50:493184. [PMID: 37209088 DOI: 10.14503/thij-20-7459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
BACKGROUND Left ventricular diastolic dysfunction and nocturnal "nondipping" of blood pressure detected via ambulatory blood pressure monitoring are predictors of increased cardiovascular morbidity. METHODS A prospective cohort study including normotensive women with a history of preeclampsia in their current pregnancy was conducted. All cases were subjected to 24-hour ambulatory blood pressure monitoring and 2-dimensional transthoracic echocardiography 3 months after delivery. RESULTS This study included 128 women with a mean (SD) age of 28.6 (5.1) years and a mean (SD) basal blood pressure of 123.1 (6.4)/74.6 (5.9) mm Hg. Among the participants, 90 (70.3%) exhibited an ambulatory blood pressure monitoring profile illustrating nocturnal blood pressure "dipping" (the mean night to day time blood pressure ratio ≤ 0.9), whereas 38 (29.7%) were nondippers. Diastolic dysfunction (impaired left ventricular relaxation) was present in 28 nondippers (73.7%), whereas none of the dippers exhibited diastolic dysfunction. Women with severe preeclampsia were more frequently nondippers (35.5% vs 24.2%; P = .02) and experienced diastolic dysfunction (29% vs 15%; P = .01) than were those with mild preeclampsia. Severe preeclampsia (odds ratio [OR], 1.08; 95% CI, 1.05-10.56; P < .001) and history of recurrent preeclampsia (OR, 1.36; 95% CI, 1.3-4.26; P ≤ .001) were significant predictors for nondipping status and diastolic dysfunction (OR, 1.55; 95% CI, 1.1-2.2; and OR, 1.23; 95% CI, 1.2-2.2, respectively; P < .05). CONCLUSION Women with a history of preeclampsia were at higher risk for developing late cardiovascular events. The severity and recurrence of preeclampsia were significant predictors of both nondipping profile and diastolic dysfunction.
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Affiliation(s)
- Marwa Sayed
- Department of Cardiology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mariam Rashed
- Department of Cardiology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed M Abbas
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Amr Youssef
- Department of Cardiology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed Abdel Ghany
- Department of Cardiology, Faculty of Medicine, Assiut University, Assiut, Egypt
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4
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Pikir BS, Subagjo A, Wardhani DE, Andrianto, Oktaviono YH, Nugraha RA. Comparison of carotid intima media thickness between women with history of preeclampsia and normal pregnancy: a meta-analysis of systematic review. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2022. [DOI: 10.1186/s43162-022-00155-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
On a clinical level, preeclampsia and atherosclerotic cardiovascular disease share common risk factors. Carotid intima media thickness (CIMT) is ultrasound-based imaging, non-invasive, simple, and reproducible method of subclinical atherosclerosis evaluation. Nowadays, there were studies concerning of CIMT among preeclamptic women, although the results were different.
Objective
To prove that CIMT among women with histories of preeclampsia was greater compared to normal pregnancy.
Methods
We conducted a meta-analysis of studies that reported CIMT, in women who had preeclampsia and had normal pregnancy. Studies were identified through three databases: PubMed, Google Scholar, and SAGE Journals with publication year of 2010–2020. Heterogeneity was assessed using the I2 statistic. Standardized mean difference was used as measured of effect size.
Results
Nine eligible studies were included in the meta-analysis. This meta-analysis consisted of 439 women with preeclampsia histories and 526 women with normal pregnancy histories. Women who had preeclampsia had significantly higher CIMT compared to those with normal pregnancy with standardized mean difference −0.38 and 95% confidence interval (CI) −0.68 to −0.07 (p=0.02).
Conclusion
CIMT was greater among women with histories of preeclampsia compared to normal pregnancy.
Trial registration
PROSPERO CRD42021228825
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5
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Janssen EBNJ, Hooijschuur MCE, Lopes van Balen VA, Morina-Shijaku E, Spaan JJ, Mulder EG, Hoeks AP, Reesink KD, van Kuijk SMJ, van't Hof A, van Bussel BCT, Spaanderman MEA, Ghossein-Doha C. No accelerated arterial aging in relatively young women after preeclampsia as compared to normotensive pregnancy. Front Cardiovasc Med 2022; 9:911603. [PMID: 35966519 PMCID: PMC9371444 DOI: 10.3389/fcvm.2022.911603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Preeclampsia, an endothelial disorder of pregnancy, predisposes to remote cardiovascular diseases (CVD). Whether there is an accelerated effect of aging on endothelial decline in former preeclamptic women is unknown. We investigated if the arterial aging regarding endothelial-dependent and -independent vascular function is more pronounced in women with a history of preeclampsia as compared to women with a history of solely normotensive gestation(s). Methods Data was used from the Queen of Hearts study (ClinicalTrials.gov Identifier NCT02347540); a large cross-sectional study on early detection of cardiovascular disease among young women (≥18 years) with a history of preeclampsia and a control group of low-risk healthy women with a history of uncomplicated pregnancies. Brachial artery flow-mediated dilation (FMD; absolute, relative and allometric) and sublingually administered nitroglycerine-mediated dilation (NGMD; absolute and relative) were measured using ultrasound. Cross-sectional associations of age with FMD and NGMD were investigated by linear regression. Models were adjusted for body mass index, smoking, antihypertensive drug use, mean arterial pressure, fasting glucose, menopausal state, family history of CVD and stress stimulus during measurement. Effect modification by preeclampsia was investigated by including an interaction term between preeclampsia and age in regression models. Results Of the 1,217 included women (age range 22–62 years), 66.0% had a history of preeclampsia and 34.0% of normotensive pregnancy. Advancing age was associated with a decrease in relative FMD and NGMD (unadjusted regression coefficient: FMD: −0.48%/10 years (95% CI:−0.65 to −0.30%/10 years), NGMD: −1.13%/10 years (−1.49 to −0.77%/10 years)) and increase in brachial artery diameter [regression coefficient = 0.16 mm/10 years (95% CI 0.13 to 0.19 mm/10 years)]. Similar results were found when evaluating FMD and NGMD as absolute increase or allometrically, and after confounder adjustments. These age-related change were comparable in former preeclamptic women and controls (p-values interaction ≥0.372). Preeclampsia itself was independently associated with consistently smaller brachial artery diameter, but not with FMD and NGMD. Conclusion In young- to middle-aged women, vascular aging in terms of FMD and NGMD was not accelerated in women after preeclampsia compared to normotensive pregnancies, even though former preeclamptic women consistently have smaller brachial arteries.
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Affiliation(s)
- Emma B. N. J. Janssen
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+ (MUMC+), Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
- *Correspondence: Emma B. N. J. Janssen
| | - Mieke C. E. Hooijschuur
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+ (MUMC+), Maastricht, Netherlands
| | - Veronica A. Lopes van Balen
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+ (MUMC+), Maastricht, Netherlands
| | - Erjona Morina-Shijaku
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+ (MUMC+), Maastricht, Netherlands
| | - Julia. J. Spaan
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+ (MUMC+), Maastricht, Netherlands
| | - Eva G. Mulder
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+ (MUMC+), Maastricht, Netherlands
| | - Arnold P. Hoeks
- Department of Biomedical Engineering, MUMC+, Maastricht, Netherlands
| | - Koen D. Reesink
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
- Department of Biomedical Engineering, MUMC+, Maastricht, Netherlands
| | - Sander M. J. van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, MUMC+, Maastricht, Netherlands
| | - Arnoud van't Hof
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
- Department of Cardiology, MUMC+, Maastricht, Netherlands
- Department of Cardiology, Zuyderland Medical Centre, Heerlen, Netherlands
| | - Bas C. T. van Bussel
- Department of Intensive Care Medicine, MUMC+, Maastricht, Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Marc E. A. Spaanderman
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+ (MUMC+), Maastricht, Netherlands
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Chahinda Ghossein-Doha
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+ (MUMC+), Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
- Department of Cardiology, MUMC+, Maastricht, Netherlands
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6
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Barr LC, Liblik K, Johri AM, Smith GN. Maternal Cardiovascular Function Following a Pregnancy Complicated by Preeclampsia. Am J Perinatol 2022; 39:1055-1064. [PMID: 33321533 DOI: 10.1055/s-0040-1721694] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Preeclampsia is a hypertensive pregnancy complication with an unknown etiology and high maternal burden worldwide. Burgeoning research has linked preeclampsia to adverse maternal health outcomes remote from pregnancy; however, the intermediary mechanisms responsible for this association have not been sufficiently established. In the present narrative review, we summarize leading evidence of structural and functional cardiovascular changes associated with prior preeclampsia, and how these changes may be linked to future maternal disease. KEY POINTS: · Prior preeclampsia is associated with subclinical structural and functional vascular changes remote from pregnancy.. · Maternal cardiac adaptations to preeclampsia may have long-term implications on cardiovascular health.. · Clinicians have an opportunity to minimize maternal disease risk following preeclampsia..
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Affiliation(s)
- Logan C Barr
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Kiera Liblik
- Cardiovascular Imaging Network at Queen's, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Amer M Johri
- Cardiovascular Imaging Network at Queen's, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Graeme N Smith
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
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7
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Barr LC, Herr JE, Hétu MF, Smith GN, Johri AM. Increased carotid artery stiffness after preeclampsia in a cross-sectional study of postpartum women. Physiol Rep 2022; 10:e15276. [PMID: 35439370 PMCID: PMC9017974 DOI: 10.14814/phy2.15276] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 11/24/2022] Open
Abstract
Preeclampsia (PE) is a hypertensive obstetrical complication associated with increased cardiovascular disease risk. Carotid artery functional assessments allow for identification of subclinical vascular dysfunction. This cross‐sectional study measured carotid artery functional indices in healthy women with a recent pregnancy complicated by PE, versus women with a prior uncomplicated pregnancy. Women with a history of PE (N = 30) or an uncomplicated pregnancy (N = 30), were recruited between 6 months and 5 years postpartum. Left and right carotid artery ultrasound measured carotid intima media thickness, plaque burden, peak systolic velocity, end diastolic flow velocity and carotid far‐wall circumferential strain (FWCS). Carotid FWCS is inversely related to vessel stiffness, where a decrease in FWCS indicates increased vessel stiffness. Right‐side FWCS did not differ between women with a history of PE versus normotensive pregnancy. Left carotid artery FWCS was lower in formerly preeclamptic women after adjustment for diameter, pulse pressure, and heart rate compared to women following an uncomplicated pregnancy (3.35 ± 1.08 × 10−3 vs. 4.46 ± 1.40 × 10−3; p = 0.003). Those with prior severe PE had the greatest decrease in FWCS adjusted to diameter, pulse pressure, and heart rate compared to healthy controls (p = 0.02). Adjusted FWCS and total serum cholesterol were independent indicators of PE history when present in a logistic regression model with confounding variables including age, body mass index, and resting blood pressure. Further investigation is needed to elucidate if FWCS can be used as a risk stratification tool for future cardiovascular disease following a pregnancy complicated by PE. A history of PE is associated with decreased left FWCS (increased left carotid artery stiffness).
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Affiliation(s)
- Logan C Barr
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Julia E Herr
- Cardiovascular Imaging Network at Queen's, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Marie-France Hétu
- Cardiovascular Imaging Network at Queen's, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Graeme N Smith
- Department of Obstetrics & Gynaecology, Queen's University, Kingston, Ontario, Canada
| | - Amer M Johri
- Cardiovascular Imaging Network at Queen's, Department of Medicine, Queen's University, Kingston, Ontario, Canada
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8
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Aziz A, Thompson J, Gyamfi-Bannerman C, D’Alton M, Wapner R, Bello NA. The Evidence of Aspirin Use in Prevention of Adverse Pregnancy Outcomes (APOs): Should It Be Continued Long Term After an APO? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-021-00936-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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9
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High-cholesterol diet during pregnancy induces maternal vascular dysfunction in mice: potential role for oxidized LDL-induced LOX-1 and AT1 receptor activation. Clin Sci (Lond) 2021; 134:2295-2313. [PMID: 32856035 DOI: 10.1042/cs20200764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/17/2020] [Accepted: 08/26/2020] [Indexed: 01/06/2023]
Abstract
The lectin-like oxidized low-density-lipoprotein (oxLDL) receptor-1 (LOX-1) has been shown to induce angiotensin II (AngII) type 1 receptor (AT1) activation, contributing to vascular dysfunction. Preeclampsia is a pregnancy complication characterized by vascular dysfunction and increased LOX-1 and AT1 activation; however, whether LOX-1 and AT1 activity contributes to vascular dysfunction in preeclampsia is unknown. We hypothesized that increased oxLDL levels during pregnancy lead to LOX-1 activation and subsequent AT1 activation, resulting in vascular dysfunction. Pregnant wild-type (WT) and transgenic LOX-1 overexpressing (LOX-1tg) mice were fed a control diet (CD) or high-cholesterol diet (HCD, to impair vascular function) between gestational day (GD) 13.5-GD18.5. On GD18.5, AngII-induced vasoconstriction and methylcholine (MCh)-induced endothelium-dependent vasodilation responses were assessed in aortas and uterine arteries. HCD decreased fetal weight and increased circulating oxLDL/cholesterol levels in WT, but not in LOX-1tg mice. HCD did not alter AngII responsiveness or AT1 expression in both vascular beds; however, AngII responsiveness and AT1 expression were lower in aortas from LOX-1tg compared with WT mice. In aortas from WT-CD mice, acute oxLDL exposure induced AT1-mediated vasoconstriction via LOX-1. HCD impaired endothelium-dependent vasodilation and increased superoxide levels in WT aortas, but not uterine arteries. Moreover, in WT-CD mice oxLDL decreased MCh sensitivity in both vascular beds, partially via LOX-1. In summary, HCD impaired pregnancy outcomes and vascular function, and oxLDL-induced LOX-1 activation may contribute to vascular dysfunction via AT1. Our study suggests that LOX-1 could be a potential target to prevent adverse outcomes associated with vascular dysfunction in preeclampsia.
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Moe K, Sugulle M, Dechend R, Angel K, Staff AC. Functional and structural vascular biomarkers in women 1 year after a hypertensive disorder of pregnancy. Pregnancy Hypertens 2020; 21:23-29. [DOI: 10.1016/j.preghy.2020.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 11/17/2022]
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Kirollos S, Skilton M, Patel S, Arnott C. A Systematic Review of Vascular Structure and Function in Pre-eclampsia: Non-invasive Assessment and Mechanistic Links. Front Cardiovasc Med 2019. [PMID: 31803759 DOI: 10.3389/fcvm.2019.00166, 10.3389/fmed.2019.00166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Hypertensive disorders of pregnancy, such as pre-eclampsia, are known to be independently associated with the development of premature cardiovascular disease (CVD) in women. In pre-eclampsia, the placenta secretes excess anti-angiogenic factors into the maternal circulation, leading to widespread endothelial damage, and inflammation. This endothelial damage is evidenced to persist beyond the acute illness. However, whether it is permanent and responsible for the elevated rates of premature CVD seen in this at-risk group remains unclear. A systematic review of the available literature with respect to vascular structure and function prior to, during and after a pregnancy complicated by pre-eclampsia was performed. Studies non-invasively assessing vascular structure using carotid intima-media thickness (CIMT), retinal microvasculature caliber, CT coronary angiogram, or coronary calcium scores were included. Vascular function was assessed using brachial flow-mediated dilation (FMD), pulse wave analysis (PWA), and peripheral arterial tonometry (PAT). In total 59 articles were included (13 CIMT, 5 CTCA/Ca score, five retinal microvasculature, 27 FMD, 7 PAT, and 14 PWV/PWA), consisting of prospective and retrospective cohort, and case-control studies. Change in vascular structure was evidenced with significant increases in CIMT by 73-180 μm greater than that of non-affected women. This is tempered by other studies reporting resolution of structural changes postpartum, highlighting the need for further research. Accelerated coronary calcification and plaque deposition was identified, with greater rates of increased calcium scores and subclinical coronary artery disease shown by CTCA in women with a history of pre-eclampsia at 30 years postpartum. Impaired endothelial function was consistently reported prior to, during and immediately after pregnancy as evidenced by differences in FMD of 1.7-12.2% less than non-affected women, an increase in PWV by 13.2-26%, and reduced retinal microvascular caliber and arterial elasticity indices. The evidence was less conclusive for the persistence of long-term endothelial dysfunction. Understanding the underlying mechanistic links between pre-eclampsia and CVD is a key step to identifying targeted therapies aimed at "repairing the endothelium" and attenuating risk. This review has highlighted the need for a greater understanding of vascular structure and function following pre-eclampsia through high quality studies with large sample sizes, particularly in the longer postpartum period when clinical CVD disease starts to manifest.
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Affiliation(s)
- Shady Kirollos
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Michael Skilton
- Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health University of Sydney, Sydney, NSW, Australia
| | - Sanjay Patel
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Department of Coronary Diseases, The Heart Research Institute, Sydney, NSW, Australia
| | - Clare Arnott
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Department of Coronary Diseases, The Heart Research Institute, Sydney, NSW, Australia.,Department of Cardiology, The George Institute for Global Health, Sydney, NSW, Australia
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12
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Kirollos S, Skilton M, Patel S, Arnott C. A Systematic Review of Vascular Structure and Function in Pre-eclampsia: Non-invasive Assessment and Mechanistic Links. Front Cardiovasc Med 2019; 6:166. [PMID: 31803759 PMCID: PMC6873347 DOI: 10.3389/fcvm.2019.00166] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 10/30/2019] [Indexed: 12/14/2022] Open
Abstract
Hypertensive disorders of pregnancy, such as pre-eclampsia, are known to be independently associated with the development of premature cardiovascular disease (CVD) in women. In pre-eclampsia, the placenta secretes excess anti-angiogenic factors into the maternal circulation, leading to widespread endothelial damage, and inflammation. This endothelial damage is evidenced to persist beyond the acute illness. However, whether it is permanent and responsible for the elevated rates of premature CVD seen in this at-risk group remains unclear. A systematic review of the available literature with respect to vascular structure and function prior to, during and after a pregnancy complicated by pre-eclampsia was performed. Studies non-invasively assessing vascular structure using carotid intima-media thickness (CIMT), retinal microvasculature caliber, CT coronary angiogram, or coronary calcium scores were included. Vascular function was assessed using brachial flow-mediated dilation (FMD), pulse wave analysis (PWA), and peripheral arterial tonometry (PAT). In total 59 articles were included (13 CIMT, 5 CTCA/Ca score, five retinal microvasculature, 27 FMD, 7 PAT, and 14 PWV/PWA), consisting of prospective and retrospective cohort, and case-control studies. Change in vascular structure was evidenced with significant increases in CIMT by 73–180 μm greater than that of non-affected women. This is tempered by other studies reporting resolution of structural changes postpartum, highlighting the need for further research. Accelerated coronary calcification and plaque deposition was identified, with greater rates of increased calcium scores and subclinical coronary artery disease shown by CTCA in women with a history of pre-eclampsia at 30 years postpartum. Impaired endothelial function was consistently reported prior to, during and immediately after pregnancy as evidenced by differences in FMD of 1.7–12.2% less than non-affected women, an increase in PWV by 13.2–26%, and reduced retinal microvascular caliber and arterial elasticity indices. The evidence was less conclusive for the persistence of long-term endothelial dysfunction. Understanding the underlying mechanistic links between pre-eclampsia and CVD is a key step to identifying targeted therapies aimed at “repairing the endothelium” and attenuating risk. This review has highlighted the need for a greater understanding of vascular structure and function following pre-eclampsia through high quality studies with large sample sizes, particularly in the longer postpartum period when clinical CVD disease starts to manifest.
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Affiliation(s)
- Shady Kirollos
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Michael Skilton
- Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health University of Sydney, Sydney, NSW, Australia
| | - Sanjay Patel
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Department of Coronary Diseases, The Heart Research Institute, Sydney, NSW, Australia
| | - Clare Arnott
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Department of Coronary Diseases, The Heart Research Institute, Sydney, NSW, Australia.,Department of Cardiology, The George Institute for Global Health, Sydney, NSW, Australia
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Sia WW, Pertman SM, Yan RM, Tsuyuki RT. Are Preeclampsia and Adverse Obstetrical Outcomes Predictors of Cardiovascular Disease? A Case-Control Study of Women With Heart Disease. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1760-1767. [PMID: 31279766 DOI: 10.1016/j.jogc.2019.03.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study sought to determine whether preeclampsia; gestational diabetes; and adverse obstetrical outcomes such as placental abruption, intrauterine growth restriction, and preterm delivery are independent risk factors for cardiovascular disease later in life. METHODS This was a retrospective, age-matched, case-control study that surveyed 244 cases (women with confirmed coronary artery disease) and 246 controls (women who did not have coronary artery disease) on their obstetrical history and outcomes, as well as traditional cardiovascular risk factors. Analyses were performed using SAS software version 9.1.3. (Canadian Task Force Classification II-2). RESULTS Women with coronary artery disease had significantly higher rates of maternal complications such as gestational hypertension (odds ratio [OR] 3.34; 95% confidence interval [CI] 1.03-10.9), as well as conventional vascular risk factors such as dyslipidemia (OR 5.38; 95% CI 2.70-10.7), hypertension (OR 2.40; 95% CI 1.23-4.70), diabetes (OR 2.32; 95% CI 1.07-5.01), and smoking (current smoker: OR; 4.82 95% CI 1.66-14.00; former smoker: OR 2.86; 95% CI 1.43-5.71). There were more cases with preeclampsia (9.8%, vs. 5.4% in controls); however, the difference was not statistically significant. CONCLUSION Among the adverse maternal conditions, there was more gestational hypertension in women with coronary artery disease. In this study, hypertensive disorders of pregnancy were the most important maternal risk factors for cardiovascular disease later in life and should be flagged early for close monitoring and/or intervention.
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Affiliation(s)
- Winnie W Sia
- Department of Medicine, University of Alberta, Edmonton, AB.
| | - Shea M Pertman
- Department of Medicine, University of Alberta, Edmonton, AB
| | - Raymond M Yan
- Faculty of Medicine, University of Calgary, Calgary, AB
| | - Ross T Tsuyuki
- Department of Medicine, University of Alberta, Edmonton, AB
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14
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Wu F, Yang H, Liu B. Association between Homocysteine and Arterial Stiffness in Women with a History of Preeclampsia. J Vasc Res 2019; 56:152-159. [PMID: 31132776 DOI: 10.1159/000500358] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 04/15/2019] [Indexed: 11/19/2022] Open
Abstract
Growing evidence has reported that a history of preeclampsia (PE) increases the risk of developing cardiovascular disease (CVD). Arterial stiffness plays a predictive role in CVD. Previous studies have demonstrated the close association between homocysteine (Hcy) level and arterial stiffness in community-based populations. This study was to assess whether Hcy level was independently associated with arterial stiffness in 168 women with a PE history who were analyzed at a 5-year follow-up. Brachial-ankle pulse wave velocity (baPWV) was measured by an automatic pulse-wave analyzer and a value >1,400 cm/s was defined as high arterial stiffness. Biochemical parameters were recorded and an Hcy value >10 μmol/L was defined as having hyperhomocysteine (H-Hcy). Variables that were significantly associated with baPWV were tested for independence by multivariate logistic regression analysis. We found that body mass index (OR 1.017, 95% CI 1.008-1.029), systolic blood pressure (OR 1.048, 95% CI 1.019-1.072), total cholesterol (OR 1.059, 95% CI 1.007-1.086), and Hcy level (OR 1.021, 95% CI 1.010-1.037) were independent determinants of baPWV in women with previous PE. Our findings indicate that Hcy pathway might be involved in arterial stiffness in women with a PE history. Whether Hcy would be a promising biomarker for serial stratified CVD risk management in these women deserves further evaluation on a large scale.
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Affiliation(s)
- Fan Wu
- Department of Gynaecology and Obstetrics, Shanghai Tenth People's Hospital Affiliated to Tongji University, Shanghai, China
| | - Hongyan Yang
- Department of Neurology, Tongji Hospital Branch, Tongji University, Shanghai, China
| | - Bin Liu
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China,
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15
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Stanhewicz AE. Residual vascular dysfunction in women with a history of preeclampsia. Am J Physiol Regul Integr Comp Physiol 2018; 315:R1062-R1071. [PMID: 30133302 DOI: 10.1152/ajpregu.00204.2018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Preeclampsia is a hypertensive disorder of pregnancy characterized by new-onset hypertension, proteinuria, and edema occurring after 20 wk of gestation, with a prevalence of ~7-10% of pregnancies in the United States and ~8 million pregnancies worldwide. Despite the postpartum remission of preeclamptic symptoms, women who have had preeclampsia are two to four times more likely to develop cardiovascular disease (CVD) and are significantly more likely to die of CVD compared with women with a history of normal pregnancy. Although the relation between history of preeclampsia and elevated CVD risk is well documented, the mechanism(s) underlying this association remains unclear. One hypothesis explaining this association is that the initial vascular damage and dysfunction sustained during the preeclamptic pregnancy persist chronically. Indeed, even in the absence of, or in advance of, overt CVD women who have had preeclampsia have compromised vascular endothelial function. Emerging mechanistic studies in these women have provided some insight into the underlying mechanisms of this persistent vascular dysfunction and have begun to identify potential therapeutic targets for the prevention or mitigation of CVD progression in this vulnerable population. This review summarizes the existing literature examining vascular function and dysfunction in women with a history of preeclampsia and highlights future directions for mechanistic investigations and development of novel intervention strategies aimed at halting or slowing the progression of CVD in these women.
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Affiliation(s)
- Anna E Stanhewicz
- Department of Kinesiology, Pennsylvania State University , University Park, Pennsylvania
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16
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Breetveld NM, Ghossein-Doha C, van Neer J, Sengers MJJM, Geerts L, van Kuijk SMJ, van Dijk AP, van der Vlugt MJ, Heidema WM, Brunner-La Rocca HP, Scholten RR, Spaanderman MEA. Decreased endothelial function and increased subclinical heart failure in women several years after pre-eclampsia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:196-204. [PMID: 28557250 DOI: 10.1002/uog.17534] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/05/2017] [Accepted: 05/19/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Pre-eclampsia (PE) is associated with both postpartum endothelial dysfunction and asymptomatic structural heart alterations consistent with heart failure Stage B (HF-B). In this study, we assessed the relationship between endothelial function, measured by flow-mediated dilation (FMD), and HF-B in women with a history of PE. METHODS This was an observational study in which 67 formerly pre-eclamptic women (≥ 4 years postpartum) and 37 healthy parous controls were assessed ultrasonographically for cardiac function and geometry, as well as for endothelial function by means of brachial artery FMD. HF-B was diagnosed as left ventricular hypertrophy (left ventricular mass index (LVMi) > 95 g/m2 ), concentric remodeling (relative wall thickness > 0.42 and LVMi ≤ 95 g/m2 ), mild systolic dysfunction (left ventricular ejection fraction > 40% and < 55%) or asymptomatic valvular disease. Cardiovascular and metabolic syndrome variables were compared between women with history of PE and controls, as well as between those in the formerly pre-eclamptic group who had HF Stage A, HF-B or no HF. Logistic regression analysis was performed to assess the associations of FMD with PE, metabolic syndrome risk factors and obstetric parameters. RESULTS The prevalence of HF-B amongst formerly pre-eclamptic women was three-fold higher than that observed for controls (25% vs 8%, P < 0.05), while FMD was lower in formerly pre-eclamptic women compared with controls (6.12% vs 8.22%, P < 0.01); history of PE remained associated independently with lower FMD after adjusting for metabolic syndrome risk factors and obstetric parameters (β, -1.88; 95% CI, -3.59 to -0.18). However, HF-B did not relate to low FMD in formerly pre-eclamptic women. CONCLUSIONS Years after pregnancy, formerly pre- eclamptic women have lower FMD and have HF-B more often compared with healthy parous controls. Nonetheless, HF-B was not related to reduced FMD. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- N M Breetveld
- Department of Obstetrics and Gynecology, Research School GROW, Maastricht University Medical Center, Maastricht, The Netherlands
| | - C Ghossein-Doha
- Department of Obstetrics and Gynecology, Research School GROW, Maastricht University Medical Center, Maastricht, The Netherlands
| | - J van Neer
- Department of Obstetrics and Gynecology, Research School GROW, Maastricht University Medical Center, Maastricht, The Netherlands
| | - M J J M Sengers
- Department of Obstetrics and Gynecology, Research School GROW, Maastricht University Medical Center, Maastricht, The Netherlands
| | - L Geerts
- Department of Obstetrics and Gynecology, Research School GROW, Maastricht University Medical Center, Maastricht, The Netherlands
| | - S M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht, University Medical Center, Maastricht, The Netherlands
| | - A P van Dijk
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M J van der Vlugt
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - W M Heidema
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H P Brunner-La Rocca
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R R Scholten
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M E A Spaanderman
- Department of Obstetrics and Gynecology, Research School GROW, Maastricht University Medical Center, Maastricht, The Netherlands
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Benschop L, Bergen NE, Schalekamp–Timmermans S, Jaddoe VW, Mulder MT, Steegers EA, Roeters van Lennep JE. Maternal lipid profile 6 years after a gestational hypertensive disorder. J Clin Lipidol 2018; 12:428-436.e4. [DOI: 10.1016/j.jacl.2017.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 12/08/2017] [Accepted: 12/19/2017] [Indexed: 01/21/2023]
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Namugowa A, Iputo J, Wandabwa J, Meeme A, Buga GAB, Abura S, Stofile YY. Arterial stiffness in women previously with preeclampsia from a semi-rural region of South Africa. Clin Exp Hypertens 2018; 41:36-43. [PMID: 29473758 DOI: 10.1080/10641963.2018.1441858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Women with pre-eclampsia have an increased risk of cardiovascular disease later in life. The aim of the study was to establish the presence and pattern of arterial stiffness in women previously with pre-eclampsia from a semi-rural region of South Africa. This was a prospective longitudinal study which involved 36 previously pre-eclamptic women and 86 non-pregnant controls (NPC) who had a past history of non-complicated pregnancy. Maternal wave reflection (augmentation index) and carotid-femoral pulse wave velocity were assessed noninvasively, using applanation tonometry with the SphygmoCor device. Endothelial function was assessed by EndoPAT 2000 device; pneumatic probes were fitted to the index fingers; induced flow-mediated reactive hyperemia; the ratio of the readings before and after occlusion was then used to calculate the score, the reactive hyperemia index (RHI) as a measure of endothelial function. Pulse wave velocity remained significantly higher in previously pre-eclamptic women than non-pregnant controls up to three months after delivery (p < 0.05), then it reduced to nonsignificant values. All blood pressure indices (central and brachial pressures), were higher in previously pre-eclamptic women as compared to nonpregnant controls up to one year postpartum. Regional (aortic) arterial stiffness, though it persists for some time after delivery, is transitory in previously pre-eclamptic women from the rural Africa setting. However, their increase blood pressure is an indication of compromised arterial compliance in women previously with pre-eclampsia.
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Affiliation(s)
- A Namugowa
- a Department of Human Biology, Faculty of Health Sciences , Walter Sisulu University , Mthatha , South Africa
| | - J Iputo
- a Department of Human Biology, Faculty of Health Sciences , Walter Sisulu University , Mthatha , South Africa
| | - J Wandabwa
- c Faculty of Health Sciences , Busitema University , Mbale , Uganda
| | - A Meeme
- b Departments of Obstetrics and Gynaecology and, Faculty of Health Sciences , Walter Sisulu University , Mthatha , South Africa
| | - G A B Buga
- b Departments of Obstetrics and Gynaecology and, Faculty of Health Sciences , Walter Sisulu University , Mthatha , South Africa
| | - S Abura
- a Department of Human Biology, Faculty of Health Sciences , Walter Sisulu University , Mthatha , South Africa
| | - Y Y Stofile
- a Department of Human Biology, Faculty of Health Sciences , Walter Sisulu University , Mthatha , South Africa
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Abstract
Pregnancy is known to induce rapid, progressive, and substantial changes to the cardiovascular system, ultimately facilitating successful pregnancy outcomes. Women who develop hypertensive disorders during pregnancy are considered to have "failed" the cardiovascular stress test of pregnancy and likely represent a subpopulation with inadequate cardiovascular accommodation. Preeclampsia is a serious complication with a myriad of manifestations in both mother and offspring. This pregnancy syndrome is a polygenic disease and has now been linked to a greater incidence of cardiovascular disease. Moreover, offsprings born to preeclamptic mothers exhibit an elevated risk of cardiovascular disease, stroke, and mental disorders during adulthood. This suggests that preeclampsia not only exposes the mother and the fetus to complications during pregnancy but also programs chronic diseases during adulthood in the offspring. The etiology of preeclampsia remains unknown, with various theories being suggested to explain its origin. It is primarily thought to be associated with poor placentation and entails excessive maternal inflammation and endothelial dysfunction. It is well established now that the maternal immune system and the placenta are involved in a highly choreographed cross talk that underlies adequate spiral artery remodeling required for uteroplacental perfusion and free flow of nutrients to the fetus. Although it is not clear whether immunological alterations occur early during pregnancy, studies have proposed that dysregulated systemic and placental immunity contribute to impaired angiogenesis and the onset of preeclampsia. Recently emerged strong evidence suggests a potential link among epigenetics, microRNAs (miRNAs), and pregnancy complications. This chapter will focus on important aspects of epigenetics, immunological aspects, and cardiovascular and vascular remodeling of preeclampsia.
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20
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Endothelial and kidney function in women with a history of preeclampsia and healthy parous controls: A case control study. Microvasc Res 2017; 116:71-76. [PMID: 29126987 DOI: 10.1016/j.mvr.2017.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 10/07/2017] [Accepted: 11/06/2017] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Preeclampsia (PE) is a pregnancy related endothelial disease characterized by hypertension and albuminuria. Postpartum endothelial dysfunction often persists in these women. We postulate that in women with a history of PE reduced endothelial dependent vasodilation coincides with attenuated kidney function, as both reflect endothelial dysfunction. METHODS We assessed endothelial and kidney function in women with a history of PE (n=79) and uncomplicated pregnancies (n=49) at least 4years postpartum. Women with hypertension, diabetes or kidney disease prior to pregnancy were excluded. Brachial artery flow mediated dilatation (FMD) was measured and analysed by a custom designed edge-detection and wall-tracking software. We measured albumin and creatinine levels in a 24-h urine sample and calculated glomerular filtration rate (GFR) by CKD-EPI. RESULTS Women with a history of PE had lower FMD but comparable GFR and albumin creatinine ratio (ACR) compared with controls. Independent of obstetric history, in both controls and women with a history of PE respectively, GFR (r=0.19, p=0.17 and r=0.12, p=0.29) and albumin creatinine ratio (r=0.07, p=0.62 and r=0.06 p=0.57) did not correlate with FMD. CONCLUSION At least 4years after pregnancy, women with a history of PE demonstrated decreased flow mediated dilatation when compared to healthy parous controls. In this study, decreased flow mediated dilation however did not coincide with decreased kidney function.
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21
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Giachini FR, Galaviz-Hernandez C, Damiano AE, Viana M, Cadavid A, Asturizaga P, Teran E, Clapes S, Alcala M, Bueno J, Calderón-Domínguez M, Ramos MP, Lima VV, Sosa-Macias M, Martinez N, Roberts JM, Escudero C. Vascular Dysfunction in Mother and Offspring During Preeclampsia: Contributions from Latin-American Countries. Curr Hypertens Rep 2017; 19:83. [PMID: 28986756 DOI: 10.1007/s11906-017-0781-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Pregnancy is a physiologically stressful condition that generates a series of functional adaptations by the cardiovascular system. The impact of pregnancy on this system persists from conception beyond birth. Recent evidence suggests that vascular changes associated with pregnancy complications, such as preeclampsia, affect the function of the maternal and offspring vascular systems, after delivery and into adult life. Since the vascular system contributes to systemic homeostasis, defective development or function of blood vessels predisposes both mother and infant to future risk for chronic disease. These alterations in later life range from fertility problems to alterations in the central nervous system or immune system, among others. It is important to note that rates of morbi-mortality due to pregnancy complications including preeclampsia, as well as cardiovascular diseases, have a higher incidence in Latin-American countries than in more developed countries. Nonetheless, there is a lack both in the amount and impact of research conducted in Latin America. An impact, although smaller, can be seen when research in vascular disorders related to problems during pregnancy is analyzed. Therefore, in this review, information about preeclampsia and endothelial dysfunction generated from research groups based in Latin-American countries will be highlighted. We relate the need, as present in many other countries in the world, for increased effective regional and international collaboration to generate new data specific to our region on this topic.
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Affiliation(s)
- Fernanda Regina Giachini
- Laboratory of Vascular Biology, Institute of Health Sciences and Health, Universidade Federal de Mato Grosso, Barra do Garcas, MT, Brazil
| | | | - Alicia E Damiano
- Laboratorio de Biología de la Reproducción, IFIBIO Houssay-UBA-CONICET, Buenos Aires, Argentina.,Departamento de Ciencias Biológicas, Facultad de Farmacia y Bioquimica, UBA, Buenos Aires, Argentina
| | - Marta Viana
- Biochemistry and Molecular Biology, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Angela Cadavid
- Grupo Reproducción, Departamento de Fisiologia, Facultad de Medicina Universidad de Antioquia, Medellin, Colombia
| | | | - Enrique Teran
- Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador
| | - Sonia Clapes
- Universidad de Ciencias Médicas de La Habana, Havana, Cuba
| | - Martin Alcala
- Biochemistry and Molecular Biology, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Julio Bueno
- Grupo Reproducción, Departamento de Fisiologia, Facultad de Medicina Universidad de Antioquia, Medellin, Colombia
| | - María Calderón-Domínguez
- Biochemistry and Molecular Biology, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - María P Ramos
- Biochemistry and Molecular Biology, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Victor Vitorino Lima
- Laboratory of Vascular Biology, Institute of Health Sciences and Health, Universidade Federal de Mato Grosso, Barra do Garcas, MT, Brazil
| | - Martha Sosa-Macias
- Pharmacogenomics Academia, Instituto Politécnico Nacional-CIIDIR Durango, Durango, Mexico
| | - Nora Martinez
- Laboratorio de Biología de la Reproducción, IFIBIO Houssay-UBA-CONICET, Buenos Aires, Argentina
| | - James M Roberts
- Magee-Womens Research Institute, Departments of Obstetrics, Gynecology and Reproductive Sciences, Epidemiology, and the Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carlos Escudero
- Vascular Physiology Laboratory Group of Investigation in Tumor Angiogenesis (GIANT) Group of Research and Innovation in Vascular Health (GRIVAS Health) Basic Sciences Department Faculty of Sciences, Universidad del Bio-Bio, Chillan, Chile.
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Kyung Choi S, Chul Shin J, Gyu Park Y, Yang Park I, Young Kwon J, Sun Ko H, Hee Kim Y. The efficacy of peripartum transthoracic echocardiography in women with preeclampsia. Pregnancy Hypertens 2017; 10:187-191. [DOI: 10.1016/j.preghy.2017.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 04/11/2017] [Accepted: 05/01/2017] [Indexed: 10/19/2022]
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Osol G, Ko NL, Mandalà M. Altered Endothelial Nitric Oxide Signaling as a Paradigm for Maternal Vascular Maladaptation in Preeclampsia. Curr Hypertens Rep 2017; 19:82. [PMID: 28942512 DOI: 10.1007/s11906-017-0774-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW The goal of this review is to present the newest insights into what we view as a central failure of cardiovascular adaptation in preeclampsia (PE) by focusing on one clinically significant manifestation of maternal endothelial dysfunction: nitric oxide signaling. The etiology, symptoms, and current theories of the PE syndrome are described first, followed by a review of the available evidence, and underlying causes of reduced endothelial nitric oxide (NO) signaling in PE. RECENT FINDINGS PE maladaptations include, but are not limited to, altered physiological stimulatory inputs (e.g., estrogen; VEGF/PlGF; shear stress) and substrates (L-Arg; ADMA), augmented placental secretion of anti-angiogenic and inflammatory factors such as sFlt-1 and Eng, changes in eNOS (polymorphisms, expression), and reduced bioavailability of NO secondary to oxidative stress. PE is a complex obstetrical syndrome that is associated with maternal vascular dysfunction. Diminished peripheral endothelial vasodilator influence in general, and of NO signaling specifically, are key in driving disease progression and severity.
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Affiliation(s)
- George Osol
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont College of Medicine, Given H.S.C. C-217A 89 Beaumont Ave, Burlington, VT, 5405, USA.
| | - Nga Ling Ko
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont College of Medicine, Given H.S.C. C-217A 89 Beaumont Ave, Burlington, VT, 5405, USA
| | - Maurizio Mandalà
- Department of Biology, Ecology and Earth Science, University of Calabria, Cosenza, Italy
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Jayachandran M, Garovic VD, Mielke MM, Bailey KR, Lahr BD, Miller VM. Characterization of intravascular cellular activation in relationship to subclinical atherosclerosis in postmenopausal women. PLoS One 2017; 12:e0183159. [PMID: 28910282 PMCID: PMC5598935 DOI: 10.1371/journal.pone.0183159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 07/31/2017] [Indexed: 02/02/2023] Open
Abstract
Objective Mechanisms and interactions among intravascular cells contributing to development of subclinical atherosclerosis are poorly understood. In women, both menopausal status and pregnancy history influence progression of atherosclerosis. This study examined activation and interactions among blood elements with subclinical atherosclerosis in menopausal women with known pregnancy histories. Methods Carotid intima-media thickness (CIMT), as a marker of subclinical atherosclerosis, was measured using B-mode ultrasound in age- and parity-matched women [40 with and 40 without a history of preeclampsia] 35 years after the index pregnancy. Interactions among intravascular cells (38 parameters) were measured by flow cytometry in venous blood. Data analysis was by principal component which retained 7 independent dimensions accounting for 63% of the variability among 38 parameters. Results CIMT was significantly greater in women with a history of preeclampsia (P = 0.004). Platelet aggregation and platelet interactions with granulocytes and monocytes positively associated with CIMT in postmenopausal women independent of their pregnancy history (ρ = 0.258, P< 0.05). However, the association of the number of platelets, platelet activation and monocyte-platelet interactions with CIMT differed significantly depending upon pregnancy history (test for interaction, P<0.001). Conclusion Interactions among actived intravascular cells and their association with subclinical atherosclerosis differ in women depending upon their pregnancy histories.
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Affiliation(s)
- Muthuvel Jayachandran
- Departments of Surgery, Mayo Clinic, Rochester, Minnesota, United States of America
- Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Vesna D. Garovic
- General Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Michelle M. Mielke
- Health Science Research, Division of Epidemiology, Mayo Clinic, Rochester, Minnesota, United States of America
- Neurology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Kent R. Bailey
- Health Science Research, Division of Epidemiology, Mayo Clinic, Rochester, Minnesota, United States of America
- Health Science Research, Division of Biostatistics, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Brian D. Lahr
- Health Science Research, Division of Epidemiology, Mayo Clinic, Rochester, Minnesota, United States of America
- Health Science Research, Division of Biostatistics, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Virginia M. Miller
- Departments of Surgery, Mayo Clinic, Rochester, Minnesota, United States of America
- Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, United States of America
- * E-mail:
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Groenhof TKJ, van Rijn BB, Franx A, Roeters van Lennep JE, Bots ML, Lely AT. Preventing cardiovascular disease after hypertensive disorders of pregnancy: Searching for the how and when. Eur J Prev Cardiol 2017; 24:1735-1745. [PMID: 28895439 PMCID: PMC5669282 DOI: 10.1177/2047487317730472] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Women with a history of a hypertensive disorder during pregnancy (HDP) have an increased risk of cardiovascular events. Guidelines recommend assessment of cardiovascular risk factors in these women later in life, but provide limited advice on how this follow-up should be organized. Design Systematic review and meta-regression analysis. Methods The aim of our study was to provide an overview of existing knowledge on the changes over time in three major modifiable components of cardiovascular risk assessment after HDP: blood pressure, glucose homeostasis and lipid levels. Data from 44 studies and up to 6904 women with a history of a HDP were compared with risk factor levels reported for women of corresponding age in the National Health And Nutrition Examination Survey, Estudio Epidemiólogico de la Insuficiencia Renal en España and Hong Kong cohorts (N = 27,803). Results Compared with the reference cohort, women with a HDP presented with higher mean blood pressure. Hypertension was present in a higher rate among women with a previous HDP from 15 years postpartum onwards. At 15 years postpartum (±age 45), one in five women with a history of a HDP suffer from hypertension. No differences in glucose homeostasis parameters or lipid levels were observed. Conclusions Based on our analysis, it is not possible to point out a time point to commence screening for cardiovascular risk factors in women after a HDP. We recommend redirection of future research towards the development of a stepwise approach identifying the women with the highest cardiovascular risk.
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Affiliation(s)
- T Katrien J Groenhof
- 1 Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, The Netherlands
| | - Bas B van Rijn
- 1 Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, The Netherlands.,2 Academic Unit of Human Development and Health, Institute for Life Sciences, University of Southampton, UK
| | - Arie Franx
- 1 Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, The Netherlands
| | | | - Michiel L Bots
- 4 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - A Titia Lely
- 1 Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, The Netherlands
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Milic NM, Milin-Lazovic J, Weissgerber TL, Trajkovic G, White WM, Garovic VD. Preclinical atherosclerosis at the time of pre-eclamptic pregnancy and up to 10 years postpartum: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:110-115. [PMID: 27859887 PMCID: PMC5310936 DOI: 10.1002/uog.17367] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 10/29/2016] [Accepted: 11/14/2016] [Indexed: 05/07/2023]
Abstract
OBJECTIVES Pre-eclampsia (PE) is a pregnancy-specific hypertensive disorder that has been associated with cardiovascular risk factors and vascular changes, such as acute atherosis in placental blood vessels, similar to early-stage atherosclerosis. The objective of this study was to determine whether women with PE have increased atherosclerotic burden, as determined by the carotid intima-media thickness (CIMT), compared with women without PE. METHODS We conducted a systematic review and meta-analysis of studies that reported CIMT, a non-invasive, ultrasound-based measure of subclinical atherosclerosis, in women who did vs those who did not have PE. Studies were eligible if they had been conducted during pregnancy or during the first decade postpartum, and if CIMT was measured in the common carotid artery. Studies published before 7 March 2016 were identified through PubMed, EMBASE and Web of Science. Two reviewers used predefined forms and protocols to evaluate independently the eligibility of studies based on titles and abstracts and to perform full-text screening, data abstraction and quality assessment. Heterogeneity was assessed using the I2 statistic. Standardized mean difference (SMD) was used as a measure of effect size. RESULTS Fourteen studies were included in the meta-analysis. Seven studies were carried out during pregnancy complicated by PE, 10 were carried out up to 10 years postpartum and three included measurements obtained at both time periods. Women who had PE had significantly higher CIMT than did those who did not have PE, both at the time of diagnosis (SMD, 1.10 (95% CI, 0.73-1.48); P < 0.001) and in the first decade postpartum (SMD, 0.58 (95% CI, 0.36-0.79); P < 0.001). CONCLUSIONS Atherosclerotic load is present at the time of PE and may be a mechanism associated with the disease. Measurement of CIMT may offer an opportunity for the early identification of premenopausal women with atherosclerotic burden after a PE pregnancy. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- Natasa M. Milic
- Department of Biostatistics, Medical Faculty, University of Belgrade, Belgrade, Serbia, Mayo Clinic, Rochester, MN 55905, USA
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA
| | - Jelena Milin-Lazovic
- Department of Biostatistics, Medical Faculty, University of Belgrade, Belgrade, Serbia, Mayo Clinic, Rochester, MN 55905, USA
| | - Tracey L. Weissgerber
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA
| | - Goran Trajkovic
- Department of Biostatistics, Medical Faculty, University of Belgrade, Belgrade, Serbia, Mayo Clinic, Rochester, MN 55905, USA
| | - Wendy M. White
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 55905, USA
| | - Vesna D. Garovic
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 55905, USA
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Grand’Maison S, Pilote L, Okano M, Landry T, Dayan N. Markers of Vascular Dysfunction After Hypertensive Disorders of Pregnancy. Hypertension 2016; 68:1447-1458. [DOI: 10.1161/hypertensionaha.116.07907] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 06/28/2016] [Accepted: 09/12/2016] [Indexed: 12/15/2022]
Abstract
Women with prior hypertensive disorders of pregnancy (HDP) are at twice the risk of cardiovascular disease compared with women with prior normotensive pregnancy, possibly because of sustained vascular dysfunction after delivery. The aim of this systematic review and meta-analysis is to summarize evidence of vascular dysfunction at least 3 months after HDP. Articles in all languages were retrieved from principal databases. Studies included were observational, with HDP as the main exposure and measurements of vascular dysfunction via imaging modalities or serum biomarkers as the main outcome, assessed at least 3 months postpartum. We pooled results of modalities reported in >3 studies using a random effects model. Of 6109 potentially relevant studies, 72 were included that evaluated 10 imaging modalities and 11 serum biomarkers in 8702 women. There was evidence of vascular dysfunction in women post HDP compared with women with prior normal pregnancy when measured by carotid-femoral pulse wave velocity (0.64 m/s [0.17–1.11]), carotid intima–media thickness (0.025 mm [0.004–0.045]), and augmentation index (5.48% [1.58–9.37]), as well as mean levels of soluble fms-like tyrosine kinase (6.12 pg/mL [1.91–10.33]). Between-groups differences in measures of vascular dysfunction were more pronounced when assessments were performed in younger women (<40 years) or closer to the index pregnancy for almost all modalities. In conclusion, pooled data from studies evaluating vascular imaging suggest that some vascular dysfunction persists after HDP as compared with women with prior normal pregnancy.
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Affiliation(s)
- Sophie Grand’Maison
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada (S.G., L.P., M.O.); Research Institute (S.G., L.P., N.D.), Division of General Internal Medicine (L.P., N.D.), and Medical Library (T.L.), McGill University Health Centre, Montreal, Quebec, Canada
| | - Louise Pilote
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada (S.G., L.P., M.O.); Research Institute (S.G., L.P., N.D.), Division of General Internal Medicine (L.P., N.D.), and Medical Library (T.L.), McGill University Health Centre, Montreal, Quebec, Canada
| | - Marisa Okano
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada (S.G., L.P., M.O.); Research Institute (S.G., L.P., N.D.), Division of General Internal Medicine (L.P., N.D.), and Medical Library (T.L.), McGill University Health Centre, Montreal, Quebec, Canada
| | - Tara Landry
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada (S.G., L.P., M.O.); Research Institute (S.G., L.P., N.D.), Division of General Internal Medicine (L.P., N.D.), and Medical Library (T.L.), McGill University Health Centre, Montreal, Quebec, Canada
| | - Natalie Dayan
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada (S.G., L.P., M.O.); Research Institute (S.G., L.P., N.D.), Division of General Internal Medicine (L.P., N.D.), and Medical Library (T.L.), McGill University Health Centre, Montreal, Quebec, Canada
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Harville EW, Juonala M, Viikari JSA, Kähönen M, Raitakari OT. Vascular ultrasound measures before pregnancy and pregnancy complications: A prospective cohort study. Hypertens Pregnancy 2016; 36:53-58. [PMID: 27858505 DOI: 10.1080/10641955.2016.1237643] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To examine the relationship between pre-pregnancy indicators of cardiovascular risk and pregnancy complications and outcomes. STUDY DESIGN Data from 359 female participants in the Cardiovascular Risk in Young Finns Study were linked with the national birth registry. Flow-mediated dilatation (FMD; maximum change in the left brachial artery diameter after rest and hyperemia); carotid intima-media thickness (IMT); Young's elastic modulus (YEM); and carotid artery distensibility (Cdist) at the visit prior to the pregnancy were examined as predictors of hypertensive disorders, birthweight, and gestational age using multivariable linear regression with adjustment for confounders (age, BMI, smoking, and socioeconomic status). RESULTS No relations were seen between FMD, IMT, or the stiffness indices, and hypertensive disorders. Higher pre-pregnancy FMD was associated with lower gestational age, while increased Cdist was associated with reduced birthweight-for-gestational-age. CONCLUSIONS Some cardiovascular ultrasound measures of pre-pregnancy may predict pregnancy complications, but the association is likely to be small.
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Affiliation(s)
- Emily W Harville
- a Department of Epidemiology , Tulane University School of Public Health , New Orleans , Louisiana , USA
| | - Markus Juonala
- b Department of Medicine, University of Turku and Division of Medicine , Turku University Hospital , Turku , Finland.,c Murdoch Childrens Research Institute , Parkville , Victoria , Australia
| | - Jorma S A Viikari
- b Department of Medicine, University of Turku and Division of Medicine , Turku University Hospital , Turku , Finland
| | - Mika Kähönen
- d Department of Clinical Psychology , Tampere University Hospital and University of Tampere , Tampere , Finland
| | - Olli T Raitakari
- e The Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku and Department of Clinical Physiology , Turku University Hospital , Turku , Finland
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van der Graaf AM, Paauw ND, Toering TJ, Feelisch M, Faas MM, Sutton TR, Minnion M, Lefrandt JD, Scherjon SA, Franx A, Navis G, Lely AT. Impaired sodium-dependent adaptation of arterial stiffness in formerly preeclamptic women: the RETAP-vascular study. Am J Physiol Heart Circ Physiol 2016; 310:H1827-33. [DOI: 10.1152/ajpheart.00010.2016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 04/06/2016] [Indexed: 12/27/2022]
Abstract
Women with a history of preeclampsia have an increased risk for cardiovascular diseases later in life. Persistent vascular alterations in the postpartum period might contribute to this increased risk. The current study assessed arterial stiffness under low sodium (LS) and high sodium (HS) conditions in a well-characterized group of formerly early-onset preeclamptic (fPE) women and formerly pregnant (fHP) women. Eighteen fHP and 18 fPE women were studied at an average of 5 yr after pregnancy on 1 wk of LS (50 mmol Na+/day) and 1 wk of HS (200 mmol Na+/day) intake. Arterial stiffness was measured by pulse-wave analysis (aortic augmentation index, AIx) and carotid-femoral pulse-wave velocity (PWV). Circulating markers of the renin-angiotensin aldosterone system (RAAS), extracellular volume (ECV), nitric oxide (NO), and hydrogen sulfide (H2S) were measured in an effort to identify potential mechanistic elements underlying adaptation of arterial stiffness. AIx was significantly lower in fHP women on LS compared with HS while no difference in AIx was apparent in fPE women. PWV remained unchanged upon different sodium loads in either group. Comparable sodium-dependent changes in RAAS, ECV, and NO/H2S were observed in fHP and fPE women. fPE women have an impaired ability to adapt their arterial stiffness in response to changes in sodium intake, independently of blood pressure, RAAS, ECV, and NO/H2S status. The pathways involved in impaired adaptation of arterial stiffness, and its possible contribution to the increased long-term risk for cardiovascular diseases in fPE women, remain to be investigated. Listen to this article's corresponding podcast at http://ajpheart.podbean.com/e/vascular-health-after-preeclampsia/ .
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Affiliation(s)
- Anne Marijn van der Graaf
- Department of Pathology and Medical Biology, Division of Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Nina D. Paauw
- Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tsjitske J. Toering
- Department of Pathology and Medical Biology, Division of Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Martin Feelisch
- Clinical and Experimental Sciences, Faculty of Medicine, NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Marijke M. Faas
- Department of Pathology and Medical Biology, Division of Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, Groningen, the Netherlands
| | - Thomas R. Sutton
- Clinical and Experimental Sciences, Faculty of Medicine, NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Magdalena Minnion
- Clinical and Experimental Sciences, Faculty of Medicine, NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Joop. D. Lefrandt
- Department of Vascular Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; and
| | - Sicco A. Scherjon
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, Groningen, the Netherlands
| | - Arie Franx
- Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gerjan Navis
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, Groningen, the Netherlands
| | - A. Titia Lely
- Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
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Valensise H, Lo Presti D, Gagliardi G, Tiralongo GM, Pisani I, Novelli GP, Vasapollo B. Persistent Maternal Cardiac Dysfunction After Preeclampsia Identifies Patients at Risk for Recurrent Preeclampsia. Hypertension 2016; 67:748-53. [PMID: 26902488 DOI: 10.1161/hypertensionaha.115.06674] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 12/17/2015] [Indexed: 11/16/2022]
Abstract
The purpose of our study was to assess cardiac function in nonpregnant women with previous early preeclampsia before a second pregnancy to highlight the cardiovascular pattern, which may take a risk for recurrent preeclampsia. Seventy-five normotensive patients with previous preeclampsia and 147 controls with a previous uneventful pregnancy were enrolled in a case-control study and submitted to echocardiographic examination in the nonpregnant state 12 to 18 months after the first delivery. All patients included in the study had pregnancy within 24 months from the echocardiographic examination and were followed until term. Twenty-two (29%) of the 75 patients developed recurrent preeclampsia. In the nonpregnant state, patients with recurrent preeclampsia compared with controls and nonrecurrent preeclampsia had lower stroke volume (63 ± 14 mL versus 73 ± 12 mL and 70 ± 11 mL, P<0.05), cardiac output (4.6 ± 1.2 L versus 5.3 ± 0.9 L and 5.2 ± 1.0 L, P<0.05), higher E/E' ratio (11.02 ± 3.43 versus 7.34 ± 2.11 versus 9.03 ± 3.43, P<0.05), and higher total vascular resistance (1638 ± 261 dyne · s(-1) · cm(-5) versus 1341 ± 270 dyne · s(-1) · cm(-5) and 1383 ± 261 dyne · s(-1) · cm(-5), P<0.05). Left ventricular mass index was higher in both recurrent and nonrecurrent preeclampsia compared with controls (30.0 ± 6.3 g/m(2.7) and 30.4 ± 6.8 g/m(2.7) versus 24.8 ± 5.0 g/m(2.7), P<0.05). Signs of diastolic dysfunction and different left ventricular characteristics are present in the nonpregnant state before a second pregnancy with recurrent preeclampsia. Previous preeclamptic patients with nonrecurrent preeclampsia show left ventricular structural and functional features intermediate with respect to controls and recurrent preeclampsia.
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Affiliation(s)
- Herbert Valensise
- From the Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy (H.V., D.L.P., G.G., G.M.T., I.P.); Department of Cardiology, San Sebastiano Martire Hospital-Frascati, Rome, Italy (G.P.N.); and Department of Obstetrics and Gynecology, AFaR, Associazione Fatebenefratelli per la Ricerca, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy (B.V.).
| | - Damiano Lo Presti
- From the Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy (H.V., D.L.P., G.G., G.M.T., I.P.); Department of Cardiology, San Sebastiano Martire Hospital-Frascati, Rome, Italy (G.P.N.); and Department of Obstetrics and Gynecology, AFaR, Associazione Fatebenefratelli per la Ricerca, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy (B.V.)
| | - Giulia Gagliardi
- From the Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy (H.V., D.L.P., G.G., G.M.T., I.P.); Department of Cardiology, San Sebastiano Martire Hospital-Frascati, Rome, Italy (G.P.N.); and Department of Obstetrics and Gynecology, AFaR, Associazione Fatebenefratelli per la Ricerca, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy (B.V.)
| | - Grazia Maria Tiralongo
- From the Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy (H.V., D.L.P., G.G., G.M.T., I.P.); Department of Cardiology, San Sebastiano Martire Hospital-Frascati, Rome, Italy (G.P.N.); and Department of Obstetrics and Gynecology, AFaR, Associazione Fatebenefratelli per la Ricerca, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy (B.V.)
| | - Ilaria Pisani
- From the Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy (H.V., D.L.P., G.G., G.M.T., I.P.); Department of Cardiology, San Sebastiano Martire Hospital-Frascati, Rome, Italy (G.P.N.); and Department of Obstetrics and Gynecology, AFaR, Associazione Fatebenefratelli per la Ricerca, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy (B.V.)
| | - Gian Paolo Novelli
- From the Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy (H.V., D.L.P., G.G., G.M.T., I.P.); Department of Cardiology, San Sebastiano Martire Hospital-Frascati, Rome, Italy (G.P.N.); and Department of Obstetrics and Gynecology, AFaR, Associazione Fatebenefratelli per la Ricerca, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy (B.V.)
| | - Barbara Vasapollo
- From the Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy (H.V., D.L.P., G.G., G.M.T., I.P.); Department of Cardiology, San Sebastiano Martire Hospital-Frascati, Rome, Italy (G.P.N.); and Department of Obstetrics and Gynecology, AFaR, Associazione Fatebenefratelli per la Ricerca, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy (B.V.)
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Weissgerber TL, Milic NM, Milin-Lazovic JS, Garovic VD. Impaired Flow-Mediated Dilation Before, During, and After Preeclampsia: A Systematic Review and Meta-Analysis. Hypertension 2016; 67:415-23. [PMID: 26711737 PMCID: PMC4713258 DOI: 10.1161/hypertensionaha.115.06554] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 12/07/2015] [Indexed: 11/16/2022]
Abstract
Endothelial dysfunction is believed to play a critical role in preeclampsia; however, it is unclear whether this dysfunction precedes the pregnancy or is caused by pathophysiological events in early pregnancy. It is also unclear for how long vascular dysfunction may persist postpartum and whether it represents a mechanism linking preeclampsia with future cardiovascular disease. Our objective was to determine whether women with preeclampsia had worse vascular function compared with women who did not have preeclampsia by performing a systematic review and meta-analysis of studies that examined endothelial dysfunction using flow-mediated dilation. We included studies published before May 29, 2015, that examined flow-mediated dilation before, during, or after preeclampsia. Differences in flow-mediated dilation between study groups were evaluated by standardized mean differences. Out of 610 abstracts identified through PubMED, EMBASE, and Web of Science, 37 studies were eligible for the meta-analysis. When compared with women who did not have preeclampsia, women who had preeclampsia had lower flow-mediated dilation before the development of preeclampsia (≈20-29 weeks gestation), at the time of preeclampsia, and for 3 years postpartum, with the estimated magnitude of the effect ranging between 0.5 and 3 standard deviations. Similar effects were observed when the analysis was limited to studies that excluded women with chronic hypertension, smokers, or both. Vascular dysfunction predates preeclampsia and may contribute to its pathogenesis. Future studies should address whether vascular changes that persist after preeclamptic pregnancies may represent a mechanistic link with increased risk for future cardiovascular disease.
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Affiliation(s)
- Tracey L Weissgerber
- From the Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN (T.L.W., N.M.M., V.D.G.); and Department of Biostatistics, Medical Faculty, University of Belgrade, Serbia (N.M.M., J.S.M.-L.).
| | - Natasa M Milic
- From the Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN (T.L.W., N.M.M., V.D.G.); and Department of Biostatistics, Medical Faculty, University of Belgrade, Serbia (N.M.M., J.S.M.-L.)
| | - Jelena S Milin-Lazovic
- From the Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN (T.L.W., N.M.M., V.D.G.); and Department of Biostatistics, Medical Faculty, University of Belgrade, Serbia (N.M.M., J.S.M.-L.)
| | - Vesna D Garovic
- From the Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN (T.L.W., N.M.M., V.D.G.); and Department of Biostatistics, Medical Faculty, University of Belgrade, Serbia (N.M.M., J.S.M.-L.)
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Stergiotou I, Bijnens B, Cruz-Lemini M, Figueras F, Gratacos E, Crispi F. Maternal subclinical vascular changes in fetal growth restriction with and without pre-eclampsia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:706-712. [PMID: 25678131 DOI: 10.1002/uog.14815] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 01/31/2015] [Accepted: 02/06/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To assess maternal vascular structure and function in pregnancies complicated by fetal growth restriction (FGR), in women with and without pre-eclampsia (PE) at the time of FGR diagnosis. METHODS We evaluated 124 women with a pregnancy complicated by FGR, of whom 60 had PE and 64 did not, and compared these findings to those of 110 normal women (controls). The group of FGR pregnancies without PE was further subdivided according to gestational age at FGR diagnosis into early onset (< 32 weeks) or late onset (≥ 32 weeks). Maternal carotid intima-media thickness (IMT), blood pressure (BP), carotid artery distensibility (CD), circumferential wall stress (CWS) and inferior vena cava (IVC) collapsibility were assessed by ultrasound at the time of FGR diagnosis. RESULTS Compared to controls, cases of FGR with PE showed increased maternal carotid IMT (0.425 (interquartile range (IQR), 0.381-0.486) vs 0.409 (IQR, 0.386-0.439) mm; P = 0.021), BP (mean, 109 (IQR, 101-117) vs 82 (IQR, 77-89) mmHg; P < 0.001) and CWS (19.7 (IQR, 17.0-22.7) vs 12.2 (IQR, 11.1-13.7) kPa; P < 0.001), and reduced CD (25.3 (IQR, 15.7-35.6) vs 31.9 (IQR, 25.4-41.1) kPa(-1) × 10(-3) ; P = 0.037) and IVC collapsibility indices (0.07 (IQR, 0.06-1.11) vs 0.10 (IQR, 0.06-0.13); P = 0.136). Similarly, compared to controls, in cases of FGR without PE maternal carotid IMT (0.436 (IQR, 0.392-0.476) mm; P = 0.001) and BP (88 (IQR, 81-95) mmHg; P < 0.001) were increased but CD and IVC collapsibility were similar. When analysis was subclassified according to gestational age at diagnosis, IMT and CWS were significantly increased only in early-onset FGR while BP was increased in both groups. CONCLUSION Normotensive women with pregnancy complicated by FGR share some subclinical vascular features with those of women with PE, which further reinforces the notion that, at least in a proportion of cases, there is a common placental disease that influences maternal cardiovascular features.
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Affiliation(s)
- I Stergiotou
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Barcelona, Spain
- IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - B Bijnens
- ICREA, Universitat Pompeu Fabra, Barcelona, Spain
| | - M Cruz-Lemini
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Barcelona, Spain
- IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - F Figueras
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Barcelona, Spain
- IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - E Gratacos
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Barcelona, Spain
- IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - F Crispi
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Barcelona, Spain
- IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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Barrett HL, Kubala MH, Scholz Romero K, Denny KJ, Woodruff TM, McIntyre HD, Callaway LK, Dekker Nitert M. Placental lipase expression in pregnancies complicated by preeclampsia: a case-control study. Reprod Biol Endocrinol 2015; 13:100. [PMID: 26336959 PMCID: PMC4558775 DOI: 10.1186/s12958-015-0098-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/20/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Preeclampsia (PE) is associated with maternal and neonatal morbidity and mortality. In PE, the physiological hyperlipidaemia of pregnancy is exaggerated. The purpose of this study was to examine the expression of adipose triglyceride lipase (ATGL), hormone sensitive lipase (HSL), lipoprotein lipase (LPL) and endothelial lipase (EL) in pregnancies complicated by PE. METHODS Placentae were collected from 16 women with PE and 20 women with uncomplicated pregnancies matched for maternal prepregnancy BMI and gestational age of delivery. Gene and protein expression of the placental lipases were measured by Q-PCR and Western blot. DNA methylation of the promoter of LPL was assessed by bisulfite sequencing. Lipase localisation and activity were analysed. RESULTS Gene expression of all lipases was significantly reduced, as was HSL protein level in women with PE. All lipases were localised to trophoblasts and endothelial cells in PE and control placentae. There was no difference in methylation of the LPL promoter between PE and control placentae. Lipase activity was not altered in placentae from women with PE. CONCLUSION These results suggest that the decreased placental lipase gene but not protein expression or lipase activity, which is associated with late-onset PE is not a major contributor to the abnormal lipids seen in PE.
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Affiliation(s)
- Helen L Barrett
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia.
- Obstetric Medicine, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.
- School of Medicine, The University of Queensland, Herston, QLD, Australia.
| | - Marta H Kubala
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia.
| | | | - Kerina J Denny
- School of Biomedical Sciences, The University of Queensland, St Lucia, QLD, Australia.
| | - Trent M Woodruff
- School of Biomedical Sciences, The University of Queensland, St Lucia, QLD, Australia.
| | - H David McIntyre
- School of Medicine, The University of Queensland, Herston, QLD, Australia.
- Mater Research Institute, The University of Queensland Brisbane, Brisbane, QLD, Australia.
| | - Leonie K Callaway
- Obstetric Medicine, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.
- School of Medicine, The University of Queensland, Herston, QLD, Australia.
| | - Marloes Dekker Nitert
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia.
- School of Medicine, The University of Queensland, Herston, QLD, Australia.
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Zoet GA, Koster MPH, Velthuis BK, de Groot CJM, Maas AHEM, Fauser BCJM, Franx A, van Rijn BB. Determinants of future cardiovascular health in women with a history of preeclampsia. Maturitas 2015; 82:153-61. [PMID: 26255680 DOI: 10.1016/j.maturitas.2015.07.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 07/03/2015] [Accepted: 07/06/2015] [Indexed: 02/07/2023]
Abstract
Women 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, while 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 long-term strategies to effectively prevent CVD, specifically targeted at women with a history of preeclampsia. Additionally, evaluation of feasibility, cost-effectiveness, and implementation of CVD screening and prevention initiatives targeted at former preeclampsia patients are needed.
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Affiliation(s)
- Gerbrand A Zoet
- Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Lundlaan 6, PO Box 85090, 3508 AB Utrecht, The Netherlands.
| | - Maria P H Koster
- Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Lundlaan 6, PO Box 85090, 3508 AB Utrecht, The Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Christianne J M de Groot
- Department of Obstetrics and Gynaecology, VU University Medical Center Amsterdam, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Bart C J M Fauser
- Department of Reproductive Medicine & Gynaecology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Arie Franx
- Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Lundlaan 6, PO Box 85090, 3508 AB Utrecht, The Netherlands
| | - Bas B van Rijn
- Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Lundlaan 6, PO Box 85090, 3508 AB Utrecht, The Netherlands; Academic Unit of Human Development and Health, University of Southampton, Princess Anne Hospital, Coxford Road, Southampton SO16 5YA, United Kingdom
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Flow-mediated dilation: can new approaches provide greater mechanistic insight into vascular dysfunction in preeclampsia and other diseases? Curr Hypertens Rep 2015; 16:487. [PMID: 25182159 DOI: 10.1007/s11906-014-0487-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Endothelial dysfunction is a key feature of preeclampsia and may contribute to increased cardiovascular disease risk years after pregnancy. Flow-mediated dilation (FMD) is a non-invasive endothelial function test that predicts cardiovascular event risk. New protocols allow researchers to measure three components of the FMD response: FMD, low flow-mediated constriction, and shear stimulus. This review encourages researchers to think beyond "low FMD" by examining how these three components may provide additional insights into the mechanisms and location of vascular dysfunction. The review then examines what FMD studies reveal about vascular dysfunction in preeclampsia while highlighting opportunities to gain greater mechanistic insight from new protocols. Studies using traditional protocols show that FMD is low in mid-pregnancy prior to preeclampsia, at diagnosis, and for 3 years post-partum. However, FMD returns to normal by 10 years post-partum. Studies using new protocols are needed to gain more mechanistic insight.
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Rasmussen LG, Lykke JA, Staff AC. Angiogenic biomarkers in pregnancy: defining maternal and fetal health. Acta Obstet Gynecol Scand 2015; 94:820-32. [DOI: 10.1111/aogs.12629] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 03/04/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Lene G. Rasmussen
- Department of Obstetrics and Gynecology; Oslo University Hospital; Oslo Norway
- Faculty of Medicine; University of Copenhagen; Copenhagen Denmark
| | - Jacob A. Lykke
- Faculty of Medicine; University of Copenhagen; Copenhagen Denmark
- Department of Obstetrics and Gynecology; Hvidovre University Hospital; Copenhagen Denmark
- Departement of Obstetrics; Rigshospitalet Copenhagen University Hospital; Copenhagen Denmark
| | - Anne C. Staff
- Department of Obstetrics and Gynecology; Oslo University Hospital; Oslo Norway
- Faculty of Medicine; University of Oslo; Oslo Norway
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Osol G, Bernstein I. Preeclampsia and maternal cardiovascular disease: consequence or predisposition? J Vasc Res 2014; 51:290-304. [PMID: 25300258 DOI: 10.1159/000367627] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 08/13/2014] [Indexed: 11/19/2022] Open
Abstract
Formerly preeclamptic women stand a higher chance of developing cardiovascular disease (CVD) later in life and may experience a shortened life span. This review updates the pathophysiology and definition of this complex disease and highlights the protective role of pregnancy by considering the relationship between pregnancy interval and likelihood of disease recurrence. The evidence for persistent maternal cardiovascular impairment following preeclampsia (PE) is considered, e.g. postpartum changes in CVD occurrence, blood pressure elevation and changes in the renin-angiotensin-aldosterone system). Since maternal endothelial dysfunction is a hallmark of PE, we summarize the evidence for reduced flow-mediated dilation in women with previous PE, and consider the utility and shortcomings of this clinical measure. In addition to viewing postpartum changes as a consequence of this disease, we consider the alternative view that PE might be the manifestation of a maternal phenotype that already has some predisposition to or is in the earlier stages of CVD; in this case, some of the postpartum residual deficits (or their antecedents) may have already been present prior to pregnancy. Finally, we consider the use of novel biomarkers for predicting or detecting PE prior to the appearance of clinical symptoms.
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Affiliation(s)
- George Osol
- Department of Obstetrics and Gynecology, University of Vermont College of Medicine, Burlington, Vt., USA
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Stergiotou I, Crispi F, Valenzuela-Alcaraz B, Bijnens B, Gratacos E. Patterns of maternal vascular remodeling and responsiveness in early- versus late-onset preeclampsia. Am J Obstet Gynecol 2013; 209:558.e1-558.e14. [PMID: 23911383 DOI: 10.1016/j.ajog.2013.07.030] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 06/18/2013] [Accepted: 07/27/2013] [Indexed: 01/11/2023]
Abstract
OBJECTIVE We sought to assess vascular structure and function in early- and late-onset preeclampsia (PE) at the time of diagnosis. STUDY DESIGN We evaluated 100 PE cases subdivided into 50 early- and 50 late-onset cases according to gestational age at onset (</>34 weeks), and 100 controls paired by maternal age and gestational age at scan with cases. Carotid intima-media thickness (IMT), distensibility, and circumferential wall stress together with inferior vena cava (IVC) collapsibility were assessed by ultrasound. RESULTS Early PE was characterized by increased carotid IMT diameters, and arterial stiffness with no significant changes in IVC parameters as compared to normotensive pregnancies. Late PE was characterized by significantly increased carotid IMT and lumen diameters as compared to controls while arterial stiffness, as expressed by distensibility, did not provide pronounced changes. A significant decrease of IVC collapsibility index was also observed in late PE as compared to controls. CONCLUSION The current data suggest that distinct vascular adaptations in early and late PE could reflect different pathophysiologic mechanisms. Future studies are warranted to further assess the complex etiologies and clinical expressions of the 2 entities.
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Affiliation(s)
- Iosifina Stergiotou
- Department of Maternal-Fetal Medicine, Instituto Clinic de Ginecología, Obstetricia y Neonatología, Hospital Clinic, Universitat de Barcelona, the Fetal and Perinatal Medicine Research Group, Institut d'Investigacions Biomediques August Pi i Sunyer, and the Centro de Investigación Biomédica en Red de Enfermedades Raras, Barcelona, Spain
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Sandvik MK, Leirgul E, Nygård O, Ueland PM, Berg A, Svarstad E, Vikse BE. Preeclampsia in healthy women and endothelial dysfunction 10 years later. Am J Obstet Gynecol 2013; 209:569.e1-569.e10. [PMID: 23899451 DOI: 10.1016/j.ajog.2013.07.024] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 06/11/2013] [Accepted: 07/23/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Recent studies have shown that women with a history of preeclampsia have an increased risk of cardiovascular disease. The present study investigated cardiovascular risk factors 10 years after preeclampsia in previously healthy women. STUDY DESIGN Based on data from the Medical Birth Registry in Norway, we selected 182 women with and 180 women without preeclampsia in their first pregnancy 9-11 years earlier, excluding women with cardiovascular or renal disease before pregnancy. Flow-mediated dilation of the brachial artery (FMD) and intima-media thickness (IMT) of the carotid artery were measured and blood samples were drawn. Blood samples were analyzed for cardiovascular risk markers and for circulating markers of endothelial function. RESULTS A total of 89 women with previous preeclampsia and 69 women without preeclampsia participated, an overall attendance rate of 44%. FMD and IMT were similar between groups. Women with previous preeclampsia more often had urate and soluble fms-like tyrosine kinase values above the 75th percentile (odds ratio [OR], 2.4; P = .03, and OR, 2.4; P = .04, respectively) and high-density lipoprotein cholesterol values below the 25th percentile (OR, 2.3; P = .04). Women with preeclampsia with low birthweight offspring were associated with asymmetric dimethylarginine, L-arginine, and homoarginine above the 75th percentile, whereas the women with preeclampsia with normal-weight offspring were associated with urate and soluble fms-like tyrosine kinase above the 75th percentile. CONCLUSION Preeclampsia was not associated with impaired FMD or increased IMT 10 years after pregnancy in previously healthy women, but preeclampsia was associated with changes in circulating markers that might represent early endothelial dysfunction.
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