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Alameh A, Anaya F, Jabri A, Sukhon F, Alhuneafat L, Khader S, Villablanca P, Aggrawal V, Siraj A, Balakumaran K, Alqarqaz M. Hypertrophic cardiomyopathy in pregnancy: Nationwide analysis of patients characteristics and outcomes. Curr Probl Cardiol 2024; 49:102638. [PMID: 38734121 DOI: 10.1016/j.cpcardiol.2024.102638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 05/08/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION Hypertrophic cardiomyopathy (HCM) poses unique challenges in the management of pregnant patients due to the complex interplay of physiological changes of pregnancy. Despite its relatively low prevalence among pregnant women, HCM can significantly impact maternal and fetal outcomes. This study aims to enhance understanding of pregnant patients with HCM and the associated outcomes through a nationwide analysis of patient characteristics and outcomes. METHODS A retrospective analysis was conducted using data obtained from the Agency for Healthcare Research in Quality (AHRQ) Nationwide Inpatient Sample (NIS) database from January 2016 to December 2020. 3,599,855 pregnant patients without HCM and 187 pregnant patients with HCM were identified using International Classification of Disease (ICD) codes, and baseline characteristics, medical comorbidities, and outcomes were compared between the two groups. RESULTS Significant differences were observed in baseline characteristics, including age distribution, racial composition, and prevalence of systemic organ disease, between pregnant women with and without HCM. Women with HCM had higher odds of experiencing maternal complications, such as acute heart failure and peripartum cardiomyopathy, as well as higher rates of fetal distress and obstetric interventions, including preterm delivery and caesarean section. CONCLUSION Comprehensive cardiovascular assessment and risk stratification are essential in pregnant women with HCM to optimize maternal and fetal outcomes. Moreover, disparities in baseline characteristics and outcomes among black pregnant women with HCM highlight the need for a multifactorial approach to addressing pregnancy-related complications.
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Affiliation(s)
- Anas Alameh
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Firas Anaya
- Department of Medicine, MetroHealth Medical Center, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
| | - Ahmad Jabri
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Fares Sukhon
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Laith Alhuneafat
- Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Safwan Khader
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Pedro Villablanca
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Vikas Aggrawal
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Aisha Siraj
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Kathir Balakumaran
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Mohammad Alqarqaz
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA
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Zahid S, Mohamed MS, Rajendran A, Minhas AS, Khan MZ, Nazir NT, Ocon AJ, Weber BN, Isiadinso I, Michos ED. Rheumatoid arthritis and cardiovascular complications during delivery: a United States inpatient analysis. Eur Heart J 2024; 45:1524-1536. [PMID: 38427130 DOI: 10.1093/eurheartj/ehae108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/12/2024] [Accepted: 02/07/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND AND AIMS Persons with rheumatoid arthritis (RA) have an increased risk of obstetric-associated complications, as well as long-term cardiovascular (CV) risk. Hence, the aim was to evaluate the association of RA with acute CV complications during delivery admissions. METHODS Data from the National Inpatient Sample (2004-2019) were queried utilizing ICD-9 or ICD-10 codes to identify delivery hospitalizations and a diagnosis of RA. RESULTS A total of 12 789 722 delivery hospitalizations were identified, of which 0.1% were among persons with RA (n = 11 979). Individuals with RA, vs. those without, were older (median 31 vs. 28 years, P < .01) and had a higher prevalence of chronic hypertension, chronic diabetes, gestational diabetes mellitus, obesity, and dyslipidaemia (P < .01). After adjustment for age, race/ethnicity, comorbidities, insurance, and income, RA remained an independent risk factor for peripartum CV complications including preeclampsia [adjusted odds ratio (aOR) 1.37 (95% confidence interval 1.27-1.47)], peripartum cardiomyopathy [aOR 2.10 (1.11-3.99)], and arrhythmias [aOR 2.00 (1.68-2.38)] compared with no RA. Likewise, the risk of acute kidney injury and venous thromboembolism was higher with RA. An overall increasing trend of obesity, gestational diabetes mellitus, and acute CV complications was also observed among individuals with RA from 2004-2019. For resource utilization, length of stay and cost of hospitalization were higher for deliveries among persons with RA. CONCLUSIONS Pregnant persons with RA had higher risk of preeclampsia, peripartum cardiomyopathy, arrhythmias, acute kidney injury, and venous thromboembolism during delivery hospitalizations. Furthermore, cardiometabolic risk factors among pregnant individuals with RA rose over this 15-year period.
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Affiliation(s)
- Salman Zahid
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
| | - Mohamed S Mohamed
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, NY, USA
| | - Aardra Rajendran
- Division of Cardiology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Anum S Minhas
- Division of Cardiology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Muhammad Zia Khan
- Heart and Vascular Institute, West Virginia University, Morgantown, WV, USA
| | - Noreen T Nazir
- Division of Cardiology, University of Illinois at Chicago, Chicago, IL, USA
| | - Anthony J Ocon
- Division of Allergy, Immunology & Rheumatology, Rochester Regional Health, Rochester, NY, USA
| | - Brittany N Weber
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Ijeoma Isiadinso
- Division of Cardiology, Center for Heart Disease Prevention, Emory University School of Medicine, Atlanta, GA, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
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Fishel Bartal M, Chen HY, Amro F, Mendez-Figueroa H, Wagner SM, Sibai BM, Chauhan SP. Racial and Ethnic Disparities among Pregnancies with Chronic Hypertension and Adverse Outcomes. Am J Perinatol 2024; 41:e1145-e1155. [PMID: 36528021 DOI: 10.1055/a-2000-6289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE We aimed to ascertain whether the risk of adverse pregnancy outcomes in the United States among individuals with chronic hypertension differed by maternal race and ethnicity and to assess the temporal trend. STUDY DESIGN Population-based retrospective study using the U.S. Vital Statistics datasets evaluated pregnancies with chronic hypertension, singleton live births that delivered at 24 to 41 weeks. The coprimary outcomes were a composite maternal adverse outcome (preeclampsia, primary cesarean delivery, intensive care unit admission, blood transfusion, uterine rupture, or unplanned hysterectomy) and a composite neonatal adverse outcome (preterm birth, small for gestational age, Apgar's score <5 at 5 minutes, assisted ventilation> 6 hours, seizure, or death). Multivariable Poisson regression models were used to estimate adjusted relative risks (aRRs) and 95% confidence intervals (CIs). RESULTS Between 2014 and 2019, the rate of chronic hypertension in pregnancy increased from 1.6 to 2.2%. After multivariable adjustment, an increased risk for the composite maternal adverse outcome was found in Black (aRR = 1.10, 95% CI = 1.09-1.11), Hispanic (aRR = 1.04, 95% CI = 1.02-1.05), and Asian/Pacific Islander (aRR = 1.07, 95% CI = 1.05-1.10), compared with White individuals. Compared with White individuals, the risk of the composite neonatal adverse outcome was higher in Black (aRR = 1.39, 95% CI = 1.37-1.41), Hispanic (aRR = 1.15, 95% CI = 1.13-1.16), Asian/Pacific Islander (aRR = 1.34, 95% CI = 1.31-1.37), and American Indian (aRR = 1.12, 95% CI = 1.07-1.17). The racial and ethnic disparity remained unchanged during the study period. CONCLUSION We found a racial and ethnic disparity with maternal and neonatal adverse outcomes in pregnancies with chronic hypertension that remained unchanged throughout the study period. KEY POINTS · Between 2014 and 2019, the rate of chronic hypertension in pregnancy increased.. · Among people with chronic hypertension, there are racial and ethnic disparities in adverse outcomes.. · Black, Hispanic, and Asian/Pacific Islander have a higher risk of the adverse neonatal outcomes..
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Affiliation(s)
- Michal Fishel Bartal
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
- Department of Obstetrics and Gynecology, Sheba Medical Center at Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Han-Yang Chen
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Farah Amro
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Hector Mendez-Figueroa
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Stephen M Wagner
- Department of Obstetrics and Gynecology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Baha M Sibai
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Suneet P Chauhan
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
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Lawson Y, Comerford KB, Mitchell EP. A review of dairy food intake for improving health for black women in the US during pregnancy, fetal development, and lactation. J Natl Med Assoc 2024; 116:219-227. [PMID: 38368233 DOI: 10.1016/j.jnma.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 02/19/2024]
Abstract
Pregnancy and lactation are special life stages that require regular nutritional and medical attention to help protect the health of the mother and promote the growth and development of the offspring. Despite an increased focus on maternal and fetal health over the last several decades, the rates of pregnancy-related morbidity and mortality are increasing in the United States (US). On average, Black women who are pregnant or lactating face greater health disparities and birth complications than other racial/ethnic groups in the US. The issues contributing to these disparities are multi-faceted and include sociocultural, economic, medical, and dietary factors. For example, Black women face greater rates of food insecurity, worse access to healthcare, and lower nutrient status when compared to White women. A growing body of research suggests that consuming a healthier dietary pattern is one of the most potent modifiable risk factors associated with improved fertility and reducing pregnancy-related complications. Recent publications have also shed light on the role of dairy foods in improving diet quality and nutrient status among Black women and for impacting maternal and fetal health outcomes, such as preeclampsia, spontaneous abortion, preterm birth, and fetal growth. To support healthy pregnancy and lactation, the current national dietary guidelines recommend the consumption of 3 servings of dairy foods per day. However, the vast majority of Black women in the US are falling short of these recommendations and are not meeting nutrient requirements for calcium and vitamin D. Therefore, strategies that target misconceptions surrounding lactose intolerance and focus on the health value of adequate dairy intake among Black women of child-bearing age may benefit both prenatal and postpartum health. This review presents the current evidence on health disparities faced by pregnant and lactating Black women in the US, and the role of dairy foods in supporting healthy pregnancy, fetal development, and lactation outcomes in this population.
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Affiliation(s)
- Yolanda Lawson
- FACOG, Associate Attending, Baylor University Medical Center, Dallas, TX, United States
| | - Kevin B Comerford
- OMNI Nutrition Science, California Dairy Research Foundation, Davis, CA, United States.
| | - Edith P Mitchell
- Sidney Kimmel Cancer at Jefferson, Philadelphia, PA, United States
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Elkattawy O, Shah Y, Alimdjanova S, Ghbrial M, Javed J, Mohamed O, Dayal M, Hossain A, Elkattawy S, Shamoon F. The Impact of Coronary Artery Disease on Outcomes in Patients Hospitalized With Pre-eclampsia. Cureus 2024; 16:e59309. [PMID: 38817475 PMCID: PMC11136588 DOI: 10.7759/cureus.59309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2024] [Indexed: 06/01/2024] Open
Abstract
Introduction Pre-eclampsia leads to long-lasting cardiovascular effects in women in the postpartum period, but prevalence and in-hospital adverse events of coronary artery disease (CAD) in women with pre-eclampsia are poorly understood. The prevalence, outcomes, and mortality risks identified in this study allow for possible routes of clinical intervention of CAD in women with pre-eclampsia. The purpose of this study was to determine the prevalence and outcomes of CAD in women diagnosed with pre-eclampsia compared to those with pre-eclampsia with no history of CAD. Predictors of mortality in pre-eclampsia were also analyzed. Methods Data were obtained from the National Inpatient Sample from January 2016 to December 2019. We used the multivariate logistic regression to assess the independent association of CAD with outcomes in patients admitted with pre-eclampsia. We also used the multivariate logistic regression to analyze predictors of mortality in patients hospitalized with pre-eclampsia. Results Women with pre-eclampsia admitted between January 2016 and December 2019 were included in our analysis. A total of 256,010 patients were diagnosed with pre-eclampsia. Of these patients, 174 (0.1%) patients had CAD. Multivariate analysis demonstrated that CAD in patients with pre-eclampsia was independently associated with angioplasty (adjusted odds ratio [aOR] 62.28; 95% CI 20.459-189.591; p=0.001), permanent pacemaker (aOR 35.129; 95% CI 13.821-89.287; p=0.001), left heart catheterization (aOR 29.416; 95% CI 7.236-119.557; p=0.001), non-ST-elevation myocardial infarction (NSTEMI) (aOR 25.832; 95% CI 7.653-87.189; p=0.001), and congestive heart failure (CHF) (aOR 13.948; 95% CI 7.648-25.438; p=0.001). We also used the multivariate logistic regression model to assess predictors of mortality in patients admitted with pre-eclampsia. These included age at admission (aOR 1.064; 95% CI 1.009-1.121; p=0.021), Asian/Pacific-Islander race (aOR 4.893; 95% CI 1.884-12.711; p=0.001), and comorbidities such as CHF (aOR 19.405; 95% CI 6.408-58.768; p=0.001), eclampsia (aOR 17.253; 95% CI 5.323-55.924; p=0.001), syndrome of HELLP (hemolysis, elevated liver enzymes, low platelets) (aOR 6.204; 95% CI 2.849-13.510; p=0.001), coagulopathy (aOR 6.524; 95% CI 1.997-21.308; p=0.002), and liver disease (aOR 5.217; 95% CI 1.156-23.554; p=0.032). Conclusion In a large cohort of patients admitted with pre-eclampsia, we found the prevalence of CAD to be 0.1%. CAD was associated with several clinical outcomes, including NSTEMI. Predictors of mortality in patients with pre-eclampsia included demographic variables such as age and Asian race, as well as comorbidities such as CHF and coagulopathy.
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Affiliation(s)
- Omar Elkattawy
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Yash Shah
- Radiology, Rutgers University New Jersey Medical School, Newark, USA
| | | | - Mina Ghbrial
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Jahanzeb Javed
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Omar Mohamed
- Medicine, Saint Barnabas Medical Center, Livingston, USA
| | - Manik Dayal
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Afif Hossain
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Sherif Elkattawy
- Cardiology, Saint Joseph University Medical Center, Paterson, USA
| | - Fayez Shamoon
- Cardiology, Saint Joseph University Medical Center, Paterson, USA
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Choi ES, Jung YM, Kim D, Cho SE, Park ES, Park CW, Park JS, Jun JK, Lee SM. Long-term cardiovascular outcome in women with preeclampsia in Korea: a large population-based cohort study and meta-analysis. Sci Rep 2024; 14:7480. [PMID: 38553468 PMCID: PMC10980767 DOI: 10.1038/s41598-024-57858-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 03/22/2024] [Indexed: 04/02/2024] Open
Abstract
Recent studies reported the long-term cardiovascular risk of preeclampsia. However, only a few studies have investigated the association between preeclampsia and long-term cardiovascular disease in Asian populations, although there could be racial/ethnic differences in the risk of cardiovascular diseases. Therefore, we aimed to evaluate the long-term effects of preeclampsia on cardiovascular disease in an Asian population. This study included 68,658 parous women in the Health Examinees Study (HEXA) cohort of South Korea and compared the risk of long-term cardiovascular disease, including ischemic heart disease and stroke, according to the history of preeclampsia. We also performed a meta-analysis combining current study data with data from existing literature in the Asian population. Among the study population, 3413 (5.23%) women had a history of preeclampsia, and 767 (1.12%) and 404 (0.59%) women developed ischemic heart disease and stroke for 22 years. Women with a history of preeclampsia were at a higher risk for both ischemic heart disease (adjusted hazard ratio 1.66 [1.19-2.04]) and stroke (adjusted hazard ratio 1.48 [1.02-2.16]) than those without. In the meta-analysis, the pooled hazard ratio of ischemic heart disease and stroke were also increased in women with a history of preeclampsia (ischemic heart disease 1.65 [1.51-1.82]; stroke 1.78 [1.52-2.10]).
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Affiliation(s)
- Eun-Saem Choi
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Mi Jung
- Department of Obstetrics and Gynecology, College of Medicine, Guro Hospital, Korea University, Seoul, Republic of Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Dayoung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Su Eun Cho
- Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Eun Sun Park
- Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Chan-Wook Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Joong Shin Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Jong Kwan Jun
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
- The Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Seung Mi Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea.
- The Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea.
- Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
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Nardella D. Pumps: A Possible Tool to Promote More Equitable Lactation Outcomes. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2024; 97:99-106. [PMID: 38559458 PMCID: PMC10964822 DOI: 10.59249/mwyw7163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Pregnant individuals and infants in the US are experiencing rising morbidity and mortality rates. Breastfeeding is a cost-effective intervention associated with a lower risk of health conditions driving dyadic morbidity and mortality, including cardiometabolic disease and sudden infant death. Pregnant individuals and infants from racial/ethnic subgroups facing the highest risk of mortality also have the lowest breastfeeding rates, likely reflective of generational socioeconomic marginalization and its impact on health outcomes. Promoting breastfeeding among groups with the lowest rates could improve the health of dyads with the greatest health risk and facilitate more equitable, person-centered lactation outcomes. Multiple barriers to lactation initiation and duration exist for families who have been socioeconomically marginalized by health and public systems. These include the lack of paid parental leave, increased access to subsidized human milk substitutes, and reduced access to professional and lay breastfeeding expertise. Breast pumps have the potential to mitigate these barriers, making breastfeeding more accessible to all interested dyads. In 2012, The Patient Protection and Affordable Care Act (ACA) greatly expanded access to pumps through the preventative services mandate, with a single pump now available to most US families. Despite their near ubiquitous use among lactating individuals, little research has been conducted on how and when to use pumps appropriately to optimize breastfeeding outcomes. There is a timely and critical need for policy, scholarship, and education around pump use given their widespread provision and potential to promote equity for those families facing the greatest barriers to achieving their personal breastfeeding goals.
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Affiliation(s)
- Deanna Nardella
- National Clinician Scholars Program, Department of
Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Pediatrics, Yale School of Medicine, New
Haven, CT, USA
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Elijovich F, Kirabo A, Laffer CL. Salt Sensitivity of Blood Pressure in Black People: The Need to Sort Out Ancestry Versus Epigenetic Versus Social Determinants of Its Causation. Hypertension 2024; 81:456-467. [PMID: 37767696 PMCID: PMC10922075 DOI: 10.1161/hypertensionaha.123.17951] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Race is a social construct, but self-identified Black people are known to have higher prevalence and worse outcomes of hypertension than White people. This may be partly due to the disproportionate incidence of salt sensitivity of blood pressure in Black people, a cardiovascular risk factor that is independent of blood pressure and has no proven therapy. We review the multiple physiological systems involved in regulation of blood pressure, discuss what, if anything is known about the differences between Black and White people in these systems and how they affect salt sensitivity of blood pressure. The contributions of genetics, epigenetics, environment, and social determinants of health are briefly touched on, with the hope of stimulating further work in the field.
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Affiliation(s)
- Fernando Elijovich
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Annet Kirabo
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Cheryl L Laffer
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
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Elkattawy O, Patel S, Montoya J, Sarfaraz K, Alabed S, Gobji O, Elkattawy S, Romero J, Shamoon F. The Impact of Congestive Heart Failure on Outcomes in Patients Hospitalized With Preeclampsia. Cureus 2024; 16:e56387. [PMID: 38633946 PMCID: PMC11022979 DOI: 10.7759/cureus.56387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION The purpose of this study was to determine the prevalence of congestive heart failure (CHF) among patients admitted with preeclampsia as well as to analyze the independent association of CHF with in-hospital outcomes among women with preeclampsia. METHODS Data were obtained from the National (Nationwide) Inpatient Sample (NIS) from January 2016 to December 2019. We assessed the independent association of CHF with outcomes in patients admitted with preeclampsia. Predictors of mortality in patients admitted with preeclampsia were also analyzed. RESULTS Women with preeclampsia in the United States between 2016 and 2019 were included in our analysis. A total of 256,010 cases were isolated, comprising 1150 patients with preeclampsia and CHF (0.45%). Multivariate analysis demonstrated that CHF in patients with preeclampsia was independently associated with several outcomes, among them cardiac arrest (adjusted OR (aOR) 4.635, p=0.004), ventricular tachycardia (aOR 17.487, p<0.001), pulmonary embolism (aOR 6.987, p<0.001), and eclampsia (aOR 2.503, p=0.011). Conversely, we found CHF to be protective against postpartum hemorrhage (aOR 0.665, p=0.003). Among the predictors of mortality in preeclampsia are age (aOR 1.062, p=0.022), Asian or Pacific Islander race (aOR 4.695, p=0.001), and CHF (aOR 25.457, p<0.001). Conclusions: In a large cohort of patients admitted with preeclampsia, we found the prevalence of CHF to be 0.45%. CHF was associated with several adverse outcomes as well as increased length of stay.
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Affiliation(s)
- Omar Elkattawy
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Saahil Patel
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Javier Montoya
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Kanzah Sarfaraz
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Sedra Alabed
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Omar Gobji
- Internal Medicine, New York Medical College, Valhalla, USA
| | - Sherif Elkattawy
- Cardiology, St. Joseph's University Medical Center, Paterson, USA
| | - Jesus Romero
- Internal Medicine, Trinitas Regional Medical Center, Elizabeth, USA
| | - Fayez Shamoon
- Cardiology, St. Joseph's University Medical Center, Paterson, USA
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Murkey JA, Gaston SA, Payne CW, Jackson WB, Jackson CL. Food security status and cardiometabolic health among pregnant women in the United States. Front Glob Womens Health 2024; 4:1286142. [PMID: 38415184 PMCID: PMC10896860 DOI: 10.3389/fgwh.2023.1286142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/12/2023] [Indexed: 02/29/2024] Open
Abstract
Introduction Pregnant women and their offspring are particularly vulnerable to food insecurity and its adverse effects during critical periods of fetal development. Racially/ethnically minoritized women in the United States (US) who are pregnant are additionally burdened by food insecurity, which may exacerbate cardiovascular health (CVH) disparities. Despite heightened social vulnerability, few studies have employed an intersectional framework, including race and gender, to assess the food insecurity and CVH relationship. Methods We used 2012-2018 and 2020 National Health Interview Survey data among US pregnant women aged 18-49 years old (N = 1,999) to assess the prevalence of food insecurity status by race/ethnicity and to investigate household food security status in relation to ideal CVH, using a modified ideal CVH (mICVH) metric. We categorized food security status as "very low/low", "marginal", or "high". To assess mICVH, a summary score of 7 clinical characteristics and health behaviors was dichotomized as yes [(7)] vs. no [<7]. Prevalence ratios (PRs) and 95% confidence intervals (CIs) of associations between food security status and mICVH were estimated using Poisson regression with robust variance. Models were adjusted for age, household income, educational attainment, geographic region, marital status, alcohol consumption, survey year, and race/ethnicity (in overall model). Results The mean age ± standard error was 29.0 ± 0.2 years. Among pregnant women, 12.7% reported "very low/low", 10.6% reported "marginal", and 76.7% reported "high" food security. "Very low/low" food security prevalence was higher among NH-Black (16.2%) and Hispanic/Latina (15.2%) pregnant women compared to NH-White (10.3%) and NH-Asian (3.2%) pregnant women. The mICVH prevalence was 11.6% overall and 14.5% for NH-White, 4.1% for NH-Black, 5.0% for Hispanic/Latina, and 26.7% for NH-Asian pregnant women. Among all pregnant women, "very low/low" and "marginal" vs. "high" food security status was associated with a lower prevalence of mICVH {[PRvery low/low = 0.26 (95% CI: 0.08-0.75)]; [PRmarginal = 0.47 (95% CI: 0.23 -0.96)]}. Conclusion Household food insecurity was higher among pregnant women in minoritized racial/ethnic groups and was associated with lower mICVH prevalence. Given the higher burden of food insecurity among minoritized racial/ethnic groups, food security may be an important intervention target to help address disparities in poor CVH among pregnant women.
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Affiliation(s)
- Jamie A Murkey
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, United States
| | - Symielle A Gaston
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, United States
| | - Christopher W Payne
- Social & Scientific Systems, Inc., a DLH Holdings Company, Durham, NC, United States
| | - W Braxton Jackson
- Social & Scientific Systems, Inc., a DLH Holdings Company, Durham, NC, United States
| | - Chandra L Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, United States
- Intramural Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, United States
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11
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Keith MH, Martin MA. Social Determinant Pathways to Hypertensive Disorders of Pregnancy Among Nulliparous U.S. Women. Womens Health Issues 2024; 34:36-44. [PMID: 37718230 PMCID: PMC10840909 DOI: 10.1016/j.whi.2023.08.001] [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: 10/19/2022] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Hypertensive disorders of pregnancy are a leading cause of maternal morbidity and mortality in the United States and impact Black mothers at disproportionately higher rates. Hypertensive disparities among racialized groups are rooted in systemic inequalities, and we hypothesize that clinical markers of allostatic load capture embodied disparities in stressors that can link upstream social determinants of health with downstream hypertensive outcomes. METHODS We analyzed observational cohort data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (n = 6,501) and developed a structural equation model linking latent social determinants of health, longitudinal markers of allostatic load across gestation, and hypertensive pregnancy outcomes in a multigroup framework. RESULTS Non-Hispanic Black mothers-to-be (n = 1,155) showed higher rates of hypertensive disorders of pregnancy (32%) than non-Hispanic white women (n = 5,346, 23%). Among both groups, the social environment showed stronger direct effects on allostatic markers than via behaviorally mediated dietary, exercise, or smoking pathways. Demographic aspects of the social environment (e.g., household income, partnered status) were the most salient predictor of hypertensive risk and showed stronger effects among Black women. CONCLUSIONS Embodied stress rooted in the social environment is a major path driving maternal hypertensive disparities in the United States, with effects that vary across racialized groups. These pathway findings underscore the greater impact of systemic stressors relative to individual health behaviors. More comprehensive and detailed analyses of sociostructural domains are needed to identify promising avenues for policy and intervention to improve maternal health.
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Affiliation(s)
- Monica H Keith
- Department of Anthropology, University of Washington, Seattle, Washington.
| | - Melanie A Martin
- Department of Anthropology, University of Washington, Seattle, Washington; Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington
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12
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Purohit A, Kim YJ, Michos ED. Cardiovascular disease prevention in women - the current state in 2023. Curr Opin Cardiol 2024; 39:54-60. [PMID: 37921758 DOI: 10.1097/hco.0000000000001099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
PURPOSE OF REVIEW Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality for women globally. The purpose of this review is to provide an updated overview of CVD prevention in women, focusing on what is currently understood about female-specific or female-predominant CVD risk factors and the importance of tailored strategies for risk assessment and medical interventions. RECENT FINDINGS Recent studies have demonstrated the need to account for risk factors specific to women in current risk assessment models for CVD, including early menarche, polycystic ovary syndrome, adverse pregnancy outcomes, early menopause, and chronic inflammatory conditions. Incorporation of these findings has led to advancements in sex-specific guidelines, diagnostic tools, and treatment approaches that have led to improvement in the precision of CVD prevention strategies. At-risk women benefit similarly to lipid-lowering and other preventive therapies as men but are less likely to be treated. SUMMARY CVD prevention in women has made substantial progress over the past decade, marked by increasing awareness among clinicians, improved understanding of sex-specific risk-enhancing factors, and incorporation of sex-specific guidelines for management. However, there remain knowledge gaps that warrant ongoing efforts to optimize CVD prevention strategies in women, which will ultimately lead to improved cardiovascular health outcomes.
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Affiliation(s)
| | | | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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13
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Howard E, Gillispie-Bell V, Olet S, Glenn B, Ammar N, Price-Haywood EG. Evaluating Racial Disparities in Implementation and Monitoring of a Remote Blood Pressure Program in a Pregnant Population-A Retrospective Cohort Study. Ochsner J 2024; 24:22-30. [PMID: 38510223 PMCID: PMC10949055 DOI: 10.31486/toj.23.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
Background: Whether remote blood pressure (BP) monitoring can decrease racial disparities in BP measurement during pregnancy and the postpartum period remains unclear. This study evaluated whether Black and White patients enrolled in the Connected Maternity Online Monitoring (CMOM) program showed improvements in BP ascertainment and interval. Methods: A retrospective cohort of 3,976 pregnant patients enrolled in CMOM were compared to matched usual care patients between January 2016 and September 2022 using electronic health record data. The primary outcomes were BP ascertainment (number of BP measurements) and BP interval (time between BP measurements) during pregnancy and the postpartum period. The proportion of patients with a hypertensive disorder of pregnancy who checked their BP within 7 days of discharge following delivery was also assessed. Results: Enrollment in CMOM was lower among Black patients than White patients (42.1% vs 54.7%, P<0.0001). Patients in the CMOM group had more BP measurements than patients in the usual care group during pregnancy (rate ratio=1.78, 95% CI 1.74-1.82) and the postpartum period (rate ratio=1.30, 95% CI 1.23-1.37), with significant improvements for both Black and White patients enrolled in CMOM compared to patients in usual care. The CMOM intervention did not result in an improvement in 7-day postpartum adherence to checking BP for Black patients (risk ratio=1.03, 95% CI 0.94-1.11) as it did for White patients (risk ratio=1.09, 95% CI 1.01-1.17). Conclusion: Remote BP monitoring programs are a helpful tool to improve the frequency of BP measurements and shorten intervals between measurements during the prenatal and postpartum periods for all patients. Future evaluation is needed to determine the barriers to offering the program to and enrolling Black patients.
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Affiliation(s)
- Elizabeth Howard
- Ochsner-Xavier Institute for Health Equity and Research, Ochsner Clinic Foundation, New Orleans, LA
| | - Veronica Gillispie-Bell
- Ochsner-Xavier Institute for Health Equity and Research, Ochsner Clinic Foundation, New Orleans, LA
- Department of Obstetrics and Gynecology, Ochsner Clinic Foundation, New Orleans, LA
- The University of Queensland Medical School, Ochsner Clinical School, New Orleans, LA
| | - Susan Olet
- Ochsner-Xavier Institute for Health Equity and Research, Ochsner Clinic Foundation, New Orleans, LA
| | - Beth Glenn
- Ochsner-Xavier Institute for Health Equity and Research, Ochsner Clinic Foundation, New Orleans, LA
| | - Nariman Ammar
- Ochsner-Xavier Institute for Health Equity and Research, Ochsner Clinic Foundation, New Orleans, LA
| | - Eboni G. Price-Haywood
- Ochsner-Xavier Institute for Health Equity and Research, Ochsner Clinic Foundation, New Orleans, LA
- The University of Queensland Medical School, Ochsner Clinical School, New Orleans, LA
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14
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Hu G, Lin J, Feng H, Horswell R, Chu S, Shen Y. Trends of hypertensive disorders of pregnancy among the Medicaid population before and during COVID-19. RESEARCH SQUARE 2023:rs.3.rs-3616259. [PMID: 38077001 PMCID: PMC10705593 DOI: 10.21203/rs.3.rs-3616259/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
Hypertensive disorders of pregnancy (HDP) are a group of high blood pressure disorders during pregnancy that are a leading cause of maternal and infant morbidity and mortality. The trend of HDP among the Medicaid population during the coronavirus disease of 2019 (COVID-19) is severely lacking. To determine the trends in the annual prevalence of HDP among Louisiana Medicaid pregnant women before and during the COVID-19 pandemic (2016-2021), a total of 113,776 pregnant women aged 15-50 years was included in this study. For multiparous individuals, only the first pregnancy was used in the analyses. Women with a diagnosis of each type-specific HDP were identified by using the ICD-10 codes. The prevalence of HDP increased from 10.5% in 2016 to 17.7% in 2021. The highest race/ethnicity-specific incidence of HDP was seen in African American women (13.1%), then white women (9.4%), followed by other women (7.9%). HDP remains as a very prevalent and significant global health issue, especially in African American women. Obesity and physical inactivity are major risk factors of HDP, which became amplified during the COVID-19 pandemic and led to a higher prevalence of HDP. Severe HDP substantially increases the risk of mortality in offspring and long-term issues in both the mother and infant. This is very pertinent to the Medicaid population due to the disparities and barriers that diminish the quality of healthcare they receive.
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Affiliation(s)
- Gang Hu
- Pennington Biomedical Research Center
| | | | | | | | - San Chu
- Pennington Biomedical Research Center
| | - Yun Shen
- Pennington Biomedical Research Center
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15
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Rajendran A, Minhas AS, Kazzi B, Varma B, Choi E, Thakkar A, Michos ED. Sex-specific differences in cardiovascular risk factors and implications for cardiovascular disease prevention in women. Atherosclerosis 2023; 384:117269. [PMID: 37752027 PMCID: PMC10841060 DOI: 10.1016/j.atherosclerosis.2023.117269] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/13/2023] [Accepted: 08/31/2023] [Indexed: 09/28/2023]
Abstract
Cardiovascular disease (CVD) is the leading cause of mortality for women globally. Sex differences exist in the relative risks conferred by traditional CVD risk factors, including diabetes, hypertension, obesity, and smoking. Additionally, there are female-specific risk factors, including age of menarche and menopause, polycystic ovary syndrome, infertility and the use of assisted reproductive technology, spontaneous pregnancy loss, parity, and adverse pregnancy outcomes, as well as female-predominant conditions such as autoimmune diseases, migraines, and depression, that enhance women's cardiovascular risk across the lifespan. Along with measurement of traditional risk factors, these female-specific factors should also be ascertained as a part of cardiovascular risk assessment to allow for a more comprehensive overview of the risk for developing cardiometabolic disorders and CVD. When present, these factors can identify women at elevated cardiovascular risk, who may benefit from more intensive preventive interventions, including lifestyle changes and/or pharmacotherapy such as statins. This review describes sex differences in traditional risk factors and female-specific/female-predominant risk factors for CVD and examines the role of coronary artery calcium scores and certain biomarkers that can help further risk stratify patients and guide preventive recommendations.
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Affiliation(s)
- Aardra Rajendran
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anum S Minhas
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brigitte Kazzi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bhavya Varma
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eunjung Choi
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aarti Thakkar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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16
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Denoble AE, Pettker CM. Hypertension Screening in Pregnancy: Remembering the Basics, Charting the Future. JAMA 2023; 330:1040-1041. [PMID: 37721621 DOI: 10.1001/jama.2023.15088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Affiliation(s)
- Anna E Denoble
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Christian M Pettker
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
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17
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Misiura MB, Butts B, Hammerschlag B, Munkombwe C, Bird A, Fyffe M, Hemphill A, Dotson VM, Wharton W. Intersectionality in Alzheimer's Disease: The Role of Female Sex and Black American Race in the Development and Prevalence of Alzheimer's Disease. Neurotherapeutics 2023; 20:1019-1036. [PMID: 37490246 PMCID: PMC10457280 DOI: 10.1007/s13311-023-01408-x] [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] [Accepted: 07/07/2023] [Indexed: 07/26/2023] Open
Abstract
It is well known that vascular factors and specific social determinants of health contribute to dementia risk and that the prevalence of these risk factors differs according to race and sex. In this review, we discuss the intersection of sex and race, particularly female sex and Black American race. Women, particularly Black women, have been underrepresented in Alzheimer's disease clinical trials and research. However, in recent years, the number of women participating in clinical research has steadily increased. A greater prevalence of vascular risk factors such as hypertension and type 2 diabetes, coupled with unique social and environmental pressures, puts Black American women particularly at risk for the development of Alzheimer's disease and related dementias. Female sex hormones and the use of hormonal birth control may offer some protective benefits, but results are mixed, and studies do not consistently report the demographics of their samples. We argue that as a research community, greater efforts should be made to not only recruit this vulnerable population, but also report the demographic makeup of samples in research to better target those at greatest risk for the disease.
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Affiliation(s)
- Maria B Misiura
- Department of Psychology, Georgia State University, Atlanta, GA, USA.
- Center for Translational Research in Neuroimaging & Data Science, Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA.
| | - Brittany Butts
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Bruno Hammerschlag
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Chinkuli Munkombwe
- Department of Psychology, Georgia State University, Atlanta, GA, USA
- Center for Translational Research in Neuroimaging & Data Science, Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
- Neuroscience Institute, Georgia State University, Atlanta, GA, USA
| | - Arianna Bird
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Mercedes Fyffe
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Asia Hemphill
- Department of Psychology, Georgia State University, Atlanta, GA, USA
- Center for Translational Research in Neuroimaging & Data Science, Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
| | - Vonetta M Dotson
- Department of Psychology, Georgia State University, Atlanta, GA, USA
- Gerontology Institute, Georgia State University, Atlanta, GA, USA
| | - Whitney Wharton
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
- Goizueta Alzheimer's Disease Research Center, Emory University, Atlanta, GA, USA
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18
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Giorgione V, Cauldwell M, Thilaganathan B. Pre-eclampsia and Cardiovascular Disease: From Pregnancy to Postpartum. Eur Cardiol 2023; 18:e42. [PMID: 37456771 PMCID: PMC10345941 DOI: 10.15420/ecr.2022.56] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/02/2022] [Indexed: 07/18/2023] Open
Abstract
Hypertensive disorders of pregnancy (HDP) complicate approximately 10% of pregnancies. In addition to multiorgan manifestations related to endothelial dysfunction, HDP confers an increased risk of cardiovascular disease during delivery hospitalisation, such as heart failure, pulmonary oedema, acute MI and cerebrovascular events. However, the cardiovascular legacy of HDP extends beyond birth since these women are significantly more likely to develop cardiovascular risk factors in the immediate postnatal period and major cardiovascular disease in the long term. The main mediator of cardiovascular disease in women with a history of HDP is chronic hypertension, followed by obesity, hypercholesterolaemia and diabetes. Therefore, optimising blood pressure levels from the immediate postpartum period until the first months postnatally could have beneficial effects on the development of hypertension and improve long-term cardiovascular health. Peripartum screening based on maternal demographic, and clinical and echocardiographic data could help clinicians identify women with HDP at highest risk of developing postpartum hypertension who would benefit from targeted primary cardiovascular prevention.
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Affiliation(s)
- Veronica Giorgione
- Molecular and Clinical Sciences Research Institute, St. George's University of LondonLondon, UK
- Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation TrustLondon, UK
| | - Matthew Cauldwell
- Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation TrustLondon, UK
| | - Basky Thilaganathan
- Molecular and Clinical Sciences Research Institute, St. George's University of LondonLondon, UK
- Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation TrustLondon, UK
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19
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Daida Y, Pedula K. Prevalence of Overweight and Obese Prepregnancy BMI and Excessive Gestational Weight Gain Using Asian-Specific Cutoffs Among Asian and Mixed-Asian Women Living in Hawaii: A Retrospective Cohort Study. Matern Child Health J 2023; 27:728-736. [PMID: 36214801 PMCID: PMC10023603 DOI: 10.1007/s10995-022-03560-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION The use of Asian-specific Body Mass Index (aBMI) cutoffs may be more appropriate than general World Health Organization BMI (gBMI) cutoffs in determining recommended gestational weight gain (GWG) for Asian women. Since aBMI cutoffs are lower than gBMI, more Asian women will be reclassified into higher aBMI categories from gBMI. The prevalence of reclassification and its impact on GWG are not known. METHODS We utilized the electronic health records of 8886 Kaiser Permanente Hawaii members aged ≥ 18 with a singleton live birth. Prepregnancy BMI was first classified using gBMI criteria, then aBMI criteria. BMI categories were "underweight", "normal", "overweight" and "obese"; GWG was classified into lower ("lGWG"), met ("mGWG"), and exceed ("eGWG") GWG per WHO recommendations. Self-reported race/ethnicity include Asian, Asian + Pacific Islander, and Asian + white. Multiple logistic regression was used to estimate adjusted odds of reclassification. The Cochran-Mantel-Haenszel test was used to evaluate associations between race/ethnicity and GWG. RESULTS > 40% of women in each racial/ethnic group were reclassified. Asian + Pacific Islander women had significantly higher odds of being reclassified (p < .0001). In the normal gBMI and aBMI category, Asian + Pacific Islander women had the largest eGWG group. In the overweight gBMI category, Asian + Pacific Islander women had the largest eGWG group; in the overweight aBMI category, Asian + white women had the largest eGWG group. DISCUSSION A sizable percent of women were reclassified into higher BMI categories when aBMI was applied. Mixed-race Asian women were more likely to exceed GWG recommendations than Asian women.
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Affiliation(s)
- Y Daida
- Center for Integrated Healthcare Research, Kaiser Permanente Hawai'i, 501 Alakawa St Suite 201, Honolulu, HI, 96817, USA.
| | - K Pedula
- Center for Integrated Healthcare Research, Kaiser Permanente Hawai'i, 501 Alakawa St Suite 201, Honolulu, HI, 96817, USA
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20
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Minhas AS, Rooney MR, Fang M, Zhang S, Ndumele CE, Tang O, Schulman SP, Michos ED, McEvoy JW, Echouffo-Tcheugui J, Christenson R, Selvin E. Prevalence and Correlates of Elevated NT-proBNP in Pregnant Women in the General U.S. Population. JACC. ADVANCES 2023; 2:100265. [PMID: 37168845 PMCID: PMC10168650 DOI: 10.1016/j.jacadv.2023.100265] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Physiologic changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) across trimesters of pregnancy have not been well studied. OBJECTIVES The authors aimed to measure NT-proBNP in adult women, by pregnancy status and trimester, in a nationally representative sample from the National Health and Nutrition Examination Survey 1999 to 2004. METHODS We conducted a cross-sectional analysis of 2,134 women (546 pregnant) aged 20 to 40 years without a history of cardiovascular disease. RESULTS Among pregnant women in the first trimester, the prevalence of elevated NT-proBNP (>125 pg/mL) was 20.0% (SE, 6.6%) compared to 2.4% (SE, 0.8%) among women in the third trimester and 8.0% among nonpregnant women. After adjustment for demographics and cardiovascular risk factors, NT-proBNP was 44% higher (absolute difference 26.4 [95% CI: 11.2-41.6] pg/mL) in the first trimester of pregnancy compared to nonpregnant women. Among pregnant women only, adjusted NT-proBNP was 46% lower (absolute difference -22.2 [95% CI: -36.9 to -7.5] pg/mL) in women in the third trimester compared to women in the first trimester. NT-proBNP was inversely associated with body mass index and with systolic blood pressure. CONCLUSIONS Women in the first trimester of pregnancy had significantly higher NT-proBNP than those in the third trimester and compared to similarly aged nonpregnant women. The dynamic nature of NT-proBNP should be taken into consideration when ordering NT-proBNP lab tests in pregnant women.
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Affiliation(s)
- Anum S. Minhas
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Cardiology, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mary R. Rooney
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michael Fang
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sui Zhang
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Chiadi E. Ndumele
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Cardiology, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Olive Tang
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Steven P. Schulman
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Erin D. Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Cardiology, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - J. William McEvoy
- Division of Cardiology, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Justin Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Elizabeth Selvin
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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21
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Gulati M, Minhas A. Time to counter rising cardiovascular disease during pregnancy. Eur Heart J 2023; 44:738-740. [PMID: 36638281 DOI: 10.1093/eurheartj/ehac770] [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: 01/15/2023] Open
Affiliation(s)
- Martha Gulati
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars Sinai Medical Center, 127 S. San Vicente Blvd, Suite A3600, Los Angeles, CA 90048, USA
| | - Anum Minhas
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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22
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Sinha A, Ning H, Cameron N, Bancks M, Carnethon MR, Allen NB, Wilkins JT, Lloyd-Jones DM, Khan SS. Atherosclerotic Cardiovascular Disease or Heart Failure: First Cardiovascular Event in Adults With Prediabetes and Diabetes. J Card Fail 2023; 29:246-254. [PMID: 36343785 DOI: 10.1016/j.cardfail.2022.10.426] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/17/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Individuals with prediabetes and diabetes are at increased risk of atherosclerotic cardiovascular disease (ASCVD) and heart failure (HF). Whether ASCVD or HF is more likely to occur first in these populations within different race-sex groups is unknown. OBJECTIVE To determine the competing risk for the first cardiovascular event by subtype in Black and white men and women with prediabetes and diabetes. METHODS Individual-level data from adults without ASCVD or HF were pooled from 6 population-based cohorts. We estimated the competing cumulative incidences of ASCVD, HF and noncardiovascular death as the first event in middle-aged (40-59 years) and older (60-79 years) adults, stratified by race and sex, with normal fasting plasma glucose (FPG < 100 mg/dL), prediabetes (FPG 100-125 mg/dL) and diabetes (FPG ≥ 126 mg/dL or on antihyperglycemic agents) at baseline. Within each race-sex group, we estimated risk the adjusted hazard ratio of ASCVD, HF and noncardiovascular death in adults with prediabetes and diabetes relative to adults with normoglycemia after adjusting for cardiovascular risk factors. RESULTS In 40,117 participants with 638,910 person-years of follow-up, 5781 cases of incident ASCVD and 3179 cases of incident HF occurred. In middle-aged adults with diabetes, competing cumulative incidence of ASCVD as a first event was higher than HF in white men (35.4% vs 11.6%), Black men (31.6% vs 15.1%) and white women (24.3% vs 17.2%) but not in Black women (26.4% vs 28.4%). Within each group, the adjusted hazard ratio of ASCVD and HF was significantly higher in adults with diabetes than in adults with normal FPG levels. Findings were largely similar in middle-aged adults with prediabetes and older adults with prediabetes or diabetes. CONCLUSIONS Black women with diabetes are more likely to develop HF as their first CVD event, whereas individuals with diabetes from other race-sex groups are more likely to present first with ASCVD. These results can inform the tailoring of primary prevention therapies for either HF- or ASCVD-specific pathways based on individual-level risk.
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Affiliation(s)
- Arjun Sinha
- The Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL.
| | - Hongyan Ning
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL
| | - Natalie Cameron
- Department of Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL
| | - Michael Bancks
- Department of Epidemiology and Prevention, Wake Forest School of Medicine; Winston-Salem, NC
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL
| | - John T Wilkins
- The Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL
| | - Donald M Lloyd-Jones
- The Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL
| | - Sadiya S Khan
- The Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL
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Gupta S, Petras L, Tufail MU, Rodriguez Salazar JD, Jim B. Hypertension in Pregnancy: What We Now Know. Curr Opin Nephrol Hypertens 2023; 32:153-164. [PMID: 36683540 DOI: 10.1097/mnh.0000000000000857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE OF REVIEW Hypertensive disorders of pregnancy remain a highly morbid condition that affects both the mother and fetus, complicate approximately 10% of pregnancies worldwide, and contribute to immediate and long-term cardiovascular outcomes. There is still much to learn regarding pathogenesis and treatment goals. RECENT FINDINGS There is updated information on the pathogenesis of preeclampsia and treatment thresholds for HTN in pregnancy. l-Kynurenine, a metabolite of the essential amino acid l-tryptophan, has been implicated in preeclampsia as decreased levels were found in a uninephrectomized pregnant mouse model of preeclampsia, where replacement of l-kynurenine rescued the preeclamptic state. Further, data from CHIPS (The Control of HTN in Pregnancy Study) and CHAP (Chronic HTN and Pregnancy) trials demonstrate not only the safety of lowering blood pressure to either a diastolic goal of 85 mmHg (CHIPS) or less than 160/105 mmHg (CHAP) without detriment to the fetus but the CHAPS trial has also shown a decrease in the rate of preeclampsia in the treatment group. SUMMARY We will summarize the different types of hypertensive disorders in pregnancy, updates on the pathogenesis of preeclampsia, and appropriate HTN management based on the latest evidence in order to better care for mother and child.
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Affiliation(s)
- Sonali Gupta
- Division of Nephrology, Department of Medicine, Montefiore Medical Center at Albert Einstein College of Medicine
| | - Lohana Petras
- Division of Nephrology, Department of Medicine, Jacobi Medical Center at Albert Einstein College of Medicine, Bronx, New York, USA
| | - Muhammad Umer Tufail
- Division of Nephrology, Department of Medicine, Jacobi Medical Center at Albert Einstein College of Medicine, Bronx, New York, USA
| | - Juan Diego Rodriguez Salazar
- Division of Nephrology, Department of Medicine, Jacobi Medical Center at Albert Einstein College of Medicine, Bronx, New York, USA
| | - Belinda Jim
- Division of Nephrology, Department of Medicine, Jacobi Medical Center at Albert Einstein College of Medicine, Bronx, New York, USA
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Stohl HE, Stohl W. Maternal and cord blood BAFF and APRIL levels during pregnancy. Am J Reprod Immunol 2023; 89:e13654. [PMID: 36398594 DOI: 10.1111/aji.13654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/21/2022] [Accepted: 11/08/2022] [Indexed: 11/19/2022] Open
Abstract
PROBLEM Dysregulation of factors vital to the survival B cells and/or plasma cells, such as BAFF and APRIL, could be detrimental to a pregnancy. METHOD OF STUDY Serially collected first-, second-, and third-trimester serum samples were measured for BAFF and APRIL by ELISA from 150 pregnant women (71 healthy + 79 with a chronic medical disease) at a single medical center. Postpartum serum samples were also collected from the majority of these women. Matched third-trimester and cord blood samples were collected from 168 women (86 healthy + 82 with a chronic medical disease). Data were analyzed by chi-square statistic, unpaired t-test, paired t-test, Mann-Whitney rank sum test, Wilcoxon signed rank test, Spearman rank order correlation, and receiver operator characteristic (ROC) curve analyses as appropriate. RESULTS Maternal serum BAFF levels declined as the pregnancies progressed and rebounded postpartum, whereas serum APRIL levels remained relatively flat throughout pregnancy and postpartum. Cord BAFF and APRIL levels correlated positively with gestation age and were considerably greater than the corresponding maternal third-trimester serum BAFF and APRIL levels, respectively. In women who developed preeclampsia, third-trimester BAFF levels were greater, rather than lower, than their corresponding second-trimester BAFF levels. ROC curve analysis suggested a potential role for third-trimester serum BAFF level as a biomarker of preeclampsia. CONCLUSIONS BAFF and APRIL are differentially regulated in the mother during and following pregnancy, whereas each is upregulated in the developing fetus. An increase in third-trimester serum BAFF level may portend development of preeclampsia.
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Affiliation(s)
- Hindi E Stohl
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, Los Angeles, California, USA
| | - William Stohl
- Division of Rheumatology, Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, California, USA
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25
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Markers of Cardiovascular Risk Associated with Pregnancy. Curr Cardiol Rep 2023; 25:77-87. [PMID: 36745273 DOI: 10.1007/s11886-022-01830-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The purpose of the review is to summarize the unique cardiovascular disease (CVD) risk factors encountered during pregnancy and to provide the reader with a framework for acquiring a comprehensive obstetric history during the cardiovascular (CV) assessment of women. RECENT FINDINGS Individuals with a history of pregnancies complicated by hypertensive disorders of pregnancy (HDP), gestational diabetes (GDM), preterm delivery, low birth weight, and fetal growth restriction during pregnancy are at a higher risk of developing short- and long-term CV complications compared to those without adverse pregnancy outcomes (APOs). Women with a history of APOs can be at increased risk of CVD even after achieving normoglycemia and normal blood pressure control postpartum. Risk assessment and stratification in women must account for these APOs as recommended by the 2019 American College of Cardiology (ACC)/American Heart Association (AHA) guideline on the primary prevention of CVD. Early recognition, monitoring, and treatment of APOs are key to limiting CVD complications late in maternal life. Recognition of APOs as female-specific cardiovascular risk factors is critical for risk stratification for women and birthing persons. Further research is needed to understand the complex interplay between genetics, environmental, behavioral, and maternal vascular health, and the association between APOs and CVD risk.
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Social Media and Cardiovascular Health: Implications for Women. Curr Atheroscler Rep 2022; 24:901-913. [PMID: 36441421 PMCID: PMC10017051 DOI: 10.1007/s11883-022-01069-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Cardiovascular disease (CVD) is the leading cause of mortality in adult women in the USA, yet CVD is underrecognized in women. Disparities in care are further pronounced in women of racial/ethnic minority backgrounds. In this review, we discuss the role of social media (SoMe) as a tool to (i) promote women's cardiovascular (CV) health and (ii) address and potentially reduce gaps in care, particularly in general cardiology (targeting atherosclerotic cardiovascular disease), cardio-oncology, and cardio-obstetrics. We also briefly discuss women's CV health as a common, although not unique, focus of women in cardiology on SoMe. RECENT FINDINGS Studies have suggested the utility of social media to help advance subspecialties of cardiology. Leaders within general cardiology, cardio-oncology, and cardio-obstetrics have curated social media strategies to advance their respective fields and call attention to cardiovascular health disparities in female populations and racial/ethnic minorities. In addition to these types of uses, women in cardiology also frequently use SoMe to encourage a career in cardiology and to share experiences, challenges, and resources for support and career advancement as healthcare professionals; men in cardiology and especially those who are allies for sex and racial/ethnic minorities also use SoMe for these means. Herein, we highlight the role and myriad applications of social media in the promotion of women's cardiovascular health. We discuss five primary roles of social media: increasing public awareness, disseminating medical literature in a rapid and accessible fashion, facilitating professional networking, serving as a platform for medical conferences, and empowering patients. These core strategies are discussed through the lens of general cardiology, cardio-oncology, and cardio-obstetrics. We also demonstrate how these applications can be leveraged to increase representation of women in cardiology, also supporting an increased focus on women's cardiovascular health.
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Velez MP, Bougie O, Bahta L, Pudwell J, Griffiths R, Li W, Brogly SB. Mode of conception in patients with endometriosis and adverse pregnancy outcomes: a population-based cohort study. Fertil Steril 2022; 118:1090-1099. [PMID: 36307290 DOI: 10.1016/j.fertnstert.2022.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 09/02/2022] [Accepted: 09/07/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To evaluate the association between endometriosis and adverse pregnancy outcomes. DESIGN Population-based retrospective cohort study using linked universal health databases through ICES Ontario. PATIENT(S) All singleton pregnancies with an estimated date of confinement between October 2006 and February 2014. INTERVENTION(S) Endometriosis was determined based on a surgical and/or medical diagnosis (defined as an in-hospital admission or surgery with a diagnosis code of International Classification of Diseases [ICD]9-617 or ICD10-N80 and/or 2 medical consults billed as ICD9-617). MAIN OUTCOME MEASURE(S) The association between endometriosis and pregnancy outcomes was quantified by relative risks, derived using modified Poisson regression, and adjusted for maternal age, income quintiles, and history of fibroids (aRR). Mediation analysis was conducted to estimate direct effects of endometriosis diagnosis and indirect effects through mode of conception, namely: infertility without fertility treatment (known infertility but conceived without assistance), ovulation induction or intrauterine insemination, and in vitro fertilization or intracytoplasmic sperm injection, relative to unassisted conception. RESULT(S) A total of 19,099 pregnancies had an antecedent diagnosis of endometriosis, while 768,350 did not. Mean time (standard deviation) from endometriosis diagnosis to the index pregnancy was 5.6 (4.3) years. Endometriosis was associated with an increased risk of hypertensive disorders of pregnancy (aRR, 1.09; 95% confidence interval [CI], 1.02-1.16), preterm birth <37 weeks (aRR, 1.26; 95% CI, 1.20-1.33), early preterm birth <34 weeks (aRR, 1.33; 95% CI, 1.17-1.50), placenta previa (aRR, 2.07; 95% CI, 1.84-2.33), placenta abruption (aRR, 1.55; 95% CI, 1.31-1.83), other placental disorders (aRR, 1.77; 95% CI, 1.36-2.30), cesarean delivery (aRR, 1.18; 95% CI, 1.16-1.21), and stillbirth (aRR, 1.32; 95% CI, 1.09-1.59). Mediation analysis suggests that endometriosis directly affects most adverse pregnancy outcomes studied, except for stillbirth where infertility diagnosis or fertility treatment indirectly accounted for part of the increased risk. CONCLUSION(S) Endometriosis was associated with adverse pregnancy, independent of infertility diagnosis, or fertility treatment. Future studies should investigate the mechanisms of action and potential interventions.
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Affiliation(s)
- Maria P Velez
- Department of Obstetrics and Gynecology, Queen's University, Kingston, Ontario, Canada; Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada; Institute for Clinical Evaluative Sciences (ICES) Queen's, Kingston, Ontario, Canada.
| | - Olga Bougie
- Department of Obstetrics and Gynecology, Queen's University, Kingston, Ontario, Canada
| | - Leah Bahta
- Department of Obstetrics and Gynecology, Queen's University, Kingston, Ontario, Canada
| | - Jessica Pudwell
- Department of Obstetrics and Gynecology, Queen's University, Kingston, Ontario, Canada
| | - Rebecca Griffiths
- Institute for Clinical Evaluative Sciences (ICES) Queen's, Kingston, Ontario, Canada
| | - Wenbin Li
- Institute for Clinical Evaluative Sciences (ICES) Queen's, Kingston, Ontario, Canada
| | - Susan B Brogly
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada; Institute for Clinical Evaluative Sciences (ICES) Queen's, Kingston, Ontario, Canada; Department of Surgery, Queen's University, Kingston, Ontario, Canada
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Zahid S, Mohamed MS, Wassif H, Nazir NT, Khan SS, Michos ED. Analysis of Cardiovascular Complications During Delivery Admissions Among Patients With Systemic Lupus Erythematosus, 2004-2019. JAMA Netw Open 2022; 5:e2243388. [PMID: 36445710 PMCID: PMC9709646 DOI: 10.1001/jamanetworkopen.2022.43388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
IMPORTANCE Individuals with systemic lupus erythematosus (SLE) have an increased risk of pregnancy-related complications. However, data on acute cardiovascular complications during delivery admissions remain limited. OBJECTIVE To investigate whether SLE is associated with an increased risk of acute peripartum cardiovascular complications during delivery hospitalization among individuals giving birth. DESIGN, SETTING, AND PARTICIPANTS This population-based cross-sectional study was conducted with data from the National Inpatient Sample (2004-2019) by using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification (ICD-10-CM) codes to identify delivery hospitalizations among birthing individuals with a diagnosis of SLE. A multivariable logistic regression model was developed to report an adjusted odds ratio (OR) for the association between SLE and acute peripartum cardiovascular complications. Data were analyzed from May 1 through September 1, 2022. EXPOSURE Diagnosed SLE. MAIN OUTCOMES AND MEASURES Primary study end points were preeclampsia, peripartum cardiomyopathy, and heart failure. Secondary end points included ischemic and hemorrhagic stroke, pulmonary edema, cardiac arrhythmias, acute kidney injury (AKI), venous thromboembolism (VTE), length of stay, and cost of hospitalization. RESULTS A total of 63 115 002 weighted delivery hospitalizations (median [IQR] age, 28 [24-32] years; all were female patients) were identified, of which 77 560 hospitalizations (0.1%) were among individuals with SLE and 63 037 442 hospitalizations (99.9%) were among those without SLE. After adjustment for age, race and ethnicity, comorbidities, insurance, and income level, SLE remained an independent risk factor associated with peripartum cardiovascular complications, including preeclampsia (adjusted OR [aOR], 2.12; 95% CI, 2.07-2.17), peripartum cardiomyopathy (aOR, 4.42; 95% CI, 3.79-5.13), heart failure (aOR, 4.06; 95% CI, 3.61-4.57), cardiac arrhythmias (aOR, 2.06; 95% CI, 1.94-2.21), AKI (aOR, 7.66; 95% CI, 7.06-8.32), stroke (aOR, 4.83; 95% CI, 4.18-5.57), and VTE (aOR, 6.90; 95% CI, 6.11-7.80). For resource use, median (IQR) length of stay (3 [2-4] days vs 2 [2-3] days; P < .001) and cost of hospitalization ($4953 [$3305-$7517] vs $3722 [$2606-$5400]; P < .001) were higher for deliveries among individuals with SLE. CONCLUSIONS AND RELEVANCE This study found that SLE was associated with increased risk of complications, including preeclampsia, peripartum cardiomyopathy, heart failure, arrhythmias, AKI, stroke, and VTE during delivery hospitalization and an increased length and cost of hospitalization.
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Affiliation(s)
- Salman Zahid
- Department of Medicine, Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York
| | - Mohamed S. Mohamed
- Department of Medicine, Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York
| | - Heba Wassif
- Division of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Noreen T. Nazir
- Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois
| | - Sadiya S. Khan
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Zahid S, Hashem A, Minhas AS, Bennett WL, Honigberg MC, Lewey J, Davis MB, Michos ED. Trends, Predictors, and Outcomes of Cardiovascular Complications at Delivery Associated With Gestational Diabetes: A National Inpatient Sample Analysis (2004-2019). J Am Heart Assoc 2022; 11:e026786. [PMID: 36300664 PMCID: PMC9673632 DOI: 10.1161/jaha.122.026786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Gestational diabetes (GD) is associated with increased risk of long-term cardiovascular complications. However, data on acute peripartum cardiovascular complications are not well established. Hence, we aimed to investigate the association of GD with acute cardiovascular outcomes at the time of delivery admission. Methods and Results We used data from the National Inpatient Sample (2004-2019). International Classification of Diseases, Ninth Revision (ICD-9) or Tenth Revision (ICD-10) codes were used to identify delivery hospitalizations and GD diagnosis. A total of 63 115 002 weighted hospitalizations for deliveries were identified, of which 3.9% were among individuals with GD (n=2 435 301). The prevalence of both GD and obesity increased during the study period (P trends<0.01). Individuals with GD versus those without GD had a higher prevalence of obesity, hypertension, and dyslipidemia. After adjustment for age, race or ethnicity, comorbidities, insurance, and income, GD remained independently associated with cardiovascular complications including preeclampsia (adjusted odds ratio [aOR], 1.97 [95% CI, 1.96-1.98]), peripartum cardiomyopathy (aOR, 1.15 [1.08-1.22]), acute kidney injury (aOR, 1.16 [1.11-1.21]), stroke (aOR, 1.15 [1.09-1.23]), and arrhythmias (aOR, 1.48 [1.46-1.50]), compared with no GD. Moreover, delivery hospitalizations among individuals with GD were associated with increased length (3 versus 2 days, P<0.01) and cost of hospitalization ($4909 versus $3682, P<0.01). Even in the absence of preeclampsia, GD was associated with elevated cardiovascular risk. Conclusions Individuals with GD had a higher risk of preeclampsia, peripartum cardiomyopathy, acute kidney injury, stroke, and arrhythmias during delivery hospitalizations. As rates of GD are increasing globally, efforts to improve preconception cardiometabolic health and prevent GD may represent important strategies to improve peripartum maternal outcomes and mitigate long-term cardiovascular risk.
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Affiliation(s)
- Salman Zahid
- Sands‐Constellation Heart Institute, Rochester General HospitalRochesterNY
| | - Anas Hashem
- Sands‐Constellation Heart Institute, Rochester General HospitalRochesterNY
| | - Anum S. Minhas
- Division of CardiologyJohns Hopkins University School of MedicineBaltimoreMD
| | - Wendy L. Bennett
- Division of General Internal MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | - Michael C. Honigberg
- Cardiology Division, Department of MedicineMassachusetts General HospitalBostonMA
| | - Jennifer Lewey
- Division of Cardiology, Department of MedicineUniversity of PennsylvaniaPhiladelphiaPA
| | | | - Erin D. Michos
- Division of CardiologyJohns Hopkins University School of MedicineBaltimoreMD
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Choi E, Kazzi B, Varma B, Ortengren AR, Minhas AS, Vaught AJ, Bennett WL, Lewey J, Michos ED. The Fourth Trimester: a Time for Enhancing Transitions in Cardiovascular Care. CURRENT CARDIOVASCULAR RISK REPORTS 2022; 16:219-229. [PMID: 36159207 PMCID: PMC9490714 DOI: 10.1007/s12170-022-00706-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 01/26/2023]
Abstract
Purpose of Review The "fourth trimester" concept, defined as the first 12 weeks after delivery (and beyond), is a critical window of time for clinicians to intervene to optimize women's cardiovascular health after pregnancy. A timely and comprehensive postpartum cardiovascular assessment should be performed in all women following delivery in order to (1) follow up medical conditions present prior to conception, (2) evaluate symptoms and signs of common postpartum complications, and (3) identify risk factors and prevent future adverse cardiovascular outcomes. In this review, we aim to discuss major maternal cardiovascular risk factors such as hypertensive disorders of pregnancy, gestational diabetes mellitus, postpartum weight retention, and postpartum depression, as well as lactation as a potential protective risk modifying factor. Additionally, we will review effectiveness of outpatient interventions to enhance transitions in cardiovascular care during the fourth trimester. Recent Findings A seamless hand-off from obstetric to primary care, and potentially cardiology, is needed for early detection and management of hypertension, weight, glycemic control, stress and mood, and long-term cardiovascular risk. Additionally, the use of telemedicine, blood pressure self-monitoring, remote activity monitoring, and behavioral health coaches are potentially feasible modalities to augment clinic-based care for cardiovascular risk factors and weight management, but additional studies are needed to study their long-term effectiveness. Summary Development of a comprehensive postpartum care plan with careful consideration of each patient's risk profile and access to resources is critical to improve maternal morbidity and mortality, reduce health disparities, and achieve long-term cardiovascular health for women. Supporting postpartum well-being of women during this transition period requires a multidisciplinary approach, especially primary care engagement, and planning should start before delivery.
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Affiliation(s)
- Eunjung Choi
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287 USA
| | - Brigitte Kazzi
- Department of Medicine, Johns Hopkins University School of Medicine, MD 21287 Baltimore, USA
| | - Bhavya Varma
- Department of Medicine, Johns Hopkins University School of Medicine, MD 21287 Baltimore, USA
| | | | - Anum S. Minhas
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287 USA
| | - Arthur Jason Vaught
- Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287 USA
| | - Wendy L. Bennett
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21287 USA
| | - Jennifer Lewey
- Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287 USA
- Division of Cardiology, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 524-B, Baltimore, MD 21287 USA
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Ye L, Yu C, Chen X, Han Y. Application Effect of Cluster-Based Care in Patients with Hypertensive Disorders of Pregnancy and Osteoarthritis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2954330. [PMID: 35966246 PMCID: PMC9371866 DOI: 10.1155/2022/2954330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/18/2022] [Indexed: 11/18/2022]
Abstract
Objective To explore the application effect of cluster-based care in patients with hypertensive disorders of pregnancy and osteoarthritis. Methods The clinical data of 60 patients with hypertensive disorders of pregnancy and osteoarthritis in our hospital were retrospectively analyzed, among which those receiving routine care from January 2020 to December 2020 were grouped into the control group (30 patients), and those receiving cluster-based care from January 2021 to January 2022 were grouped into the research group (30 patients). Psychological status, care satisfaction, and pregnancy outcomes were compared between the two groups. Results After intervention, self-rating anxiety scale (SAS) and self-rating depression scale (SDS) scores in the research group were lower than those in the control group (P < 0.05). There was no statistical significance in the difference of the modes of delivery between the two groups (χ 2 = 1.763, P > 0.05). Patients in the research group had a lower incidence of perinatal complications than those in the control group (χ 2 = 5.689, P < 0.05). And the satisfaction rate of care in the research group (93.33% vs 70%) was higher than that in the control group (χ 2 = 4.238, P < 0.05). Conclusion Cluster-based care can reduce patients' negative mood, increase their satisfaction, and improve the maternal and infant outcomes. This type of care offers better quality care measures for patients with pregnancy hypertension and osteoarthritis, and has a wide clinical application prospect.
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Affiliation(s)
- Lili Ye
- Department of Spine Surgery, Chengyang District People's Hospital of Qingdao City, Qingdao 266109, China
| | - Chunhua Yu
- Department of Gynecology, Chengyang District People's Hospital of Qingdao City, Qingdao 266109, China
| | - Xiaoqin Chen
- Department of Spine Surgery, Chengyang District People's Hospital of Qingdao City, Qingdao 266109, China
| | - Yanyan Han
- Department of Obstetrics, Chengyang District People's Hospital of Qingdao City, Qingdao 266109, China
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Cameron NA, Petito LC, Shah NS, Perak AM, Catov JM, Bello NA, Capewell S, O’Flaherty M, Lloyd-Jones DM, Greenland P, Grobman WA, Khan SS. Association of Birth Year of Pregnant Individuals With Trends in Hypertensive Disorders of Pregnancy in the United States, 1995-2019. JAMA Netw Open 2022; 5:e2228093. [PMID: 36001318 PMCID: PMC9403773 DOI: 10.1001/jamanetworkopen.2022.28093] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Hypertensive disorders of pregnancy are leading causes of morbidity and mortality among pregnant individuals as well as newborns, with increasing incidence during the past decade. Understanding the individual associations of advancing age of pregnant individuals at delivery, more recent delivery year (period), and more recent birth year of pregnant individuals (cohort) with adverse trends in hypertensive disorders of pregnancy could help guide public health efforts to improve the health of pregnant individuals. OBJECTIVE To clarify the independent associations of delivery year and birth year of pregnant individuals, independent of age of pregnant individuals, with incident rates of hypertensive disorders of pregnancy. DESIGN, SETTING, AND PARTICIPANTS This serial cross-sectional study of 38 141 561 nulliparous individuals aged 15 to 44 years with a singleton, live birth used 1995-2019 natality data from the National Vital Statistics System. EXPOSURES Year of delivery (period) and birth year (cohort) of pregnant individuals. MAIN OUTCOMES AND MEASURES Rates of incident hypertensive disorders of pregnancy, defined as gestational hypertension, preeclampsia, or eclampsia, recorded on birth certificates. Generalized linear mixed models were used to calculate adjusted rate ratios (aRRs) comparing the incidence of hypertensive disorders of pregnancy in each delivery period (adjusted for age and cohort) and birth cohort (adjusted for age and period) with the baseline group as the reference for each. Analyses were additionally stratified by the self-reported racial and ethnic group of pregnant individuals. RESULTS Of 38 141 561 individuals, 20.2% were Hispanic, 0.8% were non-Hispanic American Indian or Alaska Native, 6.5% were non-Hispanic Asian or Pacific Islander, 13.9% were non-Hispanic Black, and 57.8% were non-Hispanic White. Among pregnant individuals who delivered in 2015 to 2019 compared with 1995 to 1999, the aRR for the incidence of hypertensive disorders of pregnancy was 1.59 (95% CI, 1.57-1.62), adjusted for age and cohort. Among pregnant individuals born in 1996 to 2004 compared with 1951 to 1959, the aRR for the incidence of hypertensive disorders of pregnancy was 2.61 (95% CI, 2.41-2.84), adjusted for age and period. The incidence was higher among self-identified non-Hispanic Black individuals in each birth cohort, with similar relative changes for period (aRR, 1.76 [95% CI, 1.70-1.81]) and cohort (aRR, 3.26 [95% CI, 2.72-3.91]) compared with non-Hispanic White individuals (period: aRR, 1.60 [95% CI, 1.57-1.63]; cohort: aRR, 2.53 [95% CI, 2.26-2.83]). CONCLUSIONS AND RELEVANCE This cross-sectional study suggests that more recent birth cohorts of pregnant individuals have experienced a doubling of rates of hypertensive disorders of pregnancy, even after adjustment for age and delivery period. Substantial racial and ethnic disparities persisted across generations.
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Affiliation(s)
- Natalie A. Cameron
- Division of Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lucia C. Petito
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nilay S. Shah
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amanda M. Perak
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
- Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Janet M. Catov
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Natalie A. Bello
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
| | - Martin O’Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
| | - Donald M. Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - William A. Grobman
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus
| | - Sadiya S. Khan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Racial Disparities in Cardiovascular Risk and Cardiovascular Care in Women. Curr Cardiol Rep 2022; 24:1197-1208. [PMID: 35802234 DOI: 10.1007/s11886-022-01738-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Research on sex and gender aspects cardiovascular disease has contributed to a reduction in cardiovascular mortality in women. However, cardiovascular disease remains the leading cause of death of women in the United States. Disparities in cardiovascular risk and outcomes among women overall persist and are amplified for women of certain ethnic and racial subgroups. We review the evidence of racial and ethnic differences in cardiovascular risk and care among women and describe a path forward to achieve equitable cardiovascular care for women of racial and ethnic minority groups. RECENT FINDINGS There is a disproportionate effect on cardiovascular outcomes in women and certain racial and ethnic groups in part due to disparities in triage, diagnosis, treatment, which lead to amplification of inequalities in women of minority racial and ethnic background. Data suggest gender and racial bias, underappreciation of nontraditional risk factors, underrepresentation of women in clinical trials and undertreatment of disease contributes to persistent differences in cardiovascular disease outcomes in women of color. Understanding the myriad of factors that contribute to increased cardiovascular risk, and disparities in treatment and outcomes among women from racial/ethnic minority backgrounds is imperative to improving cardiovascular care for this patient population.
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Faulkner JL, Wright D, Antonova G, Jaffe IZ, Kennard S, Belin de Chantemèle EJ. Midgestation Leptin Infusion Induces Characteristics of Clinical Preeclampsia in Mice, Which Is Ablated by Endothelial Mineralocorticoid Receptor Deletion. Hypertension 2022; 79:1536-1547. [PMID: 35510543 DOI: 10.1161/hypertensionaha.121.18832] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Patients with preeclampsia demonstrate increases in placental leptin production in midgestation, and an associated increase in late gestation plasma leptin levels. The consequences of mid-late gestation increases in leptin production in pregnancy is unknown. Our previous work indicates that leptin infusion induces endothelial dysfunction in nonpregnant female mice via leptin-mediated aldosterone production and endothelial mineralocorticoid receptor (ECMR) activation, which is ablated by ECMR deletion. Therefore, we hypothesized that leptin infusion in mid-gestation of pregnancy induces endothelial dysfunction and hypertension, hallmarks of clinical preeclampsia, which are prevented by ECMR deletion. METHODS Leptin was infused via miniosmotic pump (0.9 mg/kg per day) into timed-pregnant ECMR-intact (WT) and littermate-mice with ECMR deletion (KO) on gestation day (GD)11-18. RESULTS Leptin infusion decreased fetal weight and placental efficiency in WT mice compared with WT+vehicle. Radiotelemetry recording demonstrated that blood pressure increased in leptin-infused WT mice during infusion. Leptin infusion reduced endothelial-dependent relaxation responses to acetylcholine (ACh) in both resistance (second-order mesenteric) and conduit (aorta) vessels in WT pregnant mice. Leptin infusion increased placental ET-1 (endothelin-1) production evidenced by increased PPET-1 (preproendothelin-1) and ECE-1 (endothelin-converting enzyme-1) expressions in WT mice. Adrenal aldosterone synthase (CYP11B2) and angiotensin II type 1 receptor b (AT1Rb) expression increased with leptin infusion in pregnant WT mice. KO pregnant mice demonstrated protection from leptin-induced reductions in pup weight, placental efficiency, increased BP, and endothelial dysfunction. CONCLUSIONS Collectively, these data indicate that leptin infusion in midgestation induces endothelial dysfunction, hypertension, and fetal growth restriction in pregnant mice, which is ablated by ECMR deletion.
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Affiliation(s)
- Jessica L Faulkner
- Department of Physiology (J.L.F.), Medical College of Georgia at Augusta University
| | - Derrian Wright
- Vascular Biology Center (D.W., G.A., S.K., E.J.B.d.C.), Medical College of Georgia at Augusta University
| | - Galina Antonova
- Vascular Biology Center (D.W., G.A., S.K., E.J.B.d.C.), Medical College of Georgia at Augusta University
| | - Iris Z Jaffe
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA (I.Z.J.)
| | - Simone Kennard
- Vascular Biology Center (D.W., G.A., S.K., E.J.B.d.C.), Medical College of Georgia at Augusta University
| | - Eric J Belin de Chantemèle
- Vascular Biology Center (D.W., G.A., S.K., E.J.B.d.C.), Medical College of Georgia at Augusta University.,Department of Cardiology (E.J.B.d.C.), Medical College of Georgia at Augusta University
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Chou JC. Hypertensive Disorders of Pregnancy and Cardiovascular Risk: We Are Missing the Opportunity of a Lifetime. J Am Coll Cardiol 2022; 79:2412-2414. [PMID: 35710192 DOI: 10.1016/j.jacc.2022.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Josephine C Chou
- Yale University School of Medicine, New Haven, Connecticut, USA.
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Zahid S, Khan MZ, Gowda S, Faza NN, Honigberg MC, Vaught AJ, Guan C, Minhas AS, Michos ED. Trends, Predictors, and Outcomes of Cardiovascular Complications Associated With Polycystic Ovary Syndrome During Delivery Hospitalizations: A National Inpatient Sample Analysis (2002-2019). J Am Heart Assoc 2022; 11:e025839. [PMID: 35708290 PMCID: PMC9496311 DOI: 10.1161/jaha.121.025839] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Women with polycystic ovary syndrome (PCOS) have an increased risk of pregnancy‐associated complications. However, data on peripartum cardiovascular complications remain limited. Hence, we investigated trends, outcomes, and predictors of cardiovascular complications associated with PCOS diagnosis during delivery hospitalizations in the United States. Methods and Results We used data from the National Inpatient Sample (2002–2019). International Classification of Diseases, Ninth Revision (ICD‐9), or International Classification of Diseases, Tenth Revision (ICD‐10), codes were used to identify delivery hospitalizations and PCOS diagnosis. A total of 71 436 308 weighted hospitalizations for deliveries were identified, of which 0.3% were among women with PCOS (n=195 675). The prevalence of PCOS, and obesity among those with PCOS, increased during the study period. Women with PCOS were older (median, 31 versus 28 years; P<0.01) and had a higher prevalence of diabetes, obesity, and dyslipidemia. After adjustment for age, race and ethnicity, comorbidities, insurance, and income, PCOS remained an independent predictor of cardiovascular complications, including preeclampsia (adjusted odds ratio [OR], 1.56 [95% CI, 1.54–1.59]; P<0.01), eclampsia (adjusted OR, 1.58 [95% CI, 1.54–1.59]; P<0.01), peripartum cardiomyopathy (adjusted OR, 1.79 [95% CI, 1.49–2.13]; P<0.01), and heart failure (adjusted OR, 1.76 [95% CI, 1.27–2.45]; P<0.01), compared with no PCOS. Moreover, delivery hospitalizations among women with PCOS were associated with increased length (3 versus 2 days; P<0.01) and cost of hospitalization ($4901 versus $3616; P<0.01). Conclusions Women with PCOS had a higher risk of preeclampsia/eclampsia, peripartum cardiomyopathy, and heart failure during delivery hospitalizations. Moreover, delivery hospitalizations among women with PCOS diagnosis were associated with increased length and cost of hospitalization. This signifies the importance of prepregnancy consultation and optimization for cardiometabolic health to improve maternal and neonatal outcomes.
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Affiliation(s)
- Salman Zahid
- Sands-Constellation Heart Institute Rochester General Hospital Rochester NY
| | - Muhammad Zia Khan
- Division of Cardiovascular Medicine West Virginia University Heart and Vascular Institute Morgantown WV
| | - Smitha Gowda
- Division of Cardiology Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Nadeen N Faza
- Division of Cardiology Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Michael C Honigberg
- Cardiology Division, Department of Medicine Massachusetts General Hospital Boston MA
| | - Arthur Jason Vaught
- Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics Johns Hopkins University School of Medicine Baltimore MD
| | - Carolyn Guan
- Division of Cardiology Johns Hopkins University School of Medicine Baltimore MD
| | - Anum S Minhas
- Division of Cardiology Johns Hopkins University School of Medicine Baltimore MD
| | - Erin D Michos
- Division of Cardiology Johns Hopkins University School of Medicine Baltimore MD
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Minhas AS, Goldstein SA, Vaught AJ, Lewey J, Ward C, Schulman SP, Michos ED. Instituting a Curriculum for Cardio-Obstetrics Subspecialty Fellowship Training. Methodist Debakey Cardiovasc J 2022; 18:14-23. [PMID: 35734150 PMCID: PMC9165665 DOI: 10.14797/mdcvj.1101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/24/2022] [Indexed: 01/26/2023] Open
Abstract
Maternal mortality is rising in the United States, and cardiovascular disease is the leading cause. Adverse pregnancy outcomes such as preeclampsia and gestational diabetes heighten the risk of cardiovascular complications during pregnancy and the peripartum period and are associated with long-term cardiovascular risks. The field of cardio-obstetrics is a subspecialty within adult cardiology that focuses on the management of women with or at high risk for heart disease who are considering pregnancy or have become pregnant. There is growing recognition of the need for more specialists with dedicated expertise in cardio-obstetrics to improve the cardiovascular care of this high-risk patient population. Current recommendations for cardiovascular fellowship training programs accredited by the Accreditation Council for Graduate Medical Education involve establishing core competency in the knowledge of managing heart disease in pregnancy. However, little granular detail is available of what such training should entail, which can lead to knowledge gaps. Additionally, dedicated advanced subspecialty training in this area is not commonly offered. Multidisciplinary collaborative teams have been shown to improve outcomes in cardiac patients during pregnancy, and cardiovascular fellows-in-training interested in cardio-obstetrics should have the opportunity to participate in and contribute to a pregnancy heart team. In this document, we describe a proposed specialized cardio-obstetrics training pathway that could serve to adequately prepare trainees to competently and comprehensively care for women with cardiovascular disease before, during, and after pregnancy.
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Affiliation(s)
- Anum S. Minhas
- Johns Hopkins University School of Medicine, Baltimore, Maryland, US
| | | | | | - Jennifer Lewey
- University of Pennsylvania, Philadelphia, Pennsylvania, US
| | - Cary Ward
- Duke University School of Medicine, Durham, North Carolina, US
| | | | - Erin D. Michos
- Johns Hopkins University School of Medicine, Baltimore, Maryland, US
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, US
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Saunders M, Simpson D. “Can i donate a kidney?” Common questions and simplified answers to the prospective kidney donor. J Natl Med Assoc 2022; 114:S56-S61. [DOI: 10.1016/j.jnma.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ijaz SH, Jamal S, Minhas AMK, Sheikh AB, Nazir S, Khan MS, Minhas AS, Hays AG, Warraich HJ, Greene SJ, Fudim M, Honigberg MC, Khan SS, Paul TK, Michos ED. Trends in Characteristics and Outcomes of Peripartum Cardiomyopathy Hospitalizations in the United States Between 2004 and 2018. Am J Cardiol 2022; 168:142-150. [PMID: 35074213 PMCID: PMC9944609 DOI: 10.1016/j.amjcard.2021.12.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/25/2021] [Accepted: 12/28/2021] [Indexed: 12/20/2022]
Abstract
Data are limited on contemporary temporal trends in maternal characteristics and outcomes in hospitalized patients with peripartum cardiomyopathy (PC). We used the National Inpatient Sample database from January 1, 2004, to December 31, 2018, to identify PC hospitalizations in women aged 15 to 54 years. Weighted survey data were used to derive national estimates for the United States population and examine trends. Between 2004 and 2018, there was a total of 23,420 weighted hospitalizations for PC in women aged 15 to 54 years. The mean (standard error) age of this hospitalized PC population was 30.3 (0.1) years, with 44.6% White, 39.3% Black, 9.0% Hispanics, and 7.1% "Other" racial/ethnic groups. There was a nonsignificant increase in the PC hospitalization per 100,000 live births from 33.6 in 2004 to 42.4 in 2018 (p-trend = 0.06) over the study period, driven by a statistically significant increase in the younger women age group 15 to 35 years (p-trend = 0.04). The PC hospitalizations per 100,000 live births for women aged 36 to 54 years were more than double that observed in women aged 15 to 35 years (77.6 vs 33.5). PC hospitalizations were more than threefold greater in Black versus White women (103.5 vs 32.0 per 100,000 live births). Overall, inpatient mortality was 0.8%; the adjusted inpatient mortality showed a nonsignificant overall decrease from 1.1% in 2004 to 0.5% in 2018 (p-trend = 0.15). The overall mean length of stay was 4.6 days; the adjusted mean length of stay decreased from 5.8 days in 2004 to 4.6 days in 2018 (p-trend <0.01). In conclusion, there has been a nonsignificant increase in hospitalizations for PC, driven by an increasing rate of hospitalizations in younger women. The older maternal age group and Black patients had a higher proportional hospitalization as compared with the younger age group and White patients. There was a nonsignificant decrease in inpatient mortality.
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Affiliation(s)
- Sardar Hassan Ijaz
- Division of Cardiology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Shakeel Jamal
- College of Medicine, Central Michigan University, Saginaw, Michigan
| | | | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Salik Nazir
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, Ohio
| | | | - Anum S. Minhas
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Allison G. Hays
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Haider J. Warraich
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Stephen J. Greene
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina,Duke Clinical Research Institute, Durham, North Carolina
| | - Marat Fudim
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina,Duke Clinical Research Institute, Durham, North Carolina
| | | | - Sadiya S. Khan
- Division of Cardiology, Department of Medicine,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Timir K. Paul
- Division of Cardiology, East Tennessee State University, Johnson City, Tennessee
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Wang X, Carcel C, Woodward M, Schutte AE. Blood Pressure and Stroke: A Review of Sex- and Ethnic/Racial-Specific Attributes to the Epidemiology, Pathophysiology, and Management of Raised Blood Pressure. Stroke 2022; 53:1114-1133. [PMID: 35344416 DOI: 10.1161/strokeaha.121.035852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Raised blood pressure (BP) is the leading cause of death and disability worldwide, and its particular strong association with stroke is well established. Although systolic BP increases with age in both sexes, raised BP is more prevalent in males in early adulthood, overtaken by females at middle age, consistently across all ethnicities/races. However, there are clear regional differences on when females overtake males. Higher BP among males is observed until the seventh decade of life in high-income countries, compared with almost 3 decades earlier in low- and middle-income countries. Females and males tend to have different cardiovascular disease risk profiles, and many lifestyles also influence BP and cardiovascular disease in a sex-specific manner. Although no hypertension guidelines distinguish between sexes in BP thresholds to define or treat hypertension, observational evidence suggests that in terms of stroke risk, females would benefit from lower BP thresholds to the magnitude of 10 to 20 mm Hg. More randomized evidence is needed to determine if females have greater cardiovascular benefits from lowering BP and whether optimal BP is lower in females. Since 1990, the number of people with hypertension worldwide has doubled, with most of the increase occurring in low- and-middle-income countries where the greatest population growth was also seen. Sub-Saharan Africa, Oceania, and South Asia have the lowest detection, treatment, and control rates. High BP has a more significant effect on the burden of stroke among Black and Asian individuals than Whites, possibly attributable to differences in lifestyle, socioeconomic status, and health system resources. Although pharmacological therapy is recommended differently in local guidelines, recommendations on lifestyle modification are often very similar (salt restriction, increased potassium intake, reducing weight and alcohol, smoking cessation). This overall enhanced understanding of the sex- and ethnic/racial-specific attributes to BP motivates further scientific discovery to develop more effective prevention and treatment strategies to prevent stroke in high-risk populations.
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Affiliation(s)
- Xia Wang
- The George Institute for Global Health (X.W., C.C., M.W., A.E.S.), University of New South Wales, Sydney, Australia
| | - Cheryl Carcel
- The George Institute for Global Health (X.W., C.C., M.W., A.E.S.), University of New South Wales, Sydney, Australia.,Sydney School of Public Health, Sydney Medical School, The University of Sydney, New South Wales, Australia (C.C.)
| | - Mark Woodward
- The George Institute for Global Health (X.W., C.C., M.W., A.E.S.), University of New South Wales, Sydney, Australia.,The George Institute for Global Health, School of Public Health, Imperial College London, United Kingdom (M.W.)
| | - Aletta E Schutte
- The George Institute for Global Health (X.W., C.C., M.W., A.E.S.), University of New South Wales, Sydney, Australia.,School of Population Health (A.E.S.), University of New South Wales, Sydney, Australia.,Hypertension in Africa Research Team, Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa (A.E.S.)
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Suresh S, Amegashie C, Patel E, Nieman KM, Rana S. Racial Disparities in Diagnosis, Management, and Outcomes in Preeclampsia. Curr Hypertens Rep 2022; 24:87-93. [PMID: 35254590 DOI: 10.1007/s11906-022-01172-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 01/05/2023]
Abstract
PURPOSE OF THE REVIEW Racial disparities are prevalent in many aspects of obstetric care in the USA. Non-Hispanic black women have a higher prevalence of the diagnosis of hypertensive disorders of pregnancy in addition to associated morbidity and mortality. The purpose of this review is to review current data regarding racial disparities in the diagnosis and management of hypertensive disorders of pregnancy. RECENT FINDINGS Diagnosis of hypertensive disorders of pregnancy is more common among non-Hispanic black women even after adjustment for comorbidities. Furthermore, prevalence of severe morbidity among those with hypertensive disorders of pregnancy is increased in non-Hispanic black women, including cardiovascular events related. Proposed management solutions include quality improvement initiatives, telehealth, and strategies to reduce both structural racism and implicit bias. Racial disparities exist in both diagnosis and management of hypertensive disorders of pregnancy; further innovative work is needed to reduce these disparities.
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Affiliation(s)
- Sunitha Suresh
- Division of Maternal Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago Medicine, 5841 S. Maryland Ave, MC 2050, Chicago, IL, 60637, USA
| | | | - Easha Patel
- Division of Maternal Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago Medicine, 5841 S. Maryland Ave, MC 2050, Chicago, IL, 60637, USA
| | - Kristin M Nieman
- Division of Maternal Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago Medicine, 5841 S. Maryland Ave, MC 2050, Chicago, IL, 60637, USA
| | - Sarosh Rana
- Division of Maternal Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago Medicine, 5841 S. Maryland Ave, MC 2050, Chicago, IL, 60637, USA.
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Wong ND, Budoff MJ, Ferdinand K, Graham IM, Michos ED, Reddy T, Shapiro MD, Toth PP. ATHEROSCLEROTIC CARDIOVASCULAR DISEASE RISK ASSESSMENT: An American Society for Preventive Cardiology Clinical Practice Statement. Am J Prev Cardiol 2022; 10:100335. [PMID: 35342890 PMCID: PMC8943256 DOI: 10.1016/j.ajpc.2022.100335] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/17/2022] [Accepted: 03/05/2022] [Indexed: 01/08/2023] Open
Abstract
Risk for atherosclerotic cardiovascular disease (ASCVD) shows considerable heterogeneity both in generally healthy persons and in those with known ASCVD. The foundation of preventive cardiology begins with assessing baseline ASCVD risk using global risk scores based on standard office-based measures. Persons at low risk are generally recommended for lifestyle management only and those at highest risk are recommended for both lifestyle and pharmacologic therapy. Additional “risk enhancing” factors, including both traditional risk factors and novel biomarkers and inflammatory factors can be used to further assess ASCVD risk, especially in those at borderline or intermediate risk. There are also female-specific risk enhancers, social determinants of health, and considerations for high-risk ethnic groups. Screening for subclinical atherosclerosis, especially with the use of coronary calcium screening, can further inform the treatment decision if uncertain based on the above strategies. Persons with pre-existing ASCVD also have variable risk, affected by the number of major ASCVD events, whether recurrent events have occurred recently, and the presence of other major risk factors or high-risk conditions. Current guidelines define high to very high risk ASCVD accordingly. Accurate ASCVD risk assessment is crucial for the appropriate targeting of preventive therapies to reduce ASCVD risk. Finally, the clinician-patient risk discussion focusing on lifestyle management and the risks and benefits of evidence-based pharmacologic therapies to best lower ASCVD risk is central to this process. This clinical practice statement provides the preventive cardiology specialist with guidance and tools for assessment of ASCVD risk with the goal of appropriately targeting treatment approaches for prevention of ASCVD events.
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Affiliation(s)
- Nathan D. Wong
- Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, CA, United States
- Corresponding author.
| | - Matthew J. Budoff
- Division of Cardiology, Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Keith Ferdinand
- Tulane University Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA United States
| | - Ian M. Graham
- Department of Cardiology, Trinity College, Dublin, Ireland
| | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Tina Reddy
- Tulane University Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA United States
| | | | - Peter P. Toth
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- CGH Medical Center, Sterling, IL, United States
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HYPERLIPIDEMIA AND RISK FOR PRECLAMPSIA. J Clin Lipidol 2022; 16:253-260. [DOI: 10.1016/j.jacl.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/27/2022] [Accepted: 02/14/2022] [Indexed: 11/22/2022]
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Broni EK, Ndumele CE, Echouffo-Tcheugui JB, Kalyani RR, Bennett WL, Michos ED. The Diabetes-Cardiovascular Connection in Women: Understanding the Known Risks, Outcomes, and Implications for Care. Curr Diab Rep 2022; 22:11-25. [PMID: 35157237 DOI: 10.1007/s11892-021-01444-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW Cardiovascular disease (CVD) complications constitute about 50-70% of mortality in people with diabetes. However, there remains a persistently greater relative increase in CVD morbidity and mortality in women with diabetes than in their male counterparts. This review presents recent evidence for the risks, outcomes, and management implications for women with diabetes. RECENT FINDINGS Compared to men, women have higher BMI and more adverse cardiovascular risk profile at time of diabetes diagnosis with greater risk for coronary heart disease, stroke, vascular dementia, and heart failure. Pregnancy-specific risk factors of gestational diabetes and pre-eclampsia are associated with future type 2 diabetes (T2D) and CVD. Women with T2D may experience greater benefits than men from GLP-1 receptor agonists. Women with diabetes are at greater relative risk for CVD complications than men, with poorer outcomes, superimposed on preexisting gender disparities in social determinants of health, lower likelihood of being offered cardioprotective interventions, and enrollment in trials. Further research and the utilization of SGLT-2 inhibitors, GLP-1 receptor agonists, and other CVD prevention strategies will help reduce morbidity and mortality.
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Affiliation(s)
- Eric K Broni
- Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Chiadi E Ndumele
- Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Justin B Echouffo-Tcheugui
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Rita R Kalyani
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Wendy L Bennett
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Erin D Michos
- Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Blalock 524-B, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
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Gambahaya ET, Minhas AS, Sharma G, Vaught AJ, Adamo L, Zakaria S, Michos ED, Hays AG. Racial Differences in Delivery Outcomes among Women with Peripartum Cardiomyopathy. CJC Open 2021; 4:373-377. [PMID: 35495863 PMCID: PMC9039541 DOI: 10.1016/j.cjco.2021.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/12/2021] [Indexed: 01/13/2023] Open
Abstract
Background Peripartum cardiomyopathy (PPCM) is a rare idiopathic cardiomyopathy associated with pregnancy that occurs more frequently among Black women. However, less is known about the association of race/ethnicity with outcomes at the time of delivery in women with PPCM. Methods We used data from the 2016-2018 National Inpatient Sample (NIS) database to identify women with a diagnosis of PPCM based on International Classification of Diseases, 10th revision (ICD-10) codes. Using adjusted logistic regression, the association of race with PPCM and adverse cardiovascular (CV) outcomes with PPCM was evaluated across racial/ethnic groups (White, Black, Hispanic, Asian/Pacific Islander). Results Among 11,304,996 delivery hospitalizations, PPCM was present in 8735 (0.08%). After adjusting for CV risk factors (chronic hypertension, diabetes, and obesity) and socioeconomic factors (insurance status, hospital income, and residential income), Black and Native American women had greater adjusted odds of developing PPCM (adjusted odds ratio [aOR] 1.89; 95% confidence interval [CI] 1.66-2.15; aOR 1.60; 95% CI 1.02-2.50, respectively), compared with White women. In stratified analysis of CV events, however, Asian/Pacific Islander women with PPCM were the most likely to have CV complications (aOR 98; 95% CI 29-333 for pulmonary edema). Conclusions In the US, at the time of delivery hospitalization, Black and Native American women are the most likely to develop PPCM, despite adjustment for CV and socioeconomic risk factors, but Asian women have higher odds of having CV complications.
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Affiliation(s)
- Ellise T. Gambahaya
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - Anum S. Minhas
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Garima Sharma
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Arthur J. Vaught
- Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Luigi Adamo
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sammy Zakaria
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Erin D. Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Allison G. Hays
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Corresponding author: Dr Allison G. Hays, 600 N. Wolfe St, Carnegie 565, Baltimore, Maryland 21287, USA. Tel.: +1-410-955-7534.
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Minhas AS, Rahman F, Gavin N, Cedars A, Vaught AJ, Zakaria S, Resar J, Schena S, Schulman S, Zhao D, Hays AG, Michos ED. Cardiovascular and Obstetric Delivery Complications in Pregnant Women With Valvular Heart Disease. Am J Cardiol 2021; 158:90-97. [PMID: 34452683 PMCID: PMC8765669 DOI: 10.1016/j.amjcard.2021.07.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/10/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
Women with valvular heart disease may be more likely to have adverse obstetric and cardiovascular complications during pregnancy. Most current recommendations focus on stenotic lesions with less guidance regarding regurgitant lesions. We aimed to compare adverse events at delivery for women with various stenotic and regurgitant valvular diseases. We used the 2016 to 2018 National Inpatient Sample data to compare demographics, comorbidities, and obstetric and cardiovascular complications during delivery hospitalizations. After adjusting for clinical and socioeconomic factors, logistic regression was performed to investigate associations between valvular disease and outcomes. Among >11.2 million deliveries, 20,349 were in women with valvular disease. Women with valvular disease were older, had longer length of stays, and higher costs associated with delivery. They had higher prevalence of underlying cardiovascular comorbidities compared with women without valvular disease (hypertension: 5.1 vs 0.25%; pulmonary hypertension: 7.0 vs <0.1%). At delivery, they had higher adjusted odds of obstetric events including preeclampsia and/or eclampsia (aOR 1.9 [1.8 to 2.2]) and intrapartum/postpartum hemorrhage (aOR 1.4 [1.2 to 1.6]), and cardiovascular events including peripartum cardiomyopathy (aOR 65 [53 to 78]), pulmonary edema (aOR 17 [13 to 22]), acute ischemic heart disease (aOR 19 [12 to 30]) and arrhythmias (aOR 22 [19 to 27]). There were valve lesion-specific differences in the magnitude of risk but both stenotic and regurgitant lesions were associated with elevated risk of cardiovascular complications. In conclusion, pregnant women with stenotic and regurgitant valvular disease have a greater burden of cardiovascular comorbidities and increased odds of obstetric and cardiovascular events at delivery. These women may benefit from specialized care from a Cardio-Obstetrics team.
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Affiliation(s)
- Anum S Minhas
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Faisal Rahman
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nicole Gavin
- Department of Maternal Fetal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ari Cedars
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Arthur Jason Vaught
- Department of Maternal Fetal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sammy Zakaria
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jon Resar
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stefano Schena
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Steven Schulman
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Di Zhao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Allison G Hays
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Erin D Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Niemczyk NA. Updates from the Literature, September/October 2021. J Midwifery Womens Health 2021; 66:671-675. [PMID: 34596950 DOI: 10.1111/jmwh.13292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/31/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Nancy A Niemczyk
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania.,Midwife Center for Birth and Women's Health, Pittsburgh, Pennsylvania
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