Prepregnancy Obesity and Associations With Stroke and Myocardial Infarction in Women in the Years After Childbirth

Abstract

A disturbingly low rate of temporal decline in coronary heart disease mortality has been observed among women aged 35-44 years, compared with men and older women. 1 Additionally, women aged <45 years have an adverse prognosis after myocardial infarction as compared with men and older women, 2 and women 31-50 years old have a poorer prognosis than men after ischemic stroke.3 Further insight into cardiovascular risk factors and the prognosis of cardiovascular disease in young women is warranted, as requested by leading healthcare organizations including the American Heart Association. Clinical Perspective on p 337The World Health Organization states obesity to be the fifth leading cause of global death, 5 and the consequences of obesity has been found to have a higher impact in younger women (≤65 years of age) than in older women. 6 A recent report from the American Heart Association has furthermore documented that the rise in prevalent obesity is alarmingly rapid in the young.7 Despite the rising concerns regarding the obesity epidemic and the identification of young women as an overlooked group with a high morbidity after cardiovascular events, the association between obesity and the risk of cardiovascular disease in the young women has yet to be determined.We examined the associations between prepregnancy body mass index (BMI) and the risk of stroke and myocardial infarction in young, healthy women who have given birth in a nationwide study including pregnancy-associated risk factors in addition to well-established cardiovascular risk factors.Background-Cardiovascular events (stroke or myocardial infarction) are often associated with poorer prognosis in younger, compared with older individuals. We examined the associations between prepregnancy obesity and the risks of myocardial infarction and stroke in young, healthy women. ). The hazard ratios of myocardial infarction, ischemic stroke, and a composite outcome (myocardial infarction, stroke, cardiovascular death) were assessed using multivariable Cox regression models. We included 273 101 women with a median age of 30.4 years (interquartile range, 27.2-33.8). A total of 68 women experienced a myocardial infarction, and 175 women experienced an ischemic stroke. The adjusted hazard ratios of myocardial infarction compared with normal weight were 2.50 (95% confidence interval [95% CI], 0.97-6.50) in underweight, 1.68 (95% CI, 0.92-3.06) in overweight, and 2.63 (95% CI, 1.41-4.91) in obese women. For ischemic stroke the adjusted hazard ratios were 1.06 (95% CI, 0.44-2.28) in underweight, 1.27 (95% CI, 0.87-1.85) in overweight, and 1.89 (95% CI, 1.25-2.84) in obese women, respectively. For the composite outcome, hazard ratios were 1.34 (95% CI, 0.81-2.20), 1.43 (95% CI, 1.11-1.84), and 1.76 (95% CI, 1.31-2.34) for underweight, overweight, and obese women. Conclusions-In apparently healthy women of fertile age, prepregnancy obesity was associated with increased risks of ischemic stroke and myocardial infarction in the years after childbirth. (Circulation. 2014;129:...

Impact of Pregestational Weight and Weight Gain during Pregnancy on Long-Term Risk for Diseases

“…This is comparable with a recent Danish study of obese women that showed a 2.6-fold increase in risk for myocardial infarctions and a 1.9-fold increase in risk for stroke after 4.5 years of follow-up [18]. A similar increase in risk for men has been described in a prospective study of more than 3000 men between 18 and 30 years old, where BMI was found to be directly associated with myocardial systolic dysfunction after 25 years of follow-up [19].…”

Renal function during pregnancy may predict risk of future hospitalization due to atherosclerotic‐related morbidity

“…Not only overt pregnancy complications, but also more benign conditions, such as obesity, were associated with an increased risk for atherosclerotic morbidity. In young women, obesity during pregnancy was associated with an increased risk of ischaemic stroke and myocardial infarction in the years after childbirth . Likewise, in the current study obesity during pregnancy was independently associated with an increased risk of atherosclerotic hospitalizations.…”

Cardiovascular Disease Risk Among Young Urban Women

“…30 About 6.1 (4.6-7.6) years of life were lost for young, obese women, aged 20-39 years, compared to 0.9 (0.1-1.7) years for those aged 60-79 years. Now, there is evidence that excessive weight among mothers carries additional threats since prepregnancy obesity 31,32 Furthermore, young obese women put their children at risk. 33 Cardiac and vasculature structural changes of offspring resulting from maternal over-nutrition include endothelial dysfunction, 34 inflammation, 35 increased sympathetic tone, 36 and myocardial fibrosis.…”