Previous Pre-Eclampsia, Gestational Diabetes and Hypertension Place Women at High Cardiovascular Risk: But Do We Ask?

Abstract

BackgroundWomen who experience vascular complications of pregnancy, including pre-eclampsia, hypertension and diabetes, are at increased risk of coronary artery disease (CAD). Yet patients and their medical providers have low awareness of the significance of these 'non-traditional' cardiovascular risk factors. We aimed to determine the prevalence and medical provider awareness of pregnancy-related cardiovascular risk factors in women with CAD. MethodsWomen aged 18-70 years treated with percutaneous coronary intervention (PCI) across three tertiary hospitals were invited to participate in a pregnancy-related telephone interview at 12 months post-PCI. Electronic medical records (EMR) were retrospectively reviewed for documentation of pregnancy-related cardiovascular risk factors in the 12 months prior to, and including, the PCI admission. ResultsA total of 102 women (mean age 59.867.7 years) underwent PCI for CAD and completed the pregnancy history questionnaire. Approximately three-quarters (73.5%, 75/102) of women had been pregnant, of which 25.3% (19/75) had experienced vascular complications consisting of pre-eclampsia 31.5% (6/19), gestational diabetes 36.8% (7/19), and gestational hypertension 73.6% (14/19). Documentation of traditional CVD risk factors occurred in 209/211 episodes of emergency or cardiology contact (99.1%), while documentation of 'non-traditional' pregnancy-related cardiovascular risk factors occurred in 0/211 episodes of emergency or cardiology contact. ConclusionMore than a quarter of women treated with PCI for CAD had experienced a past pregnancy-related vascular complication. Despite vascular complications of pregnancy predicting future CAD, medical providers were not obtaining a history of these 'non-traditional' cardiovascular risk factors.

Does Adding Adverse Pregnancy Outcomes Improve the Framingham Cardiovascular Risk Score in Women? Data from the Tehran Lipid and Glucose Study

“…Determining the female‐specific risk factors and applying them in risk estimation tools could enhance the preventive approaches. Pregnancy complications are red flags for CVDs, 51 and extensive evidence has highlighted the pregnancy‐related cardiovascular risk factors. 5 , 9 , 52 Approximately 10% to 20% of pregnancies are complicated by APOs.…”

Randomised clinical trial using Coronary Artery Calcium Scoring in Australian Women with Novel Cardiovascular Risk Factors (CAC-WOMEN Trial): study protocol

“…[16][17][18][19] Yet, awareness of these female-specific, risk-enhancing factors, among patients and healthcare practitioners, remains low. 5 Cardiology guidelines currently tell health providers to 'consider' these female-specific conditions as 'risk enhancing' for CVD, yet give no clear guidance on what this means in practical terms; for example, should women with these female-specific risk factors receive more aggressive lipid and blood pressuring lowering medications? We need a way to decide which women, with these risk-enhancing factors, should receive aggressive primary CVD prevention.…”

“…2 Inequities in awareness, prevention and treatment of CVD in women have all been well documented. [3][4][5][6][7][8][9][10] However, prevention and treatment strategies that take into account female-specific risk factors for heart disease are needed if we are to narrow the gender gap. The Australian absolute cardiovascular disease risk calculator (ACDRC) and Framingham Risk Score are traditional risk prediction tools…”

Heart Disease in Women: Where Are We Now and What is The Future?

“…We also celebrate the expertise of Australian and New Zealand researchers within this expanding sub-specialty. The special edition contains 9 in-depth reviews [4,[6][7][8][9][10][11][12][13], and a further 16 original scientific papers covering a broad range of topics and selected from a competitive submission process [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. The female-predominant condition of SCAD is covered in an insightful review [4], with detailed discussion on the commonly associated genetic condition of fibromuscular dysplasia.…”

“…Pregnancy places a unique stress on the female cardiovascular system with specific diagnostic and management challenges of heart disease in pregnancy, and the emergence of pregnancy-related novel CVD risk factors. Two in-depth reviews focus on pregnancy issues [7,8], with a further original papers covering topics from pre-conception counselling [20], management of congenital heart disease and transplant recipients during pregnancy [21], and the lack of awareness of pregnancy-related CVD risk factors [9,22].…”