Prognostic indicators of persistent carotid intima-media thickness increase in postpartum period in a population of normotensive women with gestational diabetes mellitus

Sonaglioni, Andrea; Nicolosi, Gian Luigi; Esposito, V.; Bianchi, Stefano; Lombardo, Michele

doi:10.1016/j.ejogrb.2021.12.020

Cited by 5 publications

(3 citation statements)

References 46 publications

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“…The presence of gestational diabetes mellitus with a brief period of exposure to potentially intense glucose intolerance would contribute to endothelial changes and subsequent endothelial dysfunction, which would be further accelerated in the context of comorbidities such as obesity and dyslipidaemia, even without development of type 2 diabetes, and finally lead to clinically overt cardiovascular and cerebrovascular diseases 4142. In a recent investigation, women with gestational diabetes mellitus showed a substantial increase in common carotid artery-intima media thickness than controls at 36.2 weeks of gestation (0.81 v 0.55, P<0.001), which may be associated with the increased risk of future cardiovascular and cerebrovascular diseases after pregnancy 43. Moreover, a US multicentre, community based prospective cohort study found a positive correlation between worsening glucose tolerance and substantial increase in risk of coronary artery calcification 44.…”

Section: Discussionmentioning

confidence: 99%

“… 41 42 In a recent investigation, women with gestational diabetes mellitus showed a substantial increase in common carotid artery-intima media thickness than controls at 36.2 weeks of gestation (0.81 v 0.55, P<0.001), which may be associated with the increased risk of future cardiovascular and cerebrovascular diseases after pregnancy. 43 Moreover, a US multicentre, community based prospective cohort study found a positive correlation between worsening glucose tolerance and substantial increase in risk of coronary artery calcification. 44 In addition, researchers also found a strong association between gestational diabetes mellitus and increased left ventricular mass and impaired left ventricular relaxation and systolic function, which were independent of subsequent development of type 2 diabetes.…”

Section: Discussionmentioning

confidence: 99%

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Association of gestational diabetes mellitus with overall and type specific cardiovascular and cerebrovascular diseases: systematic review and meta-analysis

Xie

Wang

Xiao

et al. 2022

BMJ

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Objective To quantify the risk of overall and type specific cardiovascular and cerebrovascular diseases as well as venous thromboembolism in women with a history of gestational diabetes mellitus. Design Systematic review and meta-analyses. Data sources PubMed, Embase, and the Cochrane Library from inception to 1 November 2021 and updated on 26 May 2022. Review methods Observational studies reporting the association between gestational diabetes mellitus and incident cardiovascular and cerebrovascular diseases were eligible. Data, pooled by random effects models, are presented as risk ratios (95% confidence intervals). Certainty of evidence was appraised by the Grading of Recommendations, Assessment, Development, and Evaluations. Results 15 studies rated as moderate or serious risk of bias were included. Of 513 324 women with gestational diabetes mellitus, 9507 had cardiovascular and cerebrovascular disease. Of more than eight million control women without gestational diabetes, 78 895 had cardiovascular and cerebrovascular disease. Compared with women without gestational diabetes mellitus, women with a history of gestational diabetes mellitus showed a 45% increased risk of overall cardiovascular and cerebrovascular diseases (risk ratio 1.45, 95% confidence interval 1.36 to 1.53), 72% for cardiovascular diseases (1.72, 1.40 to 2.11), and 40% for cerebrovascular diseases (1.40, 1.29 to 1.51). Women with gestational diabetes mellitus showed increased risks of incident coronary artery diseases (1.40, 1.18 to 1.65), myocardial infarction (1.74, 1.37 to 2.20), heart failure (1.62, 1.29 to 2.05), angina pectoris (2.27, 1.79 to 2.87), cardiovascular procedures (1.87, 1.34 to 2.62), stroke (1.45, 1.29 to 1.63), and ischaemic stroke (1.49, 1.29 to 1.71). The risk of venous thromboembolism was observed to increase by 28% in women with previous gestational diabetes mellitus (1.28, 1.13 to 1.46). Subgroup analyses of cardiovascular and cerebrovascular disease outcomes stratified by study characteristics and adjustments showed significant differences by region (P=0.078), study design (P=0.02), source of data (P=0.005), and study quality (P=0.04), adjustment for smoking (P=0.03), body mass index (P=0.01), and socioeconomic status (P=0.006), and comorbidities (P=0.05). The risk of cardiovascular and cerebrovascular diseases was, however, attenuated but remained significant when restricted to women who did not develop subsequent overt diabetes (all gestational diabetes mellitus: 1.45, 1.33 to 1.59, gestational diabetes mellitus without subsequent diabetes: 1.09, 1.06 to 1.13). Certainty of evidence was judged as low or very low quality. Conclusions Gestational diabetes mellitus is associated with increased risks of overall and type specific cardiovascular and cerebrovascular diseases that cannot be solely attributed to conventional cardiovascular risk factors or subsequent diabetes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association of gestational diabetes mellitus with overall and type specific cardiovascular and cerebrovascular diseases: systematic review and meta-analysis

Xie

Wang

Xiao

et al. 2022

BMJ

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“…Measurements were made in the distal CCA at 1 cm from the carotid bifurcation. The average value of the left and right carotid relative wall thickness was derived from the formula: 2 × average IMT/average CCA-EDD, while the average value of the left and right CCA-cross-sectional area (CSA) (mm 2 ) was calculated according to the formula: [π × (2 × average IMT + average CCA-EDD/2) 2 − π × (average CCA-EDD/2) 2 ], as a surrogate for carotid arterial mass [40].…”

Section: Methodsmentioning

confidence: 99%

Left ventricular strain predicts subclinical atherosclerosis in nonadvanced nonalcoholic fatty liver disease patients

Sonaglioni¹,

Cerini

Nicolosi³

et al. 2022

European Journal of Gastroenterology &Amp; Hepatology

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Objectives The association between nonalcoholic fatty liver disease (NAFLD) and carotid atherosclerosis is still controversial. The present study was designed to assess the relationship between left ventricular systolic mechanics, noninvasively assessed by two-dimensional (2D) speckle-tracking echocardiography (STE) and common carotid artery (CCA) intima-media thickness (IMT), in patients with nonadvanced NAFLD. Methods All consecutive NAFLD patients diagnosed with liver stiffness measurement (LSM) <12.5 kPa on transient elastography between September 2021 and December 2021 were prospectively enrolled. All participants underwent blood tests, transient elastography, 2D transthoracic echocardiography (TTE) implemented with 2D-STE analysis of left ventricular (LV) global longitudinal strain (GLS) and finally carotid ultrasonography. Main independent predictors of subclinical atherosclerosis, defined as CCA-IMT >0. 9 mm, were evaluated. Results A total of 92 NAFLD patients (54.0 ± 11.1 years, 50% males) were prospectively analyzed. Mean LSM was 6.2 ± 2.4 kPa. FibroScan results revealed that 76.1% of patients had F0-F1, 5.4% F2 and 18.5% F3 liver fibrosis. Despite normal biventricular systolic function on 2D-TTE, LV-GLS was reduced (less negative than −20%) in 64.1% of patients. However, 62.0% of NAFLD patients were found with CCA-IMT >0. 9 mm. Age [odds ratio (OR),1.19; 95% confidence interval (CI), 1.05-1.36], hypertension (OR, 3.73; 95% CI, 1.53-9.11), LSM (OR, 4.83; 95% CI, 2.43-9.59), LV-GLS (OR, 0.49; 95% CI, 0.36-0.68) and statin therapy (OR, 0.10; 95% CI, 0.02-0.60) were independently associated with subclinical atherosclerosis. Age ≥51 years, LSM ≥5.5 kPa and LV-GLS less negative than −20% were the best cutoff values for predicting subclinical atherosclerosis. Conclusions Subclinical myocardial dysfunction and subclinical atherosclerosis are simultaneously present in patients with nonadvanced NAFLD.

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The effect of gestational diabetes mellitus on carotid artery intima-media thickness in and after pregnancy: a systematic review and meta-analysis

Sonaglioni,

Piergallini,

Naselli

et al. 2023

Acta Diabetol

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Prognostic indicators of persistent carotid intima-media thickness increase in postpartum period in a population of normotensive women with gestational diabetes mellitus

Cited by 5 publications

References 46 publications

Association of gestational diabetes mellitus with overall and type specific cardiovascular and cerebrovascular diseases: systematic review and meta-analysis

Association of gestational diabetes mellitus with overall and type specific cardiovascular and cerebrovascular diseases: systematic review and meta-analysis

Left ventricular strain predicts subclinical atherosclerosis in nonadvanced nonalcoholic fatty liver disease patients

The effect of gestational diabetes mellitus on carotid artery intima-media thickness in and after pregnancy: a systematic review and meta-analysis

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