Gestational Diabetes History and Glucose Tolerance After Pregnancy Associated With Coronary Artery Calcium in Women During Midlife: The CARDIA Study.
Gestational Diabetes History and Glucose Tolerance After Pregnancy Associated With Coronary Artery Calcium in Women During Midlife: The CARDIA Study.
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DOI：
10.1161/circulationaha.120.047320
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发表时间：
2021-03-09
期刊：
影响因子：
37.8
通讯作者：
Carr JJ
中科院分区：
文献类型：
--
作者：
Gunderson EP;Sun B;Catov JM;Carnethon M;Lewis CE;Allen NB;Sidney S;Wellons M;Rana JS;Hou L;Carr JJ
Gestational diabetes (GD) leads to earlier onset and heightened risk of type 2 diabetes, a strong risk factor for cardiovascular disease (CVD). However, it is unclear whether attaining normoglycemia can ameliorate the excess CVD risk associated with GD history. This study sought to evaluate GD history and glucose tolerance after pregnancy associated with coronary artery calcification (CAC) in women, a manifestation of atherosclerotic CVD (ASCVD), and predictor of CVD clinical events. Data from the Coronary Artery Risk Development in Young Adults Study, a U.S. multicenter, community-based prospective cohort of young Black (50%) and White adults aged 18–30 years at baseline (1985–1986). The sample included 1,133 women without diabetes at baseline, who had one or more singleton births (n=2,066) during follow up, glucose tolerance testing at baseline and up to 5 times during 25 years (1986–2011), GD status, and CAC measurements at follow up exam at years 15, 20, and/or 25 (2001–2011). CAC was measured by non-contrast cardiac computed tomography; dichotomized as Any CAC (score>0) or No CAC (score=0). Complementary log-log models for interval-censored data estimated adjusted hazard ratios of CAC and 95% confidence intervals for GD history and subsequent glucose tolerance groups (normoglycemia, prediabetes, or incident diabetes) on average 14.7 years after the last birth adjusted for pre-pregnancy and follow up covariates. Of 1,133 women, 139 (12.3%) reported GD and were aged 47.6 years (4.8 SD) at follow up. CAC was present in 25% (34/139) of women with GD and 15% (149/994) of women with no GD. Compared to no GD/normoglycemia, adjusted hazard ratios (95% confidence intervals) were 1.54 (1.06, 2.24) for no GD/prediabetes and 2.17 (1.30, 3.62) for no GD/incident diabetes, and 2.34 (1.34, 4.09), 2.13 (1.09, 4.17) and 2.02 (0.98, 4.19) for GD/normoglycemia, GD/prediabetes, and GD/incident diabetes, respectively (overall p-value=0.003). Women without previous GD showed a graded increase in the risk of CAC associated with worsening glucose tolerance. Women with a history of GD had a 2-fold higher risk of CAC across all subsequent levels of glucose tolerance. Mid-life ASCVD risk among women with previous GD is not diminished by attaining normoglycemia.
