Residual vascular dysfunction in women with a history of preeclampsia.
Residual vascular dysfunction in women with a history of preeclampsia.
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DOI：
10.1152/ajpregu.00204.2018
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发表时间：
2018-12
期刊：
影响因子：
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通讯作者：
A. Stanhewicz
中科院分区：
文献类型：
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作者：
A. Stanhewicz
子痫前期是一种妊娠期高血压疾病，以妊娠20周后新发的高血压、蛋白尿和水肿为特征，在美国的发病率约为7-10%，全球约有800万例妊娠。尽管产后先兆子痫症状有所缓解，但与有正常孕产史的女性相比，患有先兆子痫的女性患心血管疾病(CVD)的可能性要高出两到四倍，死于心血管疾病的可能性也要高得多。尽管先兆子痫病史和心血管疾病风险升高之间的关系已经有了很好的记录，但这种联系的机制(S)仍然不清楚。解释这种联系的一个假说是，在先兆子痫妊娠期间遭受的最初血管损伤和功能障碍长期存在。事实上，即使在没有或提前出现明显的心血管疾病的情况下，患有先兆子痫的妇女也会损害血管内皮功能。在这些妇女中新出现的机制研究为这种持续性血管功能障碍的潜在机制提供了一些见解，并开始确定潜在的治疗靶点，以预防或缓解这一脆弱人群的心血管疾病进展。这篇综述总结了研究有先兆子痫病史的妇女的血管功能和功能障碍的现有文献，并强调了未来机械性研究和旨在阻止或减缓这些妇女心血管疾病进展的新干预策略的发展方向。
Preeclampsia is a hypertensive disorder of pregnancy characterized by new-onset hypertension, proteinuria, and edema occurring after 20 wk of gestation, with a prevalence of ~7-10% of pregnancies in the United States and ~8 million pregnancies worldwide. Despite the postpartum remission of preeclamptic symptoms, women who have had preeclampsia are two to four times more likely to develop cardiovascular disease (CVD) and are significantly more likely to die of CVD compared with women with a history of normal pregnancy. Although the relation between history of preeclampsia and elevated CVD risk is well documented, the mechanism(s) underlying this association remains unclear. One hypothesis explaining this association is that the initial vascular damage and dysfunction sustained during the preeclamptic pregnancy persist chronically. Indeed, even in the absence of, or in advance of, overt CVD women who have had preeclampsia have compromised vascular endothelial function. Emerging mechanistic studies in these women have provided some insight into the underlying mechanisms of this persistent vascular dysfunction and have begun to identify potential therapeutic targets for the prevention or mitigation of CVD progression in this vulnerable population. This review summarizes the existing literature examining vascular function and dysfunction in women with a history of preeclampsia and highlights future directions for mechanistic investigations and development of novel intervention strategies aimed at halting or slowing the progression of CVD in these women.