The postpartum cardiovascular risk factor profile of women with isolated hyperglycemia at 1-hour on the oral glucose tolerance test in pregnancy
The postpartum cardiovascular risk factor profile of women with isolated hyperglycemia at 1-hour on the oral glucose tolerance test in pregnancy
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DOI：
10.1016/j.numecd.2011.02.010
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发表时间：
2011-09-01
影响因子：
3.9
通讯作者：
Zinman, B.
中科院分区：
文献类型：
--
作者：
Retnakaran, R.;Qi, Y.;Zinman, B.
背景和目标：与同龄人相比，患有妊娠期糖尿病 (GDM) 的女性在产后 3 个月时的心血管危险因素增强，未来患心血管疾病的风险也更高。最近，研究表明，即使产前口服葡萄糖耐量试验（OGTT）出现轻微血糖异常，也可预测未来患心血管疾病的风险增加，尽管尚不清楚该患者群体中是否存在可识别的高风险亚组。由于 OGTT 期间 1 小时孤立性高血糖引起的妊娠期糖耐量受损 (GIGT) (1-h GIGT) 与 GDM 具有代谢相似性，因此我们假设，与 GDM 一样，1-h GIGT 可以预测高风险的产后心血管表型。 方法和结果：在这项前瞻性队列研究中，485 名妇女接受了产前 OGTT，随后在 3 个月时进行了心血管危险因素评估产后。产前 OGTT 确定了 4 个妊娠期葡萄糖耐量组：GDM（n = 137）； 1 小时 GIGT（n = 39）； 2 小时或 3 小时的 GIGT (2/3 小时 GIGT)(n = 50)；和正常葡萄糖耐量 (NGT)(n = 259)。调整年龄、种族、母乳喂养和腰围后，以下心血管危险因素的平均水平从 NGT 到 2/3 小时 GIGT，再到 1 小时 GIGT，再到 GDM： LDL 胆固醇 (p = 0.0026)；总胆固醇：HDL（p = 0.0030）；载脂蛋白 B (p = 0.004)；载脂蛋白 B：载脂蛋白 A1 (p = 0.026)；瘦素（p = 0.018）；和 C 反应蛋白（p = 0.011）。结论：在没有 GDM 的女性中，1 小时 GIGT 预测产后心血管危险因素状况增强。因此，在怀孕期间患有轻度血糖异常的年轻女性中，患有 1 小时 GIGT 的患者可能是未被认识到的未来罹患心血管疾病风险的患者群体。 (C) 2011 Elsevier B.V. 保留所有权利。
Background and aims: Women with gestational diabetes mellitus (GDM) have an enhanced cardiovascular risk factor profile at 3-months postpartum and an elevated risk of future cardiovascular disease, as compared to their peers. Recently, it has emerged that even mild dysglycemia on antepartum oral glucose tolerance test (OGTT) predicts an increased risk of future cardiovascular disease, although it is not known whether there exists an identifiable high-risk subgroup within this patient population. Since gestational impaired glucose tolerance (GIGT) due to isolated hyperglycemia at 1-h during the OGTT (1-h GIGT) bears metabolic similarity to GDM, we hypothesized that, like GDM, 1-h GIGT may predict a high-risk postpartum cardiovascular phenotype.Methods and results: In this prospective cohort study, 485 women underwent antepartum OGTT, followed by cardiovascular risk factor assessment at 3-months postpartum. The antepartum OGTT identified 4 gestational glucose tolerance groups: GDM (n = 137); 1-h GIGT (n = 39); GIGT at 2- or 3-h (2/3-h GIGT)(n = 50); and normal glucose tolerance (NGT)(n = 259). After adjustment for age, ethnicity, breastfeeding and waist circumference, mean levels of the following cardiovascular risk factors progressively increased from NGT to 2/3-h GIGT to 1-h GIGT to GDM: LDL cholesterol (p = 0.0026); total cholesterol: HDL (p = 0.0030); apolipoprotein B (p = 0.004); apolipoprotein B: apolipoprotein A1 (p = 0.026); leptin (p = 0.018); and C-reactive protein (p = 0.011).Conclusions: Amongst women without GDM, 1-h GIGT predicts an enhanced postpartum cardiovascular risk factor profile. It thus emerges, that amongst young women with mild dysglycemia in pregnancy, those with 1-h GIGT may comprise an unrecognized patient population at risk for future cardiovascular disease. (C) 2011 Elsevier B.V. All rights reserved.