Early Pregnancy Atherogenic Profile in a First Pregnancy and Hypertension Risk 2 to 7 Years After Delivery.
Early Pregnancy Atherogenic Profile in a First Pregnancy and Hypertension Risk 2 to 7 Years After Delivery.
复制标题
第一次怀孕时的早期妊娠动脉粥样硬化特征和产后 2 至 7 年内的高血压风险。
DOI：
10.1161/jaha.120.017216
复制
发表时间：
2021-03
影响因子：
5.4
通讯作者：
NHLBI nuMoM2b Heart Health Study
中科院分区：
文献类型：
--
作者：
Catov JM;McNeil RB;Marsh DJ;Mercer BM;Bairey Merz CN;Parker CB;Pemberton VL;Saade GR;Chen YI;Chung JH;Ehrenthal DB;Grobman WA;Haas DM;Parry S;Polito L;Reddy UM;Silver RM;Simhan HN;Wapner RJ;Kominiarek M;Kreutz R;Levine LD;Greenland P;NHLBI nuMoM2b Heart Health Study
青年时期的心血管风险是终生心血管疾病风险的重要决定因素。有不良妊娠结局(APO)的妇女心血管风险增加，但其他因素的关系尚不清楚。在4471名初产妇女中，我们将妊娠早期动脉粥样硬化标志物与产后2-7年内APO(妊娠高血压疾病、早产、小于胎龄儿)、妊娠期糖尿病(GDM)和高血压(130/80 mm汞或降压药使用)的风险相关联。有apo/妊娠期糖尿病的女性(n=1 102)有更多的动脉粥样硬化特征(肥胖[34.2vs19.5%]，高血压[收缩压112.2 vs108.4，舒张压69.2vs66.6nmmolHg]，血糖[5.0vs4.8nmmoL/L]，胰岛素[77.6vs60.1nmol/L]，甘油三酯[1.4vs1.3nmol/L]，以及高敏C反应蛋白[5.6vs4.0nmoL/L]，和较低的高密度脂蛋白胆固醇[1.8vs1.9mmo1/L]；P<；0.05)高于没有APO/GDM的女性。她们也更有可能在产后患高血压(32.8%比18.1%，P<；0.05)。考虑到产前常规评估的混杂因素和因素，较高的血糖(相对危险度[RR]1.03[95%CI，1.00~1.06]/0.6 mmol/L)、高敏C反应蛋白(RR，1.06[95%CI，1.02~1.11]/2倍)和甘油三酯(RR，1.27[95%CI，1.14~1.41]/2倍)与晚期高血压相关。较高的体力活动具有保护作用(RR，每周3小时，RR为0.93[95%CI，0.87~0.99])。当评估为潜在特征时，具有较高血脂、高敏C反应蛋白和胰岛素值的非肥胖组(占队列的6.9%)增加了APO/GDM和后来的高血压的风险。在这些因素中，7%~15%的超额RR与APO/GDM有关。单独的和联合的妊娠早期动脉粥样硬化特征与APO/GDM的发生和2至7年后的高血压有关。网址：https://www.clinicaltrials.gov；唯一标识：nct02231398。
Cardiovascular risk in young adulthood is an important determinant of lifetime cardiovascular disease risk. Women with adverse pregnancy outcomes (APOs) have increased cardiovascular risk, but the relationship of other factors is unknown. Among 4471 primiparous women, we related first‐trimester atherogenic markers to risk of APO (hypertensive disorders of pregnancy, preterm birth, small for gestational age), gestational diabetes mellitus (GDM) and hypertension (130/80 mm Hg or antihypertensive use) 2 to 7 years after delivery. Women with an APO/GDM (n=1102) had more atherogenic characteristics (obesity [34.2 versus 19.5%], higher blood pressure [systolic blood pressure 112.2 versus 108.4, diastolic blood pressure 69.2 versus 66.6 mm Hg], glucose [5.0 versus 4.8 mmol/L], insulin [77.6 versus 60.1 pmol/L], triglycerides [1.4 versus 1.3 mmol/L], and high‐sensitivity C‐reactive protein [5.6 versus 4.0 nmol/L], and lower high‐density lipoprotein cholesterol [1.8 versus 1.9 mmol/L]; P<0.05) than women without an APO/GDM. They were also more likely to develop hypertension after delivery (32.8% versus 18.1%, P<0.05). Accounting for confounders and factors routinely assessed antepartum, higher glucose (relative risk [RR] 1.03 [95% CI, 1.00–1.06] per 0.6 mmol/L), high‐sensitivity C‐reactive protein (RR, 1.06 [95% CI, 1.02–1.11] per 2‐fold higher), and triglycerides (RR, 1.27 [95% CI, 1.14–1.41] per 2‐fold higher) were associated with later hypertension. Higher physical activity was protective (RR, 0.93 [95% CI, 0.87‐0.99] per 3 h/week). When evaluated as latent profiles, the nonobese group with higher lipids, high‐sensitivity C‐reactive protein, and insulin values (6.9% of the cohort) had increased risk of an APO/GDM and later hypertension. Among these factors, 7% to 15% of excess RR was related to APO/GDM. Individual and combined first‐trimester atherogenic characteristics are associated with APO/GDM occurrence and hypertension 2 to 7 years later. URL: https://www.clinicaltrials.gov; Unique identifier: NCT02231398.