Sub-clinical atherosclerosis in the common carotid artery in women with/without previous pre-eclampsia: A seven-year follow-up
Sub-clinical atherosclerosis in the common carotid artery in women with/without previous pre-eclampsia: A seven-year follow-up
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DOI：
10.1016/j.atherosclerosis.2019.05.024
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发表时间：
2019-11-01
期刊：
影响因子：
5.3
通讯作者：
Naessen, Tord
中科院分区：
文献类型：
--
作者：
Akhter, Tansim;Larsson, Anders;Naessen, Tord
背景和目的：子痫前期与心血管疾病和过早死亡的风险增加有关。然而，传统的颈总动脉内中膜厚度(CCA-IMT)测量不能反映这一点。相比之下，对单个CCA内膜和中层厚度的测量清楚地表明，在诊断时和先兆子痫后大约一年，血管风险都增加了。这项研究检测了个别颈总动脉壁层、心血管疾病的危险因素和内皮功能障碍的标记物在先兆子痫七年后是否正常或仍然不利。方法：使用22 MHz超声测量单个颈总动脉内膜和中层厚度。记录常规心血管危险因素。结果：有子痫前期史(23例)或正常妊娠(35例)的妇女平均年龄为39/37岁。在随访时(中位数约7年)，病例组内膜厚度和I/M高于对照组[均为0.0001；P<；0.001]，而颈总动脉-颈总动脉内膜不合理地变薄。此外，BMI、MAP、臀围、腹高、血清内皮抑素和载脂蛋白B水平均高于对照组(均P<0.05)。动脉内膜和I/M测量与年龄、MAP、内皮抑素和载脂蛋白B相关，而与CCA-IMT无逻辑相关性。结论：病例组而非对照组的动脉在7年后仍然受到不利影响。在显示先兆子痫后血管风险方面，测量内膜厚度和I/M比测量CCA-IMT更可取。
Background and aims: Pre-eclampsia is associated with increased risk of cardiovascular disease and premature death. However, conventional common carotid artery intima-media thickness (CCA-IMT) measurement does not reflect this. In contrast, measurement of the individual CCA intima and media thicknesses clearly indicates increased vascular risk both at diagnosis and about one year after pre-eclampsia. This study examined whether individual CCA wall layers, risk factors for cardiovascular disease, and markers of endothelial dysfunction had normalized or remained unfavorable seven years after pre-eclampsia.Methods: The individual CCA intima and media thicknesses were measured using 22 MHz ultrasound. Conventional cardiovascular risk factors were recorded. A thick intima, thin media and high intima/media thickness ratio (I/M) are signs of sub-clinical atherosclerosis.Results: The median age of women with previous pre-eclampsia (cases = 23) or normal pregnancies (controls = 35) was 39/37 years. At follow-up (median about seven years), the intima remained thicker and the I/M was higher in cases than in controls [all p < 0.0001; p < 0.001 after adjustment for time to follow-up, body mass index (BMI), and mean arterial pressure (MAP)], whereas the CCA-IMT was illogically thinner. Further, BMI, MAP, hip circumference, abdominal height, serum endostatin and apolipoprotein B levels were higher in cases (all p < 0.05). Intima and I/M measurements were correlated with age, MAP, endostatin and apolipoprotein B, whereas no logical correlations were found for CCA-IMT.Conclusions: The arteries in cases but not controls were still adversely affected after seven years. Measuring intima thickness and I/M appears preferable to measuring CCA-IMT for demonstrating vascular risk after pre-eclampsia.