Cardiovascular Risk in Former Gestational Diabetic Women

糖尿病与心血管疾病风险之间的联系已得到充分证实。有妊娠糖尿病（GDM）病史的妇女在以后的生活中患2型糖尿病的风险增加，有限但具有启发性的证据表明，这些妇女也更有可能具有冠心病（CHD）的不利危险因素。本项目的主要目的是研究有GDM病史的女性与无GDM病史的女性相比，冠心病危险因素的患病率。我们将测试有GDM病史的女性是否：1)与没有GDM的女性相比，有较高的10年冠心病相对危险度，2)有更多的冠心病个人危险因素，以及3)在控制体型的情况下，与没有GDM的女性相比，更有可能在更年轻的时候出现冠心病危险因素。该项目的第二个目的是评估女性对未来罹患冠心病和糖尿病风险的认知，以及认知风险是否与实际风险相关。将招募80名有GDM病史的妇女（病例）和80名无GDM病史的妇女（对照组），她们分娩时年龄在30岁或以上，现在产后5至10年。病例和对照组将根据年龄、种族和体重指数（BMI）在指数妊娠的一年内进行匹配。数据将在美国国立卫生研究院资助的普通临床研究中心的门诊入院期间收集。主要结局将计算冠心病、血脂、血压和胰岛素敏感性的相对风险。次要结果将是对糖尿病和冠心病风险的感知。通过匹配孕前体重指数来控制体型，同时控制当前体重指数和中心性肥胖。在进行假设检验之前，将考虑人口统计学和临床变量，特别是已知与冠心病风险相关和/或在病例和对照组中分布不同的变量作为控制变量。将采用回归和逻辑回归分析来检验有无GDM的女性在研究结果上的差异。相关分析将用于确定风险感知和实际风险之间的关系。

The association between diabetes and risk for cardiovascular disease is well established. Women with a history of gestational diabetes mellitus (GDM) are at increased risk of developing type 2 diabetes later in life, and limited but suggestive evidence demonstrates that these women also are more likely to have an unfavorable risk factor profile for coronary heart disease (CHD). The primary aim of this project is to examine the prevalence of risk factors for CHD in women with a history of GDM compared to women without a history of GDM. We will test whether women with a history of GDM: 1) have a higher calculated 10 year relative risk for CHD, 2) have more adverse levels of individual risk factors for CHD, and 3) are more likely to develop CHD risk factors at a younger age, compared to women who did not have GDM, controlling for body size. The secondary aim of this project is to evaluate women's perceptions of their future risk of developing both CHD and diabetes, and whether perception of risk is related to the actual risk. Eighty women with a history of GDM (cases) and 80 women without a history of GDM (controls), who were 30 years of age or older when they gave birth and are now 5 to 10 years postpartum, will be recruited. Cases and controls will be matched for age, ethnicity, and body mass index (BMI) within year of the index pregnancy. Data will be collected during an outpatient admission to the NIH funded General Clinical Research Center. The primary outcomes will be calculated relative risk of CHD, serum lipids, blood pressure, and insulin sensitivity. The secondary outcome will be perception of risk for diabetes and CHD. Body size will be controlled by matching on pre-pregnancy BMI, as well as controlling for current BWI, and central obesity. Demographic and clinical variables, in particular variables known to be related to CHD risk and/or distributed differently among cases and controls, will be considered for inclusion as control variables prior to hypothesis testing. Regression and logistic regression analysis will be used to test for differences between women with and without GDM on the study outcomes. Correlational analysis will be used to determine the relationship between perception of risk and actual risk.