DALLAS — Women with a history of gestational diabetes are at increased cardiovascular risk and deserve specific targeting for risk factor reduction, Kathleen King, Ph.D., said at the annual scientific sessions of the American Heart Association.
These women are particularly prone in middle age to an adverse lipid profile characterized by the combination of low HDL and elevated triglycerides, added Dr. King of the University of Rochester (N.Y.).
It's well established that women with a history of gestational diabetes mellitus (GDM) are at increased risk of developing type 2 diabetes. Since type 2 diabetes has been characterized by the National Cholesterol Education Program as a coronary heart disease risk equivalent, Dr. King and her coworkers hypothesized that women with a history of GDM would have a worse cardiovascular risk profile than those without such a history.
She reported on 17 women, mean age 44 years, with a history of GDM but without type 2 diabetes. They were matched with 17 controls by age, body mass index (BMI), and age of the index child, who on average was 14-15 years old. All participants underwent a 3-hour oral glucose tolerance test after 3 days on a 150-g carbohydrate/day diet followed by a 10-hour fast.
The mean triglyceride level was 140.9 mg/dL in women with a history of GDM, compared with 90.1 mg/dL in controls. Six women with prior GDM were hypertriglyceridemic as defined by a level in excess of 150 mg/dL, as was the case for only a single control subject.
Although mean HDL values didn't differ between the two groups, eight women with a history of GDM had an HDL below 50 mg/dL, compared with two controls. Five women with prior GDM, but none of the controls, had both low HDL and hypertriglyceridemia.
“This was true even though controls were matched for BMI. This indicates overweight and obesity in and of themselves may not be the only differentiating features between women with and without a history of GDM,” she observed.
Unexpectedly, mean LDL in the group with prior GDM was lower than in controls: 100.7 mg/dL, compared with 110.1 mg/dL.
Three women with a history of GDM met NCEP criteria for the metabolic syndrome, as did one in the control group. But eight women with prior GDM met at least two of the five criteria for the metabolic syndrome, as did only three controls.