ATLANTA — Consider pregnancy complications to be a red flag for premature coronary artery disease, Dr. Mimi S. Biswas said at the annual meeting of the American College of Cardiology.
She presented a retrospective cohort study involving 415 women who were evaluated for suspected CAD at Duke University, Durham, N.C., and who earlier had pregnancies managed at Duke.
Two hundred and fourteen of the women had experienced pregnancy complications, most commonly gestational diabetes mellitus, preeclampsia, preterm birth, or small or large for gestational age.
Thirty-five percent of women with a history of pregnancy complications had significant CAD detected at coronary angiography, compared with 24% without such a history.
In a multivariate analysis, Dr. Biswas and her co-investigators found that any form of pregnancy complication was associated with a 1.6-fold increased risk of significant CAD at angiography and a 2.3-fold increased risk of cardiac mortality.
Other factors that were determined to be predictors of significant CAD were hyperlipidemia, diabetes, smoking during pregnancy, and being white as opposed to black, said Dr. Biswas, who is clinical director the Women's Heart Care Clinic at the university.
Median age at delivery in this study was 28 years. Median age at cardiac catheterization was 41 years; among the 10% of women who died, the median age was 42. Median age at the time of first myocardical infarction was 43 years.
In future studies, Dr. Biswas said, the interdisciplinary Duke team plans to delve into the mechanisms underlying the observed association between pregnancy complications and premature CAD, focusing on thrombotic abnormalities, coagulopathies, hormonal changes, vascular alterations, and genetic profiling.
The investigators are also interested in seeing whether aggressive primary prevention efforts beginning immediately after a complicated pregnancy reduce the risk of premature CAD, and whether a similar preventive thrust that includes smoking cessation and prepregnancy weight loss efforts reduces the incidence of pregnancy complications, she added.
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