Marc Meller Søndergaard1, Mark A Hlatky2, Marcia L Stefanick2, Eric Vittinghoff3, Gregory Nah3, Matthew Allison4, Alison Gemmill5, Linda Van Horn6, Ki Park7, Elena Salmoirago-Blotcher8, Maryam Sattari7, Shawnita Sealy-Jefferson9, Aladdin H Shadyab4, Carolina Valdiviezo10, JoAnn E Manson11, Nisha I Parikh3. 1. Aalborg University School of Medicine and Health, Aalborg, Denmark. 2. Stanford University School of Medicine, Stanford, California. 3. UCSF School of Medicine, University of California, San Francisco. 4. UC San Diego School of Medicine, University of California, San Diego. 5. Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 6. Northwestern University Feinberg School of Medicine, Chicago, Illinois. 7. University of Florida School of Medicine, Gainesville. 8. Brown University Alpert School of Medicine, Providence, Rhode Island. 9. Ohio State University College of Public Health, Columbus. 10. MedStar Health, Washington, DC. 11. Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Abstract
Importance: Atherosclerotic cardiovascular disease (ASCVD) may have unique risk factors in women. Most women have a history of pregnancy; common adverse pregnancy outcomes (APOs) appear to be associated with ASCVD, but prior studies have limitations. Objective: To assess whether APOs are associated with increased ASCVD risk independently of traditional risk factors. Design, Setting, and Participants: The APO history among participants in the Women's Health Initiative, a large multiethnic cohort of postmenopausal women, was assessed. The associations of 5 self-reported APOs (gestational diabetes, hypertensive disorders of pregnancy, low birth weight [ie, birth weight less than 2.49 kg], high birth weight [ie, birth weight greater than 4.08 kg], and preterm delivery by 3 weeks or more) with ASCVD were analyzed, adjusting for traditional ASCVD risk factors. Data were collected and analyzed in 2017. Exposures: APOs (gestational diabetes, hypertensive disorders of pregnancy, low birth weight, high birth weight, and preterm delivery). Main Outcomes and Measures: Adjudicated ASCVD. Results: A total of 48 113 Women's Health Initiative participants responded to the survey; the median (interquartile range) age at time of enrollment was 60.0 (55.0-64.0) years. A total of 13 482 participants (28.8%) reported 1 or more APOs. Atherosclerotic cardiovascular disease was more frequent in women who reported an APO compared with those without APOs (1028 of 13 482 [7.6%] vs 1758 of 30 522 [5.8%]). Each APO, analyzed separately, was significantly associated with ASCVD, and gestational diabetes, hypertensive disorders of pregnancy, low birth weight, and preterm delivery remained significant after adjustment for traditional ASCVD risk factors. When all APOs were analyzed together, hypertensive disorders of pregnancy (odds ratio, 1.27; 95% CI, 1.15-1.40) and low birth weight (odds ratio, 1.12; 95% CI, 1.00-1.26) remained independently associated with ASCVD. All findings were materially unchanged by additional adjustment for parity, body mass index, and socioeconomic factors. Conclusions and Relevance: In this large multiethnic cohort of women, hypertensive disorders of pregnancy and low birth weight were independently associated with ASCVD after adjustment for risk factors and other APOs.
Importance: Atherosclerotic cardiovascular disease (ASCVD) may have unique risk factors in women. Most women have a history of pregnancy; common adverse pregnancy outcomes (APOs) appear to be associated with ASCVD, but prior studies have limitations. Objective: To assess whether APOs are associated with increased ASCVD risk independently of traditional risk factors. Design, Setting, and Participants: The APO history among participants in the Women's Health Initiative, a large multiethnic cohort of postmenopausal women, was assessed. The associations of 5 self-reported APOs (gestational diabetes, hypertensive disorders of pregnancy, low birth weight [ie, birth weight less than 2.49 kg], high birth weight [ie, birth weight greater than 4.08 kg], and preterm delivery by 3 weeks or more) with ASCVD were analyzed, adjusting for traditional ASCVD risk factors. Data were collected and analyzed in 2017. Exposures: APOs (gestational diabetes, hypertensive disorders of pregnancy, low birth weight, high birth weight, and preterm delivery). Main Outcomes and Measures: Adjudicated ASCVD. Results: A total of 48 113 Women's Health Initiative participants responded to the survey; the median (interquartile range) age at time of enrollment was 60.0 (55.0-64.0) years. A total of 13 482 participants (28.8%) reported 1 or more APOs. Atherosclerotic cardiovascular disease was more frequent in women who reported an APO compared with those without APOs (1028 of 13 482 [7.6%] vs 1758 of 30 522 [5.8%]). Each APO, analyzed separately, was significantly associated with ASCVD, and gestational diabetes, hypertensive disorders of pregnancy, low birth weight, and preterm delivery remained significant after adjustment for traditional ASCVD risk factors. When all APOs were analyzed together, hypertensive disorders of pregnancy (odds ratio, 1.27; 95% CI, 1.15-1.40) and low birth weight (odds ratio, 1.12; 95% CI, 1.00-1.26) remained independently associated with ASCVD. All findings were materially unchanged by additional adjustment for parity, body mass index, and socioeconomic factors. Conclusions and Relevance: In this large multiethnic cohort of women, hypertensive disorders of pregnancy and low birth weight were independently associated with ASCVD after adjustment for risk factors and other APOs.
Authors: Kathryn M Rexrode; Tracy E Madsen; Amy Y X Yu; Cheryl Carcel; Judith H Lichtman; Eliza C Miller Journal: Circ Res Date: 2022-02-17 Impact factor: 17.367
Authors: Anna C O'Kelly; Erin D Michos; Chrisandra L Shufelt; Jane V Vermunt; Margo B Minissian; Odayme Quesada; Graeme N Smith; Janet W Rich-Edwards; Vesna D Garovic; Samar R El Khoudary; Michael C Honigberg Journal: Circ Res Date: 2022-02-17 Impact factor: 17.367
Authors: Amanda R Jowell; Amy A Sarma; Martha Gulati; Erin D Michos; Arthur J Vaught; Pradeep Natarajan; Camille E Powe; Michael C Honigberg Journal: JAMA Cardiol Date: 2022-03-01 Impact factor: 14.676
Authors: Priya M Freaney; Katharine Harrington; Rebecca Molsberry; Amanda M Perak; Michael C Wang; William Grobman; Philip Greenland; Norrina B Allen; Simon Capewell; Martin O'Flaherty; Donald M Lloyd-Jones; Sadiya S Khan Journal: J Am Heart Assoc Date: 2022-05-18 Impact factor: 6.106
Authors: Lochan M Shah; Yaa A Kwapong; Ellen Boakye; S Michelle Ogunwole; Wendy L Bennett; Roger S Blumenthal; Allison G Hays; Michael J Blaha; Khurram Nasir; Sammy Zakaria; Guoying Wang; Xiaobin Wang; Garima Sharma Journal: CJC Open Date: 2022-02-19
Authors: Gayathree Murugappan; Stephanie A Leonard; Leslie V Farland; Emily S Lau; Aladdin H Shadyab; Robert A Wild; Peter Schnatz; Suzan L Carmichael; Marcia L Stefanick; Nisha I Parikh Journal: Fertil Steril Date: 2022-03-16 Impact factor: 7.490
Authors: Melinda B Davis; Katherine Arendt; Natalie A Bello; Haywood Brown; Joan Briller; Kelly Epps; Lisa Hollier; Elizabeth Langen; Ki Park; Mary Norine Walsh; Dominique Williams; Malissa Wood; Candice K Silversides; Kathryn J Lindley Journal: J Am Coll Cardiol Date: 2021-04-13 Impact factor: 24.094
Authors: Angela H E M Maas; Giuseppe Rosano; Renata Cifkova; Alaide Chieffo; Dorenda van Dijken; Haitham Hamoda; Vijay Kunadian; Ellen Laan; Irene Lambrinoudaki; Kate Maclaran; Nick Panay; John C Stevenson; Mick van Trotsenburg; Peter Collins Journal: Eur Heart J Date: 2021-03-07 Impact factor: 29.983