Pregnancy complications may mark increased risk for premature CAD

OB/GYN News, May 15, 2006 by Bruce Jancin

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.

A total of 214 of the women in the study had experienced pregnancy complications. The most common complications were gestational diabetes mellitus, preeclampsia, preterm birth, and small or large for gestational age.

Among women with a history of pregnancy complications, 35% had significant CAD at coronary angiography, compared with 24% among women without such a history.

In a multivariate analysis, 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 predictors of significant CAD were hyperlipidemia, diabetes, smoking during pregnancy, and being white as opposed to black, said Dr. Biswas, 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 MI 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 if aggressive primary prevention efforts beginning immediately after a complicated pregnancy reduce the risk of premature CAD, and if a similar preventive thrust that includes smoking cessation and prepregnancy weight loss efforts reduces the incidence of pregnancy complications, Dr. Biswas added.

BY BRUCE JANCIN

Denver Bureau

Relative Risk of CAD Increases With Pregnancy Complications

Significant CAD    1.6
Cardiac mortality  2.3

Note: Based on a study of 415 women.
Source: Dr. Biswas
ELSEVIER GLOBAL MEDICAL NEWS

Note: Table made from bar graph.