Cardiovascular disease risk factors for women. A life course-events perspective

C J Hobel,P Arora Chander

doi:10.7124/bc.00014a

Abstract

Cardiovascular disease (CVD) in women is the most common cause of death and in 2009 accounted for one third of all deaths. The purpose of this paper is to present what conditions during pregnancy and during the pre-menopause period lead to a greater risk of CVD. The early recognition and the application of interventions may decrease this risk. To emphasize this point we have taken a «Life course-events perspective». Current data suggests that genetic predisposition to disease in conjunction with behavior and environmental factors during fetal life is related to permanent changes in fetalplacental-maternal physiology and function, resulting in fetal programming characterizing the phenotype of the child which may persist into adulthood. Longitudinal studies have identified biological, behavioral and environmental factors related to childhood diseases such as hypertension, insulin resistance and mental health disorders. Gender differences have been identified and animal studies have suggested that estrogens in women are protective and when the risk of CVD in men is considered, the risk in women is delayed by 10 years. Thus, a normal pregnancy may be protective and reduce the risk of CVD in women. However, hypertension developing in women before or during pregnancy is a significant risk factor for women and diabetes further increases this risk of CVD, as does smoking. It is very clear that an «intervention action plan» must be developed. It is the current opinion of the authors that this action plan must be implemented early in life to decrease the risk for the development of CVS in women.

Highlights

When does the risk for cardiovascular disease (CVD) begin? Why wait for the disease to develop? Is it time to begin interventions early in life if the risk for this disease has been determined? The purpose of this paper is to link two important concepts; first, the «fetal origin of diseases that occur later in life» such as hypertension, diabetes and atherosclerosis, based upon the Barker hypothesis which proposes that these diseases have their origin during fetal life [1]
Matched for age white women are at lower risk of coronary heart disease relative to white men; there are recent publications to suggest that certain female children and adolescents are at risk for hypertension and insulin resistance [4, 5]; some women with a history of prior pregnancies are at increased risk during the interval between pregnancies
These investigators showed that women with hypertensive disorder in pregnancy were significantly more likely to develop diabetes at follow up suggesting that they may have had some degree of insulin resistance during pregnancy

Summary

Introduction

When does the risk for cardiovascular disease (CVD) begin? Why wait for the disease to develop? Is it time to begin interventions early in life if the risk for this disease has been determined? The purpose of this paper is to link two important concepts; first, the «fetal origin of diseases that occur later in life» such as hypertension, diabetes and atherosclerosis, based upon the Barker hypothesis which proposes that these diseases have their origin during fetal life [1]. When does the risk for cardiovascular disease (CVD) begin? Why wait for the disease to develop? Is it time to begin interventions early in life if the risk for this disease has been determined? The purpose of this paper is to link two important concepts; first, the «fetal origin of diseases that occur later in life» such as hypertension, diabetes and atherosclerosis, based upon the Barker hypothesis which proposes that these diseases have their origin during fetal life [1]. Ó Institute of Molecular Biology and Genetics NAS of Ukraine, 2010 exposures associated with inherited and acquired genetic changes increases the risk of disease during fetal life», prior to pregnancy for the woman, during pregnancy for the fetus and mother, infancy and adolescence (Figure, Phase I) [2, 3]

Background

Findings

Third trimester