Cardiovascular Complications In Women Research Articles

What interventions are effective in reducing development of hypertension and other cardiovascular complications in women who have had hypertensive disorders of pregnancy? A systematic review.

Hypertensive disorders of pregnancy (HDP) affect approximately 10-15% of pregnancies and pre-eclampsia affects 3-5% of pregnancies. Women with previous pre-eclampsia or HDP are at increased risk of hypertension (2 to 5 times) and major cardiovascular disease (1.5 to 3 times). There is little guidance on how to reduce this risk. To establish if there are interventions in women with previous HDP or pre-eclampsia that reduce the risk of developing adverse cardiovascular outcomes. A protocol was submitted to PROSPERO; inclusion and exclusion criteria were determined and a search strategy implemented. Primary outcomes were: development of hypertension or change in blood pressure and development of other cardiovascular complications. Records and full texts were screened independently by two reviewers. The Cochrane Risk of Bias tool was used for quality assessment. 3593 articles were screened. Nine articles were included. There were seven randomised-controlled trials and two quasi-experimental studies. One study trialled antihypertensive use, two studies looked at blood pressure monitoring and six studies focused on lifestyle interventions. Three trials reported significant reductions in diastolic blood pressure in the experimental group. No studies looked at the optimal time of intervention or the impact of interventions on the development of other long-term cardiovascular complications. Five studies reported participant feedback. The majority of studies were of low quality. Further research needs to explore potential interventions and optimal timing of interventions to reduce cardiovascular risk. Women also need to be consulted about their preferences for discussions about cardiovascular risk and potential interventions.

Peripartum Cardiogenic Shock and Mechanical Circulatory Support

Despite remarkable improvements in the past two decades, the annual cardiovascular mortality rate has remained higher for women than for men. Pregnant women represent an underinvestigated population in clinical research, and the mechanisms of long-term cardiovascular complications in women with obstetric complications remain to be elucidated. Regarding advanced heart failure during pregnancy, interventional approaches are effective but still underutilised. Percutaneous mechanical circulatory support is a valuable option for peripartum cardiogenic shock, although its use during pregnancy is still limited. Survival rates have improved in recent years, but further emphasis on the importance of early recognition and initiation of heart failure treatment in this patient group is warranted. The aims of this review are to summarise the current literature on the implementation of mechanical circulatory support in cardiogenic shock during pregnancy and delivery and to understand the role of percutaneous ventricular assist devices in the management of such conditions.

Maternal myocardial recovery twelve months post-partum in women with pregnancies complicated by gestational diabetes or preeclampsia - single center, longitudinal cohort study

Abstract Background Gestational diabetes mellitus (GDM) and preeclampsia (PE) are the leading obstetric complications of pregnancy. Both are associated with a substantial increase in the risk of long-term cardiovascular disease. However, pregnant women are underrepresented in clinical research and the mechanisms of long-term cardiovascular complications in women with obstetric complications remain to be elucidated. Objectives This longitudinal cohort study was designed to assess maternal cardiac alterations during the third trimester of pregnancy and their recovery twelve-months post-partum in women with GDM (n=30) or preeclampsia (n=24) compared to women with healthy pregnancies (HP)(n=38). Methods 31P-MRS and CMR were used to define PCr/ATP, tissue characteristics, left ventricular (LV) volumes, mass, EF, global longitudinal shortening (GLS), and mitral in-flow E/A ratio. Investigations were repeated 12-months postpartum. With obesity as a common risk factor for both GDM and PE, 10 overweight and 10 normal-weight nulliparous women served as non-pregnant controls. Results Participants were matched for age and ethnicity(Table-1). Both the GDM and PE groups had higher BMI compared to the HP. Compared to the HP group, women with GDM had higher LV mass (90[85,94] vs 103[96,112]g; p=0.001) and lower myocardial PCr/ATP (2.2[2.1,2.4] vs 1.9[1.7,2]; p<0.0001), LV end-diastolic volumes (EDV)(76[72,80] vs 67[63,71]ml, p=0.03) and GLS (20[18,21] vs 18[17,19]%; p=0.008). Compared to the HP group, at similar magnitudes to women with GDM, the women with PE exhibited higher LV mass (90[85,94] vs 118[111,125]g; p<0.0001) and lower myocardial PCr/ATP (2.2[2.1,2.4] vs 1.9[1.8,2.1]; p=0.0004) and GLS (20[18,21] vs 16[14,17]%; p=0.01). There were no significant differences in PCr/ATP, LV EDV, mass or GLS between the GDM and PE groups. Twelve-months postpartum there were no significant changes in any of the cardiac assessments in women in the HP, GDM or PE groups compared to their respective third-trimester pregnancy assessments (Figure-1). Compared to nulliparous normal-weight controls, HP was associated with no significant differences in myocardial PCR/ATP, LV volumes, mass, EF or GLS. The overweight nulliparous controls showed significantly higher LV mass and lower myocardial PCr/ATP and GLS than normal-weight controls. There were no significant differences in LV mass, PCr/ATP or GLS between the overweight nulliparous controls and GDM or PE groups during or after pregnancy. Conclusions Despite distinct aetiologies women with GDM and PE exhibit a similar myocardial phenotype during and after pregnancy with persistent subtle abnormalities in myocardial PCr/ATP ratio, LV mass and GLS compared to women with HP during pregnancy and twelve months’ postpartum assessments. Women with GDM and PE show similar myocardial alterations to nulliparous women with obesity, suggesting that the myocardial changes are predominantly driven by obesity-associated metabolic dysfunction.

Estradiol and follicle-stimulating hormone imbalance associated with mineral-bone metabolism disturbances and cardiovascular complications in women on hemodialysis

BACKGROUND. The influence of female sex hormones on the regulation of the processes of formation and resorption of bone tissue, as well as the effect of excess or deficiency of sex hormones on renal function is associated with the development of cardiovascular complications in patients at different stages of chronic kidney disease. THE AIM : to study the relationship between estradiol deficiency and excess FSH content with disorders of mineral and bone metabolism and cardiovascular complications in postmenopausal women on hemodialysis. PATIENTS AND METHODS. 119 women from 34 to 57 years old on hemodialysis were examined. The concentration of follicle-stimulating hormone (FSH) and estradiol2, sclerostin, and fibroblast growth factor 23 (FGF-23) was determined using a sandwich-variant solid-phase ELISA on a «Multiscan EX analyzer» («ThermoFisher Scientific Inc.», Finland) with kits of «Alkor-Bio Company» (Russian Federation) and sets of "sandwich" type manufactured by Cloud-Clone Corp., USA. Echocardiography was performed using an «ALOKA 4000 Aplio» (Toshiba, Japan) in Doppler mode. Determined the left ventricular ejection fraction (LVEF), peak systolic velocity in the aortic arch (Vps – peak systolic velocity); LV myocardial mass index (LVMI). Left ventricular hypertrophy (LVH) was defined with LVMI greater than 95 g /m 2 in women. RESULTS. There was a direct correlation between high levels of FSH and high levels of sclerostin, FSH, and FGF23, an inverse correlation between low levels of estradiol2 and sclerostin, estradiol2 and FGF23, expressed in groups of patients with more severe changes in LVMI and Vps. CONCLUSION. In women on hemodialysis, bone mineral and cardiovascular abnormalities are associated with both renal failure proper and changes in the system of female sex hormones. A decrease in estradiol levels causes an increase in the nephrotoxic FSH and contributes to the excessive synthesis of sclerostin, a key factor in bone-mineral and cardiovascular complications in CKD.

Elevated plasma pentraxin-3 in polycystic ovary syndrome is associated with hyperandrogenism: a case-control study

BackgroundPentraxin 3 (PTX3) - a crucial humoral innate immunity component – is related to obesity and cardiovascular complications in women who suffer from polycystic ovary syndrome (PCOS). However, the circulating PTX3 level in PCOS is still debated. In this study, we aimed to evaluate PTX3 plasma levels in PCOS women of childbearing age, and find possible endocrine/metabolic factors that could affect this level.MethodsA total of 360 women were enrolled: 120 PCOS women and 240 body mass index (BMI) matched normally ovulating women. Blood samples were collected on the third day of natural menstrual cycle or from the bleeding after progesterone withdrawal. The PTX3 concentration was measured by immunoassay.ResultsThe PTX3 plasma level was significantly higher in PCOS women compared to controls. There was a positive correlation between PTX3 plasma level and PCOS diagnosis, overweight, cycle length, serum LH to FSH ratio, estradiol, total testosterone (TT) on the third day of menstrual cycle, antral follicle count (AFC), as well as uric acid. Multivariant linear regression analysis indicated that participants’ serum PTX3 levels were proportional to the circulating TT level, existence of PCOS, basal estradiol level and AFC.ConclusionsOverall, the circulating PTX3 level was elevated in PCOS women and significantly associated with the presence of hyperandrogenism. This study provided the basis for further in-depth researches regarding PTX3 role in PCOS pathophysiology.

063 Differential Impact of Sleep Duration on Nocturnal Blood Pressure Dipping Between Men and Women

Abstract Introduction There is growing evidence that poor sleep may have a greater impact on the development of cardiovascular complications in women compared to men. However, most studies that have evaluated the impact of sex on sleep insufficiencies and blood pressure (BP) have not utilized ambulatory BP, and often rely more heavily on subjective sleep diaries as opposed to objective sleep assessment. The purpose of this study was to examine the impact of sex on the relationship between objectively measured sleep and nocturnal BP dipping. We hypothesized that poor sleep would be associated with decreased nocturnal BP dipping, and that this association would be stronger in women. Methods Total sleep time (TST) and sleep efficiency (SE) were monitored in fifty adults (31 men, 19 women; 36±3 years; 26±1 kg/m2) utilizing wrist actigraphy monitoring over the course of 5–14 days (Avg: 10±0 days). On a separate occasion, participants underwent a 24-hour ambulatory BP recording session. Independent samples T-tests were used to compare characteristics between sexes. Partial correlations controlling for age and BMI were utilized to probe relationships between sleep and nocturnal BP dipping. Results TST and SE were not different between sexes. However, women exhibited reduced mean arterial pressure (MAP: 86±1 vs. 90±1 mmHg, P=0.026) compared to men. Partial correlation revealed a significant relationship between TST and the magnitude of nocturnal MAP dipping in the sample population (R = 0.460, P<0.001). When stratified by sex, this significant relationship persisted in men (R = 0.610, P<0.001), but not women (R = 0.108, P>0.05). In contrast, no relationship was observed between SE and nocturnal MAP dipping (R = -0.052, P>0.05) for the sample population. Similarly, SE did not correlate with nocturnal MAP dipping in men (R = -0.080, P>0.05) or women (R = 0.045, P>0.05). Conclusion Contrary to our initial hypothesis, our results demonstrate that actigraphy-based TST is associated with nocturnal BP dipping in healthy men, but not women. This suggests a relation between impaired nocturnal BP regulation and habitual sleep duration, potentially predisposing men to an increased overall risk for cardiovascular complications. Support (if any) National Institutes of Health (HL-098676 and HL-122919)

Preeclampsia as a risk factor of the cardiovascular complications development

Introduction:The term “preeclampsia” (PE) refers to a multisystem disorder occurring after 20 weeks of pregnancy; it includes a new onset of hypertension and proteinuria and affects from 2 to 8% of all pregnancies. Cardiovascular disease (CVD) is a group of pathologies, which present significant mortality rate all over the world. The literature implicates that both disorders are linked in a sense of further cardiovascular complications in women who had preeclamptic pregnancy.Purpose:Evaluation of the relationship between pre-eclampsia and the risk of future potential maternal cardiovascular complications and proposal of the possible causes of this association.Materials and methods:We performed the database research using Pubmed, Springer Link and ResearchGate and we made review and meta-analysis of relevant studies. We searched for studies analyzing the relationship between preeclampsia and future maternal cardiovascular risk.Results:Systematic reviews and cohort studies qualified for the purpose of this review showed the relationship between preeclampsia and future cardiovascular diseases in mothers. The possible explanations include endothelium dysfunction enduring after delivery and the co-existence of common risk factors for both diseases.Conclusions:Preeclampsia is a risk factor predisposing to cardiovascular diseases and may lead to cardiac complications later in life. The course of pregnancies is very important for the future maternal health.Key words: preeclampsia; pregnancy; hypertension; cardiovascular disease

The role of proinflammatory cytokines in the development of anthracycline-induced heart failure

Objective. To study the pathogenetic and prognostic role of cytokines (tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β)) in the development of anthracycline-induced chronic heart failure (CHF).Material and Methods. A total of 176 women with breast cancer who received anthracycline antibiotics as a part of polychemotherapy regimens were examined. Upon examination, the patients in remission were divided into two groups within 12 months after the completion of chemotherapy: patients with the development of cardiotoxic remodeling (group 1, n = 52) and women with preserved cardiac function (group 2, n = 124). All patients received echocardiography study before, during, and after chemotherapy. Biochemical blood tests were done to determine the levels of TNF-α and IL-1β before chemotherapy, immediately after it, and 12 months after chemotherapy completion. Determination of polymorphisms of the TNF-α (–308G/A, rs1800629) and IL-1β genes (+3953, rs1143634) was carried out by polymerization chain reaction.Results. A higher level of TNF-α and IL-1β in group 1 was associated with the development of heart failure 12 months after the end of chemotherapy. The level of TNF-α over 7.5 pg/mL after the completion of chemotherapy allowed to predict the development of cardiovascular complications in women receiving anthracycline therapy with sensitivity of 44.2% and specificity of 75.8% (AUS = 0.600; 95% CI = 0.524–0.673; p = 0.035). The study did not reveal any significant differences in the frequency distribution for genotypes of 308G/A polymorphism (rs1800629) of the TNF-α gene and +3953 (rs1143634) polymorphism of the IL-1β gene in the studied groups.Conclusion. Patients with breast cancer who developed anthracycline-induced heart failure 12 months after the end of chemotherapy had the increased levels of TNF-α and IL-1β suggesting the pathogenetic role of proinflammatory cytokines in the development of cardiac injury during anthracycline therapy.

The role of non-drug strategies in reducing the risk of cardiovascular complications in women with metabolic syndrome during the menopausal transition

The role of non-drug strategies in reducing the risk of cardiovascular complications in women with metabolic syndrome during the menopausal transition

Association of Bulimia Nervosa With Long-term Risk of Cardiovascular Disease and Mortality Among Women

Bulimia nervosa is associated with short-term cardiovascular complications in women, but its long-term consequences on cardiovascular health are unknown. To study the association of bulimia nervosa with the long-term risk of cardiovascular disease and mortality in women. In this longitudinal cohort study, 416 709 women hospitalized in Quebec, Canada, including women hospitalized for bulimia nervosa and those for pregnancy-related events as a comparison group, were followed up for 12 years from 2006 to 2018 to identify incidences of cardiovascular disease and death. At least 1 hospitalization for bulimia nervosa. The study participants were followed up to identify future incidences of cardiovascular disease and deaths. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% CIs to assess the association of bulimia nervosa with future outcomes after adjustment for patient characteristics. The study population comprised 818 women who were hospitalized for bulimia nervosa (mean [SD] age, 28.3 [13.4] years) and 415 891 hospitalized for pregnancy-related events (mean [SD] age, 28.3 [5.4] years). Patients were followed up for a total of 2 957 677 person-years. The women hospitalized for bulimia nervosa had a greater incidence of cardiovascular disease compared with those hospitalized for pregnancy-related events (10.34 [95% CI, 7.77-13.76] vs 1.02 [95% CI, 0.99-1.06] per 1000 person-years). Incidence of future cardiovascular disease was even higher for women with 3 or more bulimia admissions (25.13 [95% CI, 13.52-46.70] per 1000 person-years). Women hospitalized for bulimia nervosa had 4.25 (95% CI, 2.98-6.07) times the risk of any cardiovascular disease and 4.72 (95% CI, 2.05-10.84) times the risk of death compared with women hospitalized for pregnancy-related events. Bulimia nervosa was found to be associated with ischemic heart disease (HR, 6.63; 95% CI, 3.34-13.13), atherosclerosis (HR, 6.94; 95% CI, 3.08-15.66), and cardiac conduction defects (HR, 2.99; 95% CI, 1.57-5.71). Bulimia was also associated with 21.93 (95% CI, 9.29-51.74) times the risk of myocardial infarction at 2 years of follow-up and 14.13 (95% CI, 6.02-33.18) times the risk at 5 years of follow-up. This study's findings suggest that bulimia nervosa may be associated with the long-term risk of any cardiovascular disease, such as ischemic cardiac events and conduction disorders, as well as with death among women. The findings also suggest that women with a history of bulimia nervosa should be screened regularly for ischemic cardiovascular disease and may benefit from prevention of and treatment for cardiovascular risk factors.

Age characteristics of risk cardiovascular complications in women with left breast cancer with preserved ejection fraction at the stage of chemotherapy and radiotherapy

A study of the risk factors for middle-aged and elderly women HER2neu with negative left breast cancer and a normal ejection fraction at the stage of chemoradiotherapy in everyday clinical practice. Matherial and methods. 61 women with left breast cancer without severe cardiovascular pathology were examined at the stage of doxorubicin therapy and 3D conformal radiation therapy. Group 1 comprised 32 patients of middle age (49.8 ± 4.5 years). Group 2 comprised 29 elderly patients (68.3 ± 3.6 years). In addition to Score risk assessment, additional factors, including psychosocial factors, were studied. All patients underwent ECG, echocardiography and 24-hour ECG monitoring. Anxiety levels were assessed using the HADS scale and scale CH. D. Spielberger -Yu.L. Khanin. The study was conducted before the start of treatment, after the completion of the doxorubicin course and after the completion of the course of radiotherapy. Results with discussion. In middle-aged patients, moderate Score risk was found in 21.9%, in the elderly at 58.6% (p = 0.0043, RR 2.68, 95% CI 1.301-5.520). A high Score risk was found in 15.6% of middle-aged patients and 41.4% of elderly patients (p = 0.0438, RR 2.648, 95% CI 1061-6.607). The most common risk factors in the patients studied in addition to age were heredity, overweight, hypercholesterolemia and diabetes mellitus. All examined patients had moderate reactive anxiety. Patients of middle age have moderate personal anxiety, in elderly patients high personal anxiety. After treatment with doxorubicin in a cumulative dose not exceeding 360 mg/m2 , a reduction in the ejection fraction below 50% was found in 6 middle-aged patients and 17.2% in elderly patients. Asymptomatic diastolic dysfunction was detected in 31.3% of middle-aged patients and 55.2% of the elderly. In patients of both groups, after arranging treatment, arrhythmia was detected. The obtained data indicate to the need for in-depth examination of middle-aged and especially elderly patients with left breast cancer with an assessment of risk factors and conducting an in-depth examination using Echocardiography, 24-hour ECG monitoring and psychological testing to prevent and early detection of cardiovascular complications.

Sex differences in cardiovascular risk management for people with diabetes in primary care: a cross-sectional study.

BackgroundDiabetes is a stronger risk factor for cardiovascular complications in women than men.AimTo evaluate whether there are sex differences in cardiovascular risk management in patients with diabetes in primary care.Design & settingA cross-sectional study was undertaken using data from 12 512 individuals with diabetes within the Dutch Julius General Practitioners Network (JGPN) from 2013.MethodLinear and Poisson regression analyses were used to assess sex differences in risk factor levels, assessment, treatment, and control.ResultsNo sex differences were found in HbA1c levels and control, while small differences were found for cardiovascular risk management. Blood pressure levels were higher (mean difference [MD] 1.09 mmHg; 95% confidence intervals [CI] = 0.41 to 1.77), while cholesterol levels (MD -0.38 mmol/l; 95% CI = -0.42 to -0.34) and body mass index ([BMI] MD -1.79 kg/m2; 95% CI = -2.03 to 1.56) were lower in men than women. Risk factor assessment was similar between sexes, apart from high-density lipoprotein cholesterol (HDL-c), which was more commonly assessed in women (risk ratio [RR] 1.16; 95% CI = 1.13 to 1.20). Among those with a treatment indication for prevention, women with cardiovascular disease (CVD) were less likely to receive lipid-lowering drugs (RR 0.84; 95% CI = 0.76 to 0.93) than men, while women without CVD were more likely to receive lipid-lowering drugs (RR 1.16; 95% CI = 1.04 to 1.2). Among those treated, women were more likely to achieve systolic blood pressure (SBP) control (RR 1.06; 95% CI = 1.02 to 1.10) and less likely to achieve low-density lipoprotein cholesterol (LDL-c) control (RR 0.88; 95% CI = 0.85 to 0.91) than men.ConclusionIn this Dutch primary care setting, sex differences in risk factor assessment and treatment of people with diabetes were small. However, women with diabetes were less likely to achieve control for LDL-c and more likely to achieve blood pressure control than men with diabetes.

Risk factors for cardiovascular complications in women with hypertensive disorders during pregnancy

Objective.We performed a cross-sectional study of risk factors and biomarkers of cardiovascular diseases among young women with hypertensive disorders during pregnancy in comparison with women without hypertension during pregnancy.Design and methods.Altogether 117 women were enrolled, 33 were included in the group of hypertensive disorders during pregnancy, and 44 formed the group without hypertension during pregnancy. The control group consisted of 40 patients. The time interval after delivery was on average 5 to 19 years.Results and conclusions.Women with hypertension during pregnancy developed changes in carbohydrate and lipid metabolism associated with hypertension and abdominal obesity, which are the components of the cluster of the metabolic syndrome. These changes are also accompanied by insulin resistance, hyperinsulinemia, adipokine imbalance, changes in fbrinolysis and more pronounced remodeling of the heart and vessels as target organs in hypertension.

Trastornos hipertensivos en el embarazo: repercusión a largo plazo en la salud cardiovascular de la mujer

Pregnancy-induced hypertension (PIH) induces maternal and fetal damage, but it can also be the beginning of future metabolic and vascular disorders. The relative risk of chronic hypertension after PIH is between 2.3 and 11, and the likelihood of subsequent development of type 2 diabetes is multiplied by 1.8. Women with prior preeclampsia/eclampsia have a twofold risk of stroke and a higher frequency of arrhythmias and hospitalization due to heart failure. Furthermore, a tenfold greater risk for long-term chronic kidney disease is observed as well.The relative risk of cardiovascular death is 2.1 times higher compared to the group without pregnancy-induced hypertension problems, although the risk is between 4 and 7 times higher in preterm birth associated with gestational hypertension or pre-existing hypertensionThe postpartum period is a great opportunity to intervene on lifestyle, obesity, make an early diagnosis of chronic hypertension and DM and provide the necessary treatments to prevent cardiovascular complications in women.

Normalized endothelial function but sustained cardiovascular risk profile 11 years following a pregnancy complicated by preeclampsia

Women with a history of preeclampsia are at increased risk of future cardiovascular disease. Preeclampsia is associated with elevated blood pressure, inflammation and endothelial dysfunction, and these findings remain 1 year after delivery. Whether these abnormalities persist long after delivery, and whether they may contribute to future cardiovascular disease, is not well studied. We studied 15 women with a history of preeclampsia and 16 matched controls with an uncomplicated pregnancy 11 years following the index pregnancy; all had also been previously examined at 1 year. We assessed arterial stiffness (pulse wave analysis), 24 h ambulatory blood pressure and endothelial function (forearm flow-mediated dilatation and pulse wave analysis following β receptor agonist provocation), and determined markers of glucose and lipid metabolism, inflammation and vascular function. The preeclampsia group had higher blood pressures and reduced night/day blood pressure ratios, increased body mass index and reduced glucose tolerance, and increased levels of tissue necrosis factor receptor 1 and intracellular adhesion molecule-1, suggesting inflammatory and vascular activation. However, the endothelial impairment observed in the preeclampsia group at 1 year was normalized at 11 years, whereas the control group remained unchanged during follow-up. Our findings of higher blood pressures, impaired glucose tolerance and normalization of endothelial function 11 years after preeclampsia suggest cardiovascular risk factors present already before pregnancy to be more important than permanent endothelial damage for the increased risk of future cardiovascular complications in women with a history of preeclampsia.

Ambulatory Blood Pressure Monitoring to Assess Cardiovascular Risk in Women

See related article, pp 397–405 Women live longer than men. The longer life expectancy of women is commonly attributed to their lower cardiovascular risk profile and to the fact that they develop cardiovascular complications at a lower rate and a later age than men. A number of population studies have indeed shown that, at comparable age, women are characterized by a lower incidence of angina pectoris, myocardial infarction, and stroke than men.1 This has contributed to the general medical belief that women are at low cardiovascular risk at least until they reach the menopause. One of the issues with this concept is this: do we potentially underestimate the real cardiovascular risk of women and thereby miss an opportunity to improve our ability to prevent cardiovascular complications in women? In this issue of Hypertension , Boggia et al2 report the results of a comparison of the cardiovascular risk associated with office and ambulatory systolic blood pressure (BP) measurements in a large cohort of women and men from the general population of 11 different countries. As reported previously, women were at lower risk of cardiovascular events than men in this international cohort followed up for a median of 11.2 years. However, when assessing the association of cardiovascular complications with 24-hour ambulatory BP and nighttime BP, the authors found that the relation of all cardiovascular events and stroke and cardiac events with nighttime BP were much steeper in …

Post-menopausal cardiovascular health: A review

Counteracting the risk of cardiovascular complications in women immediately prior to and during the climacteric is of importance. Hormone replacement therapy (HRT) has been supported as an effective means of replacing the lost endogenous estrogen with a synthetic variant, thus precluding the onset of cardiovascular complications related to the vasculature. HRT has also been cited as being linked to increased occurrence of certain cancers, most particularly breast cancer. In the context of this contradictory information, lifestyle choices are an alternative. Diet and programmes of physical activity are commonly cited as effective tools in reducing the risk of cardiovascular health decline, and prevention of chronic conditions. Despite the literature in existence there remain unanswered questions. Aerobic exercise appears to positively affect the health status of post-menopausal women as far as weight control and bone density are concerned, but the literature is less clear on whether this form of activity is beneficial in reducing cholesterol levels and blood pressure and preventing cardiovascular incidents. Resistance training is even less well defined, and there is very little available literature on the effect of a resistance training regime on health indices such as blood lipid profiles in women who have entered the climacteric. This lack of conclusive clarity affects the recommendations offered by clinicians and renders the lay-person confused and uninterested. This paper will aim to present the current arguments in the literature, while noting areas for future research toward the understanding of health, post-menopause.

Practical Assessment of Maternal Cardiovascular Risk in Pregnancy

Cardiovascular disease in pregnancy is the most common cause of maternal mortality in the developed world and an important cause of heart failure, stroke, and arrhythmia. As more children with congenital heart disease survive into adulthood, there is a more pressing need to understand the risks that pregnancy poses for these women. Pregnancy, labor, and delivery increase the hemodynamic stress on the cardiovascular system and place women with heart disease at increased risk of cardiovascular complications, which include heart failure and death. Systematic assessment of pregnancy risk in these women, ideally before conception, is essential in optimizing maternal and fetal outcomes. This article describes the process of assessing risk of pregnancy-associated cardiovascular complications in women with structural heart disease. We review the current literature on pregnancy risk in women with complex congenital lesions, valvular heart disease, cardiomyopathy, and aortopathy, and suggest an approach to risk stratification. Based on a review of the literature, we report features that pose an increased risk of adverse maternal and fetal outcomes, which include poor maternal functional status; prior history of heart failure, arrhythmia, or cerebral vascular events; cyanosis; poor systemic ventricular function; and severe aortic or mitral stenosis. Pulmonary hypertension and Eisenmenger syndrome place women at exceedingly high risk for cardiovascular complications in pregnancy, including maternal and fetal death.