Cardiovascular Risk Factors In Women Research Articles

Age-related differences in recommended anthropometric cut-off point validity to identify cardiovascular risk factors in ostensibly healthy women.

Aim: To investigate validity of widely recommended anthropometric and total fat percentage cut-off points in screening for cardiovascular risk factors in women of different ages. Methods: A population-based sample of 1002 Swedish women aged 38, 50, 75 (younger, middle-aged and elderly, respectively) underwent anthropometry, health examinations and blood tests. Total fat was estimated (bioimpedance) in 670 women. Sensitivity, specificity of body mass index (BMI; ≥25 and ≥30), waist circumference (WC; ≥80 cm and ≥88 cm) and total fat percentage (TF; ≥35%) cut-off points for cardiovascular risk factors (dyslipidaemias, hypertension and hyperglycaemia) were calculated for each age. Cut-off points yielding high sensitivity together with modest specificity were considered valid. Women reporting hospital admission for cardiovascular disease were excluded. Results: The sensitivity of WC ≥80 cm for one or more risk factors was ~60% in younger and middle-aged women, and 80% in elderly women. The specificity of WC ≥80 cm for one or more risk factors was 69%, 57% and 40% at the three ages (p < .05 for age trends). WC ≥80 cm yielded ~80% sensitivity for two or more risk factors across all ages. However, specificity decreased with increasing age (p < .0001), being 33% in elderly. WC ≥88 cm provided better specificity in elderly women. BMI and TF % cut-off points were not better than WC. Conclusions: Validity of recommended anthropometric cut-off points in screening asymptomatic women varies with age. In younger and middle-age, WC ≥80 cm yielded high sensitivity and modest specificity for two or more risk factors, however, sensitivity for one or more risk factor was less than optimal. WC ≥88 cm showed better validity than WC ≥80 cm in elderly. Our results support age-specific screening cut-off points for women.

Cardiovascular risk factors one year after a hypertensive disorder of pregnancy.

To identify differences in women's cardiovascular risk, independent of obesity, one year after delivery of a pregnancy complicated by a hypertensive disorder of pregnancy (HDP). We compared traditional and novel cardiovascular risk factors of women recruited at delivery following the diagnosis of an HDP with those of women with uncomplicated pregnancies, at 3 months and 12-18 months postpartum. Measures included blood pressure, fasting lipids, inflammatory biomarkers, and measures of insulin resistance. Multiple linear regressions were used to adjust for body mass index (BMI) and other characteristics. We studied 71 subjects: 31 women with HDP and 40 with an uncomplicated pregnancy. There were no significant differences between groups for total cholesterol, HDL-c, LDL-c, triglycerides, HgbA1c, or homeostasis model assessment-estimated insulin resistance. Values for tumor necrosis factor-α were significantly higher in the HDP group (p<0.01), while those for interleukin-6 and c-reactive protein were not. A diagnosis of HDP was associated with a 9 mm Hg difference in systolic blood pressure at both 3 months and 1 year, after adjustment for age, BMI, race, family history of cardiovascular disease, tobacco use, and insurance. Women with HDP had significantly higher blood pressure 3 months and 1 year after delivery, independent of obesity. There were no significant differences in lipids or measures of insulin resistance after adjusting for BMI. Elevated blood pressure may account for the observed associations between HDP and future cardiovascular disease.

Studies of cardiovascular risk factors in polycystic ovary syndrome patients combined with subclinical hypothyroidism

Objective: To investigate cardiovascular risk factors in women with polycystic ovary syndrome (PCOS) combined with subclinical hypothyroidism (SCH). Patients: A place-controlled study was performed. Group 1: 29 patients with PCOS and SCH; Group II: 35 patients with PCOS and normal thyroid function; and Group III: 34 healthy women with normal thyroid function.Main measure indexes: Total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL) and high-density lipoprotein (HDL), Carotid Arterial Intima-Media Thickness (CIMT), free triiodothyronine 3 (FT3), free triiodothyronine 4 (FT4), thyroid stimulating hormone (TSH), fasting glucose, 1-hour oral glucose tolerance test (OGTT1), 2-hour oral glucose tolerance test (OGTT2), fasting insulin, insulin after 1 hour oral glucose (INS1), insulin after 2 h oral glucose (INS2), HOM-IR = (fasting glucose × fasting insulin)/22.5.Results: TG, TC FIN, INS1, and HOM-IR levels were significantly higher, but the mean HDL level was significantly lower in Group I than in Group II (p < 0.05). LDL cholesterol, FGOGTT1, OGTT2, and insulin after 2 h oral glucose were not significantly higher in Group I than in Group II (p > 0.05). TG, TC, FIN and INS contents 2 h meal, HOM-IR levels were significantly higher, and the mean HDL cholesterol level was significantly lower in Group I than in Group III (p < 0.05). Blood glucose levels after 1 and 2 h were not significantly higher in Group I than in the Group III (p > 0.05). Carotid Arterial Intima-Media Thickness (CIMT) was significantly thicker in Group I than other two groups.Conclusions: The PCOS patients combined with SCH have higher risk of cardiovascular risk factors than in controls or in patients with PCOS.

Precocious markers of cardiovascular risk and vascular damage in apparently healthy women with previous gestational diabetes.

Previous gestational diabetes mellitus (pGDM) indicates future risk for type 2 diabetes (T2DM). Insulin resistance (IR) may precede T2DM in many years and is associated with an increased risk for cardiovascular diseases.AimThis study aims to identify endothelial dysfunction and cardiovascular risk factors in women with pGDM.MethodsThis cross-sectional analysis included 45 non diabetic women, 20 pGDM and 25 controls, at least one year after delivery. Body mass index (BMI), abdominal circumference (AC), blood pressure, serum lipids, liver enzymes, uric acid, nonesterified fatty acids, C-reactive protein and plasma glucose, insulin, fibrinogen and plasminogen activator inhibitor 1 were measured. HOMA IR and β were calculated. Pre and post induced ischemia videocapillaroscopy was performed in hand nailfold to evaluate microvascular morphologic aspect and functional response.ResultsAC and fasting glucose were significantly higher in pGDM (p = 0.01 and p = 0.002 respectively). Women with pGDM and BMI < 25 kg/m2 had significantly higher levels of fasting insulin and HOMA IR than controls (p = 0.008 and 0.05 respectively). Abnormal morphologic findings were more frequent and papillae rectification were 3.3 times more prevalent in pGDM (p = 0.003). Other microvascular parameters did not differ between groups.ConclusionCardiovascular risk factors and a microcirculation abnormality (papillae rectification) were significantly increased in young non-diabetic women with pGDM.

Cardiovascular risk factors in women with primary Sjögren's syndrome: United Kingdom primary Sjögren's syndrome registry results.

ObjectiveTo determine the prevalence of traditional cardiovascular risk factors using established definitions in a large cohort of clinically well-characterized primary Sjögren's syndrome (SS) patients and to compare them to healthy controls.MethodsData on cardiovascular risk factors in primary SS patients and controls were collected prospectively using a standardized pro forma. Cardiovascular risk factors were defined according to established definitions. The prevalence of cardiovascular risk factors in the primary SS group was determined and compared to that in the control group.ResultsPrimary SS patients had a higher prevalence of hypertension (28–50% versus 15.5–25.6%; P < 0.01) and hypertriglyceridemia (21% versus 9.5%; P = 0.002) than age- and sex-matched healthy controls. Furthermore, a significant percentage (56%) of hypertensive patients expected to be on antihypertensive treatment according to best practice was not receiving it.ConclusionPrimary SS patients are more than 2 times more likely to experience hypertension and hypertriglyceridemia than age- and sex-matched healthy controls. Additionally, hypertension is underdiagnosed and suboptimally treated in primary SS.

Changes in cardiovascular risk profile in women after menopause (Prague Pre and Post Menopausal Female study)

IntroductionAtherosclerosis is the main cause of mortality in the Czech Republic. In our previous cross-sectional studies, we detected a high prevalence of metabolic cardiovascular risk factors in women before and after menopause and found menopausal transition to be critical period for atherosclerosis acceleration. In the present longitudinal study, we studied changes of main cardiovascular risk factors in women after transition to menopause. MethodsWe analyzed data of 195 women who became menopausal and 292 women who stayed in menopause during 6-year period. The cardiovascular risk factors under study were as follows: smoking, body mass index, waist circumference, blood pressure, plasma lipids including apolipoprotein B and A1 and fasting glycemia. ResultsThe most striking differences between newly and steadily menopausal women were found in changes of plasma lipids. With the exception of HDL cholesterol all changes were less favorable in newly menopausal women and were not associated with treatment with statins. No significant differences between both groups were found for changes in body mass index, waist circumference, blood pressure and fasting glycemia. ConclusionsIn longitudinal study we confirmed that time around menopausal transition is one of the most dynamic periods regarding changes of cardiovascular risk factors, mainly plasma lipids.

Causes of death and associated risk factors among climacteric women from Southern Brazil: a population based-study.

BackgroundAging and menopause are particular cardiovascular risk factors for women, due to estrogen deprivation at the time of menopause. Studies show that diabetes mellitus (DM), smoking, hypertension, high body mass index (BMI), and serum lipids are associated with increased risk of cardiovascular disease (CVD), the main cause of female mortality in Brazil. The aim of this study was to assess the mortality rate, causes of death and associated risk factors in a cohort of women from Brazil.MethodsA longitudinal population-based study of menopausal status is currently underway in a city in South Brazil. In 2010, a third follow-up of this population was performed to assess cardiovascular risk and mortality rate between 1995 and 2011. For this analysis, 358 participants were studied. At baseline, participants had completed a standardized questionnaire including demographic, lifestyle, medical and reproductive characteristics. In addition to the contacts with relatives, mortality data were obtained through review of medical records in all city hospitals and the Center for Health Information (NIS/RS-SES). Multivariate-adjusted hazard risk (HR) and 95% confidence intervals (CI95%) were estimated using Cox proportional hazards regression. Survival curves were estimated using the Kaplan-Meier curve.ResultsThere were 17 (4.7%) deaths from all causes during the study period. Seven (41.2%) deaths were caused by CVD, including four cases of stroke and three cases of myocardial infarction. Six (35.3%) deaths were due to cancer, and four (23.5%) were due to other reasons. In the age and smoking-adjusted multivariate models, diabetes (HR 6.645, 95% CI: 1.938–22.79, p = 0.003), alcohol intake (HR 1.228, 95% CI: 1.014-1.487, p = 0.035) and postmenopausal status (HR = 6.216, 95% CI: 0.963–40.143, p = 0.055) were associated with all-cause mortality. A significant association was found between abdominal obesity (WHR ≥ 0.85) and mortality even after the adjustment for BMI (HR = 9.229, 95% IC: 2.083–41.504, p = 0.003).ConclusionCVD was an important cause of mortality in this cohort and DM and/or central adiposity were associated with all-cause mortality. Lifestyle and dietary factors seem to be related to risk of mortality in middle-aged women.

Lipoprotein-associated phospholipase A2 and AGEs are associated with cardiovascular risk factors in women with history of gestational diabetes mellitus

Objective: Although most women with gestational diabetes mellitus (GDM) return to normal glucose tolerance after delivery, they have increased risk of cardiometabolic diseases. This study aimed to evaluate the relationships between plasma levels of Lp-pla2 and AGEs and cardiometabolic risk factors in women with GDM.Methods: 190 women with GDM (cases) and 80 healthy women (controls) were enrolled. Demographic and clinical data were collected and analyzed about 2 years after the delivery.Results: Of the 190 cases, 19 (10%), 38 (20%) and 10 (5%) had type 2 diabetes mellitus, metabolic syndrome and hypertension after delivery, respectively. There were significant differences in variables between cases and controls: Lp-pla2 (pg/mL) 1991.5 ± 905.3 versus 1527.0 ± 799.8; AGEs (ng/mL) 403.0 ± 208.6 versus 321.8 ± 150.3. The plasma Lp-pla2 and AGEs levels were positively correlated with metabolic indexes in women with previous GDM.Conclusion: Women with GDM have increased risk of cardiometabolic disease. AGEs and Lp-pla2 could be utilized as novel biomarkers to identify at an early stage of women with increased risk of metabolic and cardiovascular disease.

Magnesium replacement does not improve insulin resistance in patients with metabolic syndrome: a 12-week randomized double-blind study.

BackgroundTo evaluate the effect of magnesium (Mg) replacement on insulin resistance and cardiovascular risk factors in women with metabolic syndrome (MS) without diabetes.MethodsThis 12-week clinical randomized double-blind study compared the effects of 400 mg/day of Mg with those of a placebo (n = 72) on fasting glucose, insulin, HOMA-IR, lipid profile and CRP. Mg was measured in serum (SMg) and in mononuclear cells (MMg).ResultsHypomagnesemia (SMg < 1.7 mg/dL) was seen in 23.2% of patients and intracellular depletion in 36.1% of patients. The MMg means were lower in patients with obesity (0.94 ± 0.54 μg/mg vs. 1.19 ± 0.6 μg/mg, P = 0.04), and insulin resistance (0.84 ± 0.33 μg/mg vs. 1.14 ± 0.69 µg/mg, P < 0.05). Mg replacement did not alter SMg (1.82 ± 0.14 mg/dL vs. 1.81 ± 0.16 mg/dL, P = 0.877) and tended to increment MMg (0.90 ± 0.40 μg/mg vs. 1.21 ± 0.73 μg/mg, P = 0.089). HOMA-IR did not alter in interventions nor in placebo group (3.2 ± 2.0 to 2.8 ± 1.9, P = 0.368; 3.6 ± 1.9 to 3.2 ± 1.8, respectively), neither did other metabolic parameters.ConclusionSerum and intracellular Mg depletion is common in patients with MS; however, Mg replacement in recommended dosage did not increase significantly Mg levels, neither reduced insulin resistance or metabolic control.

No Phenotypic Differences for Polycystic Ovary Syndrome (PCOS) Between Women With and Without Type 1 Diabetes Mellitus

Women with type 1 diabetes mellitus (DM1) have a higher prevalence of polycystic ovary syndrome (PCOS) than the general population. The aim of this study was to clarify, in DM1 women with PCOS (PCOS-DM1), the influence of insulin therapy and glycemic control and evaluate the hormonal and phenotypic differences with age-matched and body mass index (BMI)-matched women with PCOS without diabetes. We evaluated 103 DM1 women with and without PCOS treated with intensive insulin therapy; 38 age-matched and BMI-matched women with PCOS without diabetes were compared in a cross-sectional study. Clinical, anthropometric, and metabolic parameters were evaluated. Hormonal evaluation and ovary ultrasound were performed during the follicular phase of the menstrual cycle. Applying the diagnostic criteria of the Androgen Excess Society, 38 (36.89%) women with DM1 showed PCOS. The 38 PCOS-DM1 women showed no differences in treatment and glycemic control compared with DM1 women without PCOS. The only difference was a higher visceral adiposity index in PCOS-DM1 (1.21±0.70 vs 0.90±0.32; P=.002). PCOS-DM1 showed no phenotypic differences with age-matched and BMI-matched PCOS without diabetes. The hormonal pattern was similar except that higher levels of Δ4androstenedione were found in PCOS-DM1 (12.89±3.49 vs 2.79±1.75 nmol/L; P=.010). The women with PCOS-DM1 do not exhibit particular phenotypic characteristics compared with nondiabetic women with PCOS. However, this pathological disorder must not be underestimated because it could be an additional cardiovascular risk factor in women with DM1.

8주간의 절명상 프로그램이 여성의 스트레스, 우울 및 심혈관 위험인자에 미치는 효과

이 연구에서는 절명상 프로그램이 가진 보완대체의학으로서의 가능성을 알아보기 위하여 성인 여성을 대상으로 8주 간의 절명상 프로그램을 시행하고 스트레스, 우울 및 심혈관계 위험 인자에 미치는 영향을 조사하였다. 일개 요양병원에 근무하는 성인여성 60명 중 탈락기준을 통과한 57명을 대상으로 무작위대조군 실험을 진행하였다. 연구대상자들은 실험 전후에 자기기입식 설문을 통해 스트레스, 우울을 단축형 사회심리적 건강 측정도구(PWI-SF), Beck 우울척도(BDI)로 각각 조사하였고, 체질량지수, 허리둘레, 혈압, 당화혈색소, 항상성 모델 평가(homeostasis model assessment, HOMA), 저밀도지단백 콜레스테롤, 고밀도지단백 콜레스테롤, 중성지방을 측정하였다. 실험군에게 스트레칭, 절명상, 정좌명상으로 구성된 절명상 프로그램을 8주간 시행하였으며, 대조군에는 아무런 중재를 하지 않았다. 제외기준을 통과한 57명 중, 실험군 26명, 대조군 27명이 실험을 완주하였고, 실험군은 일주일에 평균 5.16회 절명상 프로그램을 시행하였다. 8주간의 실험 후, 실험군은 스트레스(t=5.102, p<0.01), 우울(t=5.259, p<0.01), 체질량지수(t=2.942, p=007)와 허리둘레(t=2.582, p=0.016)가 유의미하게 감소하였으나, 대조군은 유의한 변화가 없었다. 그 외의 변수에서는 실험군과 대조군 사이에 유의미한 차이가 없었다. 8주 간의 절명상 프로그램 시행 후, 시행 전에 비하여 실험군에서 스트레스, 우울 및 체질량지수, 허리둘레가 유의하게 감소되었고, 변화량의 차이는 대조군과의 비교에서도 유의하였다. 이는 절명상이 심신의학의 한 방법이 될 수 있음을 시사한다. Objectives: There has been an increase in the use of mind-body therapies to control cardiovascular risk factors recently. This trial was designed to determine whether the 'jeol'(Korean Buddhists' prostration) meditation program, as a new mind-body intervention, was effective in managing stress, depression and controlling cardiovascular risk factors in women working at a geriatric hospital. Methods: We conducted a randomized controlled trial to determine whether the 'jeol' meditation program could improve stress, anxiety, depression, and cardiovascular risk factors in women. We randomly assigned 57 participants to the intervention(29 participants) or control(28 participants) group. The subjects in the intervention group participated in a group Jeol meditation program once weekly, and practiced at home. The following variables were assessed: stress(Psychosocial Wellbeing Index), depression(Beck's Depression Inventory), body mass index(BMI), waist circumference, hemoglobin A1c(HbA1c), homeostasis model assessment(HOMA), low-density lipoprotein(LDL) cholesterol, high-density lipoprotein(HDL) cholesterol, and triglyceride were assessed. Results: After the 8-week program, 2 participants from the intervention group and 1 from the control group dropped out. The subjects in the intervention group exhibited decreased scores for stress(t=5.102, p<0.01), depression(t=5.259, p<0.01), BMI(t=2.942, p=0.007), and waist circumference(t=2.582, p=0.016); however these scores did not demonstrate a significant decrease in participants of the control group. The other variables showed no significant difference between the groups. Conclusion: The 'jeol' meditation program evidently reduced stress, anxiety, depression, body weight, and waist circumference in women, which suggests that this program could be employed as a mind-body therapies.

Predictors of cardiovascular risk in women.

Cardiovascular disease is the leading cause of death in women, contributing to one in three female deaths. Despite improvements in overall cardiovascular outcomes, substantial gender and ethnic disparities remain. In order to improve outcomes among women, we recommend the following: every woman should undergo risk stratification for short-term and lifetime cardiovascular risk given the substantial long-term risk of cardiovascular disease; modifiable cardiovascular risk factors in women should be modified to the greatest extent possible; and these factors include lipid abnormalities, hypertension, smoking, diabetes, obesity, physical inactivity and, possibly, inflammatory markers. The rate of decline in heart disease is slower for women than men, highlighting the need for gender-specific interventions to address the outcomes gap.

Induction of labour or expectant monitoring in hypertensive pregnancy disorders at term: do women's postpartum cardiovascular risk factors differ between the two strategies?

ObjectiveCardiovascular disease (CVD) is the leading cause of death in women in the western world. Several studies have described the association between hypertensive pregnancy disorders and CVD in later life. Our aim was to compare postpartum cardiovascular risk factors in women who had a shorter and women who had a longer exposure to endothelial activation during their term hypertensive pregnancy. Study designWe studied a subsample of women with pregnancy-induced hypertension or mild preeclampsia at term, who had participated in the randomized HYPITAT trial comparing induction of labour (IOL cohort) (n=110) or expectant monitoring (EM cohort) (n=91). We assessed, 2.5 years postpartum, cardiovascular risk factors, i.e. blood pressure, anthropometrics, glucose, HbA1C, insulin, HOMA score, total cholesterol, HDL cholesterol, triglycerides, high sensitive CRP, micro-albumin and metabolic syndrome, and compared these risk factors between the induction and expectant groups. ResultsThe mean time from randomization to delivery was 3.3 days in the induction group and 10.3 days in the expectant group (p<.001), generating a difference in exposure of 7 days. After a mean follow-up period of 2.5 years, the prevalence of hypertension (IOL 34%; EM 37%, p=.66) and metabolic syndrome (IOL 26%; EM 27%, p=1.0) was similar in both groups. Furthermore, systolic and diastolic blood pressure, BMI, waist circumference, glucose, HbA1C, insulin, HOMA score, lipids, HsCRP-levels and micro-albumin were all comparable between women who had induction of labour and those who had expectant monitoring. ConclusionIn women with hypertensive disorders in pregnancy at term, induction of labour does not affect the clinical and biochemical cardiovascular profile at 2.5 years postpartum.

A cross-sectional baseline survey investigating the relationship between dietary diversity and cardiovascular risk factors in women from the Vaal Region, South Africa

Objective: Dyslipidaemia, an abnormality in circulating serum cholesterol, triglycerides, high-density and low-density lipoproteins, is one of the risk factors of cardiovascular disease. The role of nutrients is well known in the development of cardiovascular disease, but little emphasis is placed on total diet quality. Food group diversity and food variety scores are often used to reflect diet quality. The objective of this study was to investigate the relationship between dietary diversity and cardiovascular disease risk factors among low-income women in the Vaal Region. Methods: A cross-sectional, observational baseline survey was undertaken in 722 randomly selected black women in four purposively selected peri-urban settlements in the Vaal Region. Measurements included socio-demographic data, dietary intake (24-hour recall), dietary diversity (food frequency), anthropometric (weight and height), blood pressure and biochemi- cal indices (lipid profile). Data analyses included descriptive statistics, multivariate analyses of variance, analyses of variance and regression analyses. Results: The mean individual dietary diversity score±standard deviation (SD) for the total group was 6.4±2.4. Those women in the low dietary diversity category were significantly ( p =0.020) younger (45.8±4.4 years) and had a significantly ( p =0.002) higher body mass index (30.7±2.8 kg/m 2 ). The mean±SD of body mass index for the low and medium dietary diversity categories respectively indicated obesity (≥30 kg/m 2 ) compared to overweight in the high dietary diversity category (29.3±5.4 kg/m 2 ). The mean±SD systolic blood pressure (134.9±19.5) was significantly ( p =0.000) higher in the low dietary diversity category, whereas the medium dietary diversity category showed the highest mean±SD total triglyceride level of 70.3±23.7 mg/dl. The high dietary diversity category was associated with the highest total serum cholesterol (176.4±24.2 mg/dl), low density lipoprotein cholesterol (103.8±28.7 mg/dl) and lowest high density lipoprotein cholesterol (46.1±10.6 mg/dl) levels. Conclusions: Higher dietary diversity was associated with a healthier diet, not only in terms of nutrient intakes, but also with regard to food group variety across all nine nutritious food groups. Although relationships between dietary diversity and cardiovascular disease risk factors were observed, discrepant findings have been noted.

AB0210 Vitamin D and cardiovascular disease in systemic lupus erythematosus

BackgroundVitamin D has pleiotropic actions on many chronic diseases. Multiple studies have confirmed vitamin D deficiency in patients with systemic lupus erythematosus (SLE). Genetic polymorphisms located in VDR gene and...

AB0406 Vitamin d cannot predict carotid subclinical atherosclerosis in sle

BackgroundAtherosclerosis in patients with systemic lupus erythematosus (SLE) develops earlier and is one of the important causes in mortality. Vitamin D was revealed to affect many systems including cardiovascular and...

Longitudinal analysis of cardiovascular risk parameters in women with a history of hypertensive pregnancy disorders: the Doetinchem Cohort Study

Women with hypertensive pregnancy disorders (HPD) are at increased risk of developing hypertension and cardiovascular disease later in life; however, it is not known how cardiovascular risk develops throughout life. We evaluated the longitudinal trends in cardiovascular risk factors in women after hypertensive pregnancy disorders compared with women with normotensive pregnancies. All women of the Doetinchem Cohort Study (1987-91), a population-based cohort study, were included. Women were examined (questionnaires and physical examination) four times at 5-year intervals. History of HPD was assessed from questionnaires. We compared 5-year changes in risk factors between women with and without HPD, by analysing longitudinal trends using generalised estimating equation analysis to estimate the effects of HPD and mean age, adjusting for treatment, body mass index (BMI), smoking and socio-economic status. Change over time in traditional cardiovascular risk factors, including systolic blood pressure (SBP) and diastolic blood pressure (DBP), BMI, total and high-density lipoprotein (HDL) cholesterol for women with and without a history of HPD. A total of 2703 women with normotensive pregnancies (mean age 40.5 years, SD 10.4) and 689 women with a history of HPD (mean age 38.4 years, SD 9.5) were included. Compared with normotensive women, in women with a history of HPD, SBP was 2.8 mmHg higher (95% CI 1.7-3.9), DBP was 2.3 mmHg higher (95% CI 1.6-3.0) and BMI was 0.7 kg/m(2) higher (95% CI 0.4-1.1). Total cholesterol (-0.05; 95% CI -0.1 to 0.0) and HDL cholesterol (0.02; 95% CI -0.0 to 0.1) were similar in both groups. No difference in annual change in blood pressure or in the other risk factors was observed between women with and without a history of HPD. Women with a history of HPD have higher levels of SBP, DBP and BMI compared with normotensive women, but the increase with ageing is similar in both groups.

Cardiovascular risk factors in women who had hypertensive disorders late in pregnancy: a cohort study

The purpose of this study was to determine cardiovascular risk factors in women with a history of hypertensive pregnancy disorders at term (HTP) 2.5 years after pregnancy. In a multicenter cohort study in The Netherlands from June 2008 through November 2010, cardiovascular risk factors were compared between women with a history of HTP (HTP cohort, n = 306) and women with a history of normotensive pregnancies at term (NTP cohort, n = 99). HTP women had participated in a randomized, longitudinal trial assessing the effectiveness of induction of labor in women with hypertensive pregnancy disorders at term. All women were assessed 2.5 years after pregnancy for blood pressure, anthropometrics, glucose, glycosylated hemoglobin, insulin, homeostatic model assessment score, total cholesterol, high-density lipoprotein cholesterol, triglycerides, high-sensitivity C-reactive protein, and microalbumin and metabolic syndrome. After a mean follow-up period of 2.5 years, hypertension (HTP, 34%; NTP, 1%; P < .001) and metabolic syndrome (HTP, 25%; NTP, 5%; P < .001) were more prevalent in HTP women compared with NTP women. HTP women had significantly higher systolic and diastolic blood pressure, higher body mass index, and higher waist circumference. Glucose, glycosylated hemoglobin, insulin, homeostatic model assessment score, total cholesterol, triglycerides, and high-sensitivity C-reactive protein levels were significantly higher and high-density lipoprotein cholesterol was significantly lower in HTP women. In women with a history of HTP, hypertension and metabolic syndrome are more common, and they have higher levels of biochemical cardiovascular risk factors 2.5 years after pregnancy.

Biochemical Cardiovascular Risk Factors After Hypertensive Pregnancy Disorders

The objective of this study was to perform a systematic review and meta-analysis of studies assessing biochemical cardiovascular risk factors in women with previous hypertensive pregnancy disorders and women with previous normotensive pregnancies. Data were collected from PubMed and EMBASE (from inception to February 28, 2011) supplemented by manual searches of bibliographies. Included were cohort studies and case-control studies assessing biochemical cardiovascular risk factors in women with previous hypertensive pregnancy disorders compared with women with previous normotensive pregnancies. Of 2573 studies reviewed for eligibility, quality, and data extraction, 22 were included in the review, of which 15 could be meta-analyzed. The pooled mean differences for the outcomes of interest were 0.17 mmol/L (95% confidence interval [CI], 0.08-0.25 mmol/L) for glucose (10 studies), 3.46 mU/mL (95% CI, 2.34-4.58 mU/mL) for insulin (5 studies), 0.13 mmol/L (95% CI, 0.05-0.21) for triglycerides (10 studies), 0.22 mmol/L (95% CI, 0.11-0.33 mmol/L) for total cholesterol (11 studies), -0.11 mmol/L (95% CI, -0.18 to -0.04 mmol/L) for high-density lipoprotein cholesterol (10 studies), and 0.21 mmol/L (95% CI, 0.10-0.32) for low-density lipoprotein cholesterol (9 studies), all in the disadvantage in women with previous hypertensive pregnancy disorders. Analyses for preeclampsia alone showed similar results.After completing this CME activity, physicians should be better able to assess the long-term cardiovascular consequences after hypertensive pregnancy disorders, evaluate and interpret the evidence regarding biochemical cardiovascular risk factor assessment after pregnancy, and counsel women with a history of hypertensive pregnancy disorders as to the effectiveness of cardiovascular risk factor assessment in the primary prevention of cardiovascular disease.Women with previous hypertensive pregnancy disorders have higher glucose, insulin, triglycerides, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol levels measured after pregnancy compared with women with previous normotensive pregnancies. These biochemical cardiovascular risk factors may identify women who will benefit from primary prevention of cardiovascular disease.Obstetricians and gynecologists, family physicians.

Insulin resistance and cardiovascular risk factors in women with PCOS who have normal glucose tolerance test

Introduction: We aimed to determine the insulin resistance in women with PCOS patients who have normal oral glucose tolerance test (OGTT) and to evaluate cardiovascular risk by measuring C-reactive protein (CRP) and carotid intimae-media thickness (CIMT). Methods: A total of 34 patients and age and body mass matched 20 healthy control subjects were included to this prospective study. Both of patients and control groups were consisted of normal oral glucose tolerance test. Insulin resistance (IR) was estimated using HOMA-IR method. CRP, lipid and hormone levels were measured. CIMT was measured by Carotid Artery B-Mode ultrasonography. Results: There was no significant difference between patients and controls in BMI, and waist circumference, lipid, TSH, LH, FSH, estradiol, and prolactin levels. Serum insulin, testosterone, DHEAS, ferritin levels and HOMA values were significantly higher in patient group. We found that 64.7% (n = 22/34) patients with PCOS had insulin resistance. Both of CIMT and CRP levels were significantly higher in the PCOS patients had BMI over 25 kg/m2. CRP levels was significantly higher in the PCOS patients had waist circumference greater than 80 cm. Conclusion: We found insulin resistance in the women with PCOS even if OGTT was normal. Our data were similar to literature, the women with PCOS have increased risk of premature atherosclerosis and metabolic syndrome.