Cardiovascular Risk In Women Research Articles

Parity and cardiovascular disease risk in women with chronic kidney disease

Cardiovascular (CV) disease is the leading cause of mortality in women. Young women with Chronic Kidney Disease (CKD) have up to a 30-fold risk of CV mortality. Parity is associated with CV disease in the general population, but whether parity influences CV risk in women with CKD is unknown. This study aimed to determine the association between parity and CV risk in women with CKD.

Cardiovascular health after menopause transition, pregnancy disorders, and other gynaecologic conditions: a consensus document from European cardiologists, gynaecologists, and endocrinologists.

Women undergo important changes in sex hormones throughout their lifetime that can impact cardiovascular disease risk. Whereas the traditional cardiovascular risk factors dominate in older age, there are several female-specific risk factors and inflammatory risk variables that influence a woman’s risk at younger and middle age. Hypertensive pregnancy disorders and gestational diabetes are associated with a higher risk in younger women. Menopause transition has an additional adverse effect to ageing that may demand specific attention to ensure optimal cardiovascular risk profile and quality of life. In this position paper, we provide an update of gynaecological and obstetric conditions that interact with cardiovascular risk in women. Practice points for clinical use are given according to the latest standards from various related disciplines (Figure 1).

The Impact of Depression and Anxiety on Cardiovascular Disease Risk and Outcomes in Women

Depression and anxiety are known to potentiate cardiovascular disease and result in worse outcomes. These disorders disproportionately affect women. The purpose of this review is to examine the impact of depression and anxiety on cardiovascular outcomes in women. Depression, anxiety, and psychosocial stressors work through a number of mechanisms to decrease health behavior engagement and increase cardiovascular risk in women. Ultimately, this leads to worsened quality of life, cardiovascular morbidity, and mortality among affected women. Notably, because these conditions are more prevalent in women, they may contribute to widening of pre-existing disparities in cardiovascular outcomes based on sex. Depression and anxiety may contribute to impaired quality of life and increased mortality in women with cardiovascular diseases. Therefore, it is imperative for providers to screen for, recognize, and treat these conditions.

Cardiovascular Evaluation and Considerations for Women of Advanced Maternal Age Desiring Pregnancy

Pregnancy in women of advanced maternal age (AMA) is increasingly common. Women of AMA have higher pregnancy risks, including higher risk of cardiovascular complications such as hypertensive disorders of pregnancy. This review highlights recent data comparing pregnancy risks in both younger women and women of AMA, as well as how these risks are influenced using assisted reproductive therapies (ART). It highlights long-term cardiovascular risks in women of AMA and suggestions on how to perform cardiovascular evaluations both preconception and during pregnancy in this group of women. It also highlights the importance of comprehensive cardio-obstetrics care in providing optimal preconception, pregnancy, and postpartum care for women of AMA. Though data on evaluating pregnancy risk in women of AMA are limited, what data are available suggest higher rates of hypertensive disorders of pregnancy, gestational diabetes, and multiple other cardiovascular complications. The absolute risk however remains low. These risks are amplified by ART use. Increasing attention is being paid to optimizing preconception health, especially preconception obesity and hypertension. More work is required to better characterize the risks of AMA in pregnancy and how to optimally care for these patients. What research is available emphasizes the importance of optimizing prepregnancy health. A multidisciplinary cardio-obstetrics may play an especially integral part in optimizing the safety of pregnancy in women of AMA.

Cancer and Cardiovascular Risk in Women With Hypertensive Disorders of Pregnancy Carrying a Common IGF1R Variant

ObjectiveTo evaluate the impact of insulin-like growth factor 1 receptor variant rs2016347 on the risk for breast and nonbreast cancers and cardiovascular disease in women with a history of hypertensive disorders of pregnancy (HDP). Patients and MethodsThis retrospective cohort study included all parous women in the UK Biobank with prior rs2016347 genotyping (N=204,155), with enrollment taking place from March 2006 to July 2010. History of HDP was self-reported, and outcomes included breast and all nonbreast cancers, hospital diagnoses of hypertension and cardiovascular disease, and direct blood pressure measurements. ResultsWomen with previous HDP had a higher risk for future hypertension and cardiovascular diagnoses, increased blood pressures, and lower risk for breast cancer compared with women without HDP, consistent with prior studies. Hazard ratios for all nonbreast cancers were unchanged. However, when taking genotype into account, HDP-positive women carrying at least 1 thymine (T) allele of rs2016347 had a lower risk for nonbreast cancer (hazard ratio, 0.59; 95% CI, 0.37 to 0.92; P=.02) and lower systolic blood pressure (−2.08±0.98 mm Hg; P=.03) compared with women with the guanine/guanine (GG) genotype with positive evidence of interaction (HDP:T allele) for both outcomes; P=.04 and P=.03, respectively. ConclusionWomen who experience HDP and carry a T allele of rs2016347 have 41% lower risk for developing nonbreast cancer and a lower systolic blood pressure of 2.08 mm Hg when compared with those with the GG genotype, suggesting a possible role of the insulin-like growth factor 1 axis for both cardiovascular and cancer risk in women with HDP.

Angiogenic Factors and Long-Term Cardiovascular Risk in Women That Developed Preeclampsia During Pregnancy.

Preeclampsia is caused by placental impairment with increased expression of sFlt-1 (soluble fms-like tyrosine kinase 1) and decreased PlGF (placental growth factor); it has been associated with cardiovascular morbidity and mortality later in life, but the underlying mechanism remains unknown. The aim of this study was to determine whether sFlt-1 and PlGF levels during preeclampsia are associated to long-term cardiovascular risk. We prospectively recruited 43 women with previous preeclampsia and 21 controls with uncomplicated pregnancies. Cardiovascular risk assessment ≈12 years later included maternal hemodynamic, cardiac function and structure, biomarker analysis, and carotid-intima thickness evaluation. Women with previous preeclampsia had higher prevalence of hypertensive disorders and dyslipidemia than controls. In addition, they had worse global longitudinal strain, thicker left ventricular septal and posterior walls, more myocardial mass and increased carotid intima-media thickness compared with controls. PlGF during pregnancy correlated positively with high-density lipoprotein (r=0.341; P=0.006), and negatively with global longitudinal strain (r=-0.581; P<0.001), carotid intima-media thickness (r=-0.251; P=0.045), and mean arterial blood pressure (r=-0.252; P=0.045), when adjusted by study group. sFlt correlated negatively with high-density lipoprotein (r=-0.372; P=0.002) and apolipoprotein A-1 (r=-0.257; P=0.040), and positively with carotid intima-media thickness (r=0.269; P=0.032) and left ventricular posterior wall thickness (r=0.368; P=0.003). The antiangiogenic state present in preeclampsia is related to greater prevalence of cardiovascular risk factors ≈12 years after delivery. The knowledge of altered angiogenic factors may help detect women with a higher risk for premature cardiovascular disease, who will require earlier follow-up after delivery.

OC17.01: *Angiogenic factors and long‐term cardiovascular risk in women that developed pre‐eclampsia during pregnancy

OC17.01: *Angiogenic factors and long‐term cardiovascular risk in women that developed pre‐eclampsia during pregnancy

Cardiovascular risk markers in women with metabolic syndrome at the menopausal transition using multimodal non-drug therapies

Aim. To study the effect of non-drug strategies on the main markers of cardiovascular risk in women with menopausal disorders and metabolic syndrome (MS).Material and methods. Three hundred women aged 45-50 years with disorders during the menopausal transition and MS were ranked in 5 groups. In group I, following methods were used: standard treatment, physiotherapy, balneotherapy, multivitamins and minerals, as well as physical factors (vibration therapy, chromotherapy, melotherapy, aromatherapy, aeroionotherapy). In group II, chromotherapy was excluded from the above methods, in group III — vibration therapy, in group IV, physiotherapy was not used, in group V only standard treatment was used. We assessed blood pressure (BP), lipid profile, levels of glucose and serum insulin, and estimated the HOMA-IR index (Homeostasis Model Assessment — Insulin Resistance).Results. Complex treatment using physical factors contributed to the optimization of BP control, improved carbohydrate and fat metabolism. The simultaneous use of all the above physical factors made it possible to improve BP control and most significantly reduce after 6 months of therapy in patients with mild climacteric syndrome the HOMAIR index by 56,2% and the atherogenic index by 31,2%, and in patients with moderate climacteric syndrome — by 57,2% and 30,5%, respectively (p&lt; 0,0001). The decrease in the Green test was 55,3% and 39,9%, respectively (p&lt;0,0001).Conclusion. Non-drug strategies with physiotherapy help to reduce the manifestation of cardiovascular risk in women with MS at the menopausal transition, positively affecting modifiable factors and normalizing the activity of hypothalamicpituitary-gonadal axis. The priority is the simultaneous use of vibration therapy, chromotherapy, melotherapy, aromatherapy and aeroionotherapy.

Neural control of blood pressure during pregnancy in humans.

Previous microneurographic studies found that muscle sympathetic nerve activity (MSNA) increased in normotensive pregnant women and was even greater in women with gestational hypertension and preeclampsia during the third trimester. It is possible that sympathetic activation during the latter months of normal pregnancy helps return arterial pressure to non-pregnant levels. However, when the increase in sympathetic activity is excessive, hypertension ensues. The key question that must be addressed is whether sympathetic activation develops early during pregnancy and remains high throughout gestation, or whether this sympathetic overactivity only occurs at term, providing the substrate for preeclampsia and other pregnancy-associated cardiovascular complications. This was a literature review of autonomic neural control during pregnancy. Recent work from our laboratory and other laboratories showed that in healthy women resting MSNA increased in early pregnancy, increased further in late pregnancy, and returned to the pre-pregnancy levels shortly after delivery. We found that women who exhibited excessive sympathetic activation during the first trimester, before any clinical signs and symptoms appeared, developed gestational hypertension at term. We also found that the level of corin, an atrial natriuretic peptide-converting enzyme, was increased in the maternal circulation, especially during late pregnancy, as a homeostatic response to elevated sympathetic activity. These findings provide important insight into the neural mechanisms underlying hypertensive disorders during pregnancy. With this knowledge, early prevention or treatment targeted to the appropriate pathophysiology may be initiated, which may reduce maternal and fetal death or morbidity, as well as cardiovascular risks in women later in life.

Quality of life and cardiovascular risk in women during menopausal transition and postmenopause

The task of active longevity is a priority for world and national health care. One of the resources to ensure the quality of life for aging women is the rationalization of nutrition using biologically active additives (BAA), which include substances that have proven effective in stopping the symptoms that accompany the menopausal transition and early postmenopause. Given the association of vasomotor symptoms with an increased risk of cardiovascular disease, it can be assumed that solving the problem of improving the quality of life will positively affect cardiovascular risk. Based on this hypothesis, we set the goal of the study to assess the effect of dietary supplements containing phytoestrogens on the quality of life and markers of cardiovascular risk in women during menopausal transition and postmenopause. An open, controlled study involved women aged 46–58 years who took Estrovel dietary supplement or a vitamin complex without herbal supplements, examined using questionnaires to determine the severity of menopausal complaints, assess mental status, vegetative support, as well as monitor blood pressure, and samples for vegetative providing, analysis of heart rate variability. The results of the study showed that women taking Estrovel dietary supplement to improve the quality of life, in addition to stopping the symptoms of pathological menopause, receive additional benefits in the form of improved psycho-vegetative status and markers of cardiovascular risk with high safety and good tolerance of the method.

Cardiovascular risk after hypertensive disorders of pregnancy in women with and without inheritable Thrombophilia

ABSTRACT Aim of this study was to compare cardiovascular risk in women with and without inheritable thrombophilia after hypertensive disorders of pregnancy (HDP). Blood pressure, anthropometrics and blood samples were measured 9-13 years after early-onset (<34 weeks) HDP. Amongst the 114 women included, no differences in hypertension (31.1% vs. 33.7%, OR 0.90 95% CI (0.29–2.79)), body mass index > 25 kg/m2 (43.8% vs. 53.1%, OR 0.69 95% CI (0.24–2.00)) or metabolic syndrome (18.8% vs. 13.3%, OR 1.51 95% CI (0.38–6.02)) were found. These data show similar cardiovascular risk profile in women with and without inheritable thrombophilia.

Diabetes Mellitus and Cardiovascular Risk Assessment in Mothers with a History of Gestational Diabetes Mellitus Based on Postpartal Expression Profile of MicroRNAs Associated with Diabetes Mellitus and Cardiovascular and Cerebrovascular Diseases.

Mothers with a history of gestational diabetes mellitus (GDM) have an increased risk of developing diabetes in the future and a lifelong cardiovascular risk. Postpartal expression profile of cardiovascular/cerebrovascular disease associated microRNAs was assessed 3–11 years after the delivery in whole peripheral blood of young and middle-aged mothers with a prior exposure to GDM with the aim to identify a high-risk group of mothers at risk of later development of diabetes mellitus and cardiovascular/cerebrovascular diseases who would benefit from implementation of early primary prevention strategies and long-term follow-up. The hypothesis of the assessment of cardiovascular risk in women was based on the knowledge that a series of microRNAs play a role in the pathogenesis of diabetes mellitus and cardiovascular/cerebrovascular diseases. Abnormal expression profile of multiple microRNAs was found in women with a prior exposure to GDM (miR-1-3p, miR-16-5p, miR-17-5p, miR-20a-5p, miR-20b-5p, miR-21-5p, miR-23a-3p, miR-24-3p, miR-26a-5p, miR-29a-3p, miR-100-5p, miR-103a-3p, miR-125b-5p, miR-126-3p, miR-130b-3p, miR-133a-3p, miR-143-3p, miR-145-5p, miR-146a-5p, miR-181a-5p, miR-195-5p, miR-199a-5p, miR-221-3p, miR-342-3p, miR-499a-5p, and-miR-574-3p). Postpartal combined screening of miR-1-3p, miR-16-5p, miR-17-5p, miR-20b-5p, miR-21-5p, miR-23a-3p, miR-26a-5p, miR-29a-3p, miR-103a-3p, miR-133a-3p, miR-146a-5p, miR-181a-5p, miR-195-5p, miR-199a-5p, miR-221-3p, and miR-499a-5p showed the highest accuracy for the identification of mothers with a prior exposure to GDM at a higher risk of later development of cardiovascular/cerebrovascular diseases (AUC 0.900, p < 0.001, sensitivity 77.48%, specificity 93.26%, cut off >0.611270413). It was able to identify 77.48% mothers with an increased cardiovascular risk at 10.0% FPR. Any of changes in epigenome (upregulation of miR-16-5p, miR-17-5p, miR-29a-3p, and miR-195-5p) that were induced by GDM-complicated pregnancy are long-acting and may predispose mothers affected with GDM to later development of diabetes mellitus and cardiovascular/cerebrovascular diseases. In addition, novel epigenetic changes (upregulation of serious of microRNAs) appeared in a proportion of women that were exposed to GDM throughout the postpartal life. Likewise, a previous occurrence of either GH, PE, and/or FGR, as well as a previous occurrence of GDM, is associated with the upregulation of miR-1-3p, miR-17-5p, miR-20a-5p, miR-20b-5p, miR-29a-3p, miR-100-5p, miR-125b-5p, miR-126-3p, miR-130b-3p, miR-133a-3p, miR-143-3p, miR-145-5p, miR-146a-5p, miR-181a-5p, miR-199a-5p, miR-221-3p, and miR-499a-5p. On the other hand, upregulation of miR-16-5p, miR-21-5p, miR-23a-3p, miR-24-3p, miR-26a-5p, miR-103a-3p, miR-195-5p, miR-342-3p, and miR-574-3p represents a unique feature of aberrant expression profile of women with a prior exposure to GDM. Screening of particular microRNAs may stratify a high-risk group of mothers with a history of GDM who might benefit from implementation of early primary prevention strategies.

Objective Evaluation of Psychosocial Stress and Its Association with Cardiovascular Risk in Women

Abstract Background Psychosocial stress in women is an emerging problem that is by and large unnoticed. Workplaces are being stressful places for women, but the degree of the stress as perceived by them is highly subjective. Aim To evaluate the stress using the 10-item perceived stress scale (PSS-10) and dividing the participants into low, moderate, and severe stress groups based on the scores. To objectively assess the cardiovascular risk using heart rate variability (HRV) as an index. Methods After obtaining informed and written consent, a mixed population of 50 women working at various levels in the hospital, and home-makers were included in the study. PSS-10 questionnaires were administered and scores were obtained. Electrocardiogram was obtained from lead II at rest for 10 minutes, and HRV was estimated using the LabChart Pro software (ADInstruments). Results Of the participants, 72% were in the moderate perceived stress group. Mean PSS scores were 10.33 ± 0.82, 19.72 ± 3.4, and 29.3 ± 2.3 in low, moderate, and high stress groups, respectively. Frequency-domain measures showed very significant difference across the groups. Very low frequency (VLF) was reduced (p = 0.04) and low frequency (LF) was higher (p = 0.01) in the high stress group. Conclusions Reduced VLF in the high perceived stress group is an indicator of higher cardiovascular mortality risk, which also signifies posttraumatic stress disorder. High LF and reduced high-low frequency powers signify autonomic imbalance in these women. Their perceptions of the stress were also more toward the inability to contain positive emotions when compared with having negative emotions related to stress.

Cardiovascular Risk in Women Deprived of Freedom from a Public Prison in Mato Grosso, Brazil.

Cardiovascular diseases occur worldwide and have progressively affected the female sex, without distinction of life context; however, the prison environment may intensify the risk of developing them. To evaluate the cardiovascular risk in women deprived of freedom from a public prison in Mato Grosso, Brazil. This is a quantitative, cross-sectional and analytical study performed with all incarcerated women from the prison institution in the second half of the years 2016, 2017 and 2018, through a structured questionnaire and statistical analysis through the RStudio. The results showed that, although participants presented low cardiovascular risk, the BMI values pointed to overweight in all the years analyzed, in addition to the waist-to-height ratio, conicity index, waist circumference and waist-hip ratio presenting similar means or that transcend the established cutoff point. There was an association between the anthropometric variables and age, conjugal status, education, alcoholism, systolic blood pressure, metabolic complications, sleep and a family history of non-communicable chronic diseases. The BMI variable showed association with all anthropometric variables related to cardiovascular risk, except to WHR. When considering the ambience factor, modifiable risk factors may negatively influence the long-term health of these women, particularly in relation to the cardiovascular system. The found scenario, in relation to the cardiovascular risk, points to the need for interventions, regarding the clinical condition and life-styles adopted by this population.

Women's cardiovascular risk before and after menopause: A red alert for heart attack!

Cardiovascular disease is now the leading cause of death in women, 16 times more frequent than breast cancer, and with more and more young women at risk. Young women are exposed to serial loss of chance, related to sex, with specific female hormonal cardiovascular risk factors (CVRF): contraception, pregnancy and menopause; and to gender: atypic symptoms, underestimation, poor risk-factor control, undertreatment and lack of follow-up, and specific atheromatous disease. Prevalence and impact of risk factors differ between males and females. At a given age, women show more CVRFs than men. This is due to negative lifestyle changes, with increasing smoking, stress, obesity and sedentary lifestyles. Some CVRFs such as hypertension, smoking, stress and diabetes have more severe arterial impact in women than men. Psychosocial factors are emerging risk factors, especially in younger women. Specific hormonal risk is linked to contraception, endometriosis, polycystic ovary syndrome, gestational diabetes, pre-eclampsia, miscarriage, age at menarche, hysterectomy and menopause. Moreover, classic CV risk scores are not adapted to women. An aggressive approach to CVRF management is essential for primary prevention of CV disease, using specific guidelines. Health professionals should conduct earlier personalized screening for women at risk and should encourage appropriate lifestyle changes. The gyneco-cardiology healthcare pathway is a real opportunity to improve cardiovascular prevention in women.

Abstract P137: Women Experience A Greater Decline In Brachial Artery Distensibility With Age Than Men

Introduction: Brachial artery distensibility is reduced in type 1 diabetes and can predict future coronary artery disease (CAD). Although women generally have reduced cardiovascular risk as compared with men, type 1 diabetes increases cardiovascular risk to a greater degree in women such that their cardiovascular risk matches that in men. Sex differences in arterial distensibility may contribute to the increased cardiovascular risk in women with type 1 diabetes. Hypothesis: We tested the hypothesis that brachial distensibility differed by sex and by diabetes status in a cohort of adults with and without type 1 diabetes. Methods: We measured brachial distensibility via DynaPulse instrument (PulseMetric, San Diego, CA) in 268 adults with type 1 diabetes (mean age 44±9 years) and 373 adults without diabetes (mean age 47 ±8 years) who completed clinical study visits 8±0.89 years apart. A linear mixed model was used to calculate mean brachial distensibility by age at the study visits in men and women by diabetes status. This model was adjusted for age, sex, diabetes status, and visit number. An age group*sex*diabetes interaction was used to calculate least squares means (LSmeans) brachial distensibility and examine trends in each stratum of interest. Results: Brachial distensibility decreases with increasing age (Figure 1). This reduction is greatest for women with type 1 diabetes and smallest for men without diabetes, with decreases from the oldest to youngest age group of 2.6 %/mmHg and 0.98 %/mmHg, respectively. Prior to the age of 40 years, women have better brachial distensibility than men regardless of diabetes status, while men have better brachial distensibility than women beginning in the 40-45 years age group. Conclusions: Women experience a steeper decline in their brachial distensibility than men regardless of diabetes status. Rapid reduction in brachial distensibility may contribute to the increases in cardiovascular risk in women with type 1 diabetes.

Psychological stress, cardiac symptoms, and cardiovascular risk in women with suspected ischaemia but no obstructive coronary disease.

This paper evaluated cross-sectional relationships between psychological stress and coronary artery disease (CAD) risk among women with suspected ischaemia and no obstructive coronary artery disease (INOCA). Between 1996 and 2000, 551 women with INOCA were enrolled in the Women's Ischemia Syndrome Evaluation (WISE) cohort from four U.S. institutions. Between 2009 and 2012, 376 women with INOCA were recruited from two U.S. institutions for an independent cohort study titled WISE-Coronary Vascular Dysfunction (WISE-CVD). Participants underwent coronary angiography and testing for CAD symptoms and risk factors at baseline. Psychological stress was assessed in the form of home/work stress in WISE and home/work stress and financial stress in WISE-CVD. Results showed that home/work stress predicted greater depression, functional impairment, CAD symptoms, and lower self-rated health in WISE but was inconsistent as a predictor in WISE-CVD. In contrast, >60% of WISE-CVD women reported moderate or severe financial stress. Financial stress levels predicted more CAD risk factors and cardiac symptoms, poorer self-rated health, and greater depression and functional impairment. Among women with INOCA, psychological stress was associated with CAD symptoms and CAD risk factors. The prevalence and predictive value of psychological stress in this population supports the inclusion of stress measures in future CAD research.

Nonlinear and time-dependent effects of sparsely measured continuous time-varying covariates in time-to-event analysis.

Many flexible extensions of the Cox proportional hazards model incorporate time-dependent (TD) and/or nonlinear (NL) effects of time-invariant covariates. In contrast, little attention has been given to the assessment of such effects for continuous time-varying covariates (TVCs). We propose a flexible regression B-spline-based model for TD and NL effects of a TVC. To account for sparse TVC measurements, we added to this model the effect of time elapsed since last observation (TEL), which acts as an effect modifier. TD, NL, and TEL effects are estimated with the iterative alternative conditional estimation algorithm. Furthermore, a simulation extrapolation (SIMEX)-like procedure was adapted to correct the estimated effects for random measurement errors in the observed TVC values. In simulations, TD and NL estimates were unbiased if the TVC was measured with a high frequency. With sparse measurements, the strength of the effects was underestimated but the TEL estimate helped reduce the bias, whereas SIMEX helped further to correct for bias toward the null due to "white noise" measurement errors. We reassessed the effects of systolic blood pressure (SBP) and total cholesterol, measured at two-year intervals, on cardiovascular risks in women participating in the Framingham Heart Study. Accounting for TD effects of SBP, cholesterol and age, the NL effect of cholesterol, and the TEL effect of SBP improved substantially the model's fit to data. Flexible estimates yielded clinically important insights regarding the role of these risk factors. These results illustrate the advantages of flexible modeling of TVC effects.

A Protocol for Nurse-Practitioner Led Cardiovascular Follow-Up After Pregnancy Complications in a Socioeconomically Disadvantaged Population.

Background: Women who experience pregnancy complications have an increased risk of future cardiovascular disease when compared to their healthy counterparts. Despite recommendations, there is no standardized cardiovascular follow-up in the postpartum period for these women, and the Australian follow-up protocols that have been previously described are research-based. This study proposes a new model of care for a nurse practitioner-led postpartum intervention clinic for women who experience severe hypertensive disorders of pregnancy, gestational diabetes mellitus requiring medication, severe intrauterine growth restriction, idiopathic preterm delivery, or placental abruption, in a socioeconomically disadvantaged population.Methods: All women receiving antenatal care or who deliver at the Lyell McEwin Hospital, a tertiary acute care facility located in the northern Adelaide metropolitan area, following a severe complication of pregnancy are referred to the intervention clinic for review at 6 months postpartum. A comprehensive assessment is conducted from demographics, medical history, diet and exercise habits, psychosocial information, health literacy, pathology results, and physical measurements. Subsequently, patient-specific education and clinical counseling are provided by a specialized nurse practitioner. Clinic appointments are repeated at 18 months and 5 years postpartum. All data is also collated into a registry, which aims to assess the efficacy of the intervention at improving modifiable cardiovascular risk factors and reducing cardiovascular risk.Discussion: There is limited information on the efficacy of postpartum intervention clinics in reducing cardiovascular risk in women who have experienced pregnancy complications. Analyses of the data collected in the registry will provide essential information about how best to reduce cardiovascular risk in women in socioeconomically disadvantaged and disease-burdened populations.

Nutritional status and cardiovascular risk in women with breast cancer

Objective: To evaluate the nutritional status and the cardiovascular risk in women with breast cancer and identify factors associated with excessive body weight. Methods: A descriptive, cross-sectional, quantitative study was carried out in an oncology outpatient clinic and, gynecology/oncology wards at the Hospital das Clínicas da Universidade Federal de Pernambuco, from March to August 2019. The data analyzed was related to sociodemographic, gynecologic, clinic, anthropometric and lifestyle factors. Nutritional status was assessed using Body Mass Index, considering excessive body weight when &gt; 25 kg/m2 for adults and &gt; 27 kg/m2 for elderly. Obesity was considered &gt; 30 kg/m2. Cardiovascular risk was defined by waist circumference (≥ 80 cm), neck circumference (≥ 34 cm) and waist-to-height ratio (&gt; 0.5). Results: A total of 46 patients were included, with a mean age of 51.9 years, and the majority in outpatient follow-up. The population was mostly Caucasian women, who were married or in a civil union, who had had at least one pregnancy, were in menopause, and were sedentary. High frequencies of excessive body weight (76.1%) and obesity (43.5%) were observed, and anthropometric parameters revealed an elevated frequency of cardiovascular risk in this population, waist circumference (97.8%), neck circumference (84.8%), and waist-to-height ratio (95.7%). Unemployment (p = 0.020), and waist (p = 0.001) and neck (p = 0.001) circumferences were statistically associated factors to excessive body weight. Conclusions: The anthropometric profile of women with breast cancer indicated excess body weight and elevated cardiovascular risk, which suggests to the need for nutrition intervention and follow-up after the diagnosis.