Women's Cardiovascular Health Research Articles

Gestational Diabetes Mellitus and Postpartum Hypertension: Evidence for a Tight Linkage Toward Women's Cardiovascular Health.

Gestational Diabetes Mellitus and Postpartum Hypertension: Evidence for a Tight Linkage Toward Women's Cardiovascular Health.

Gestational Diabetes Significantly Associated With Food Insecurity and Insurance Status in the United States [ID 2683536

INTRODUCTION: Gestational diabetes (GD) is on the rise in the United States, posing risks to women's cardiovascular health, pregnancy, and their offspring's well-being. We sought to characterize the association between food insecurity and health care access and GD prevalence. METHODS: We analyzed data from 29,732 females aged 18+ in the 2021–2022 National Health Interview Survey to determine the prevalence of self-reported GD and its relationship with food security and health insurance status. We used χ2 tests to compare GD rates across different food security classifications and insurance statuses. Additionally, we cross-examined GD rates within food security groups based on insurance coverage. RESULTS: The overall GD prevalence among females was 5.70%. Stratified by food security, significant differences emerged (P<.05): 5.23% for high security, 7.99% for marginal security, 7.72% for low security, and 11.85% for very low security. We observed significant differences in GD rates by insurance coverage (P<.05): 5.57% for insured and 7.72% for uninsured respondents. Notably, when individuals were not highly food secure, there was no significant difference in the prevalence of GD between those who were insured or uninsured. CONCLUSION: This study highlights the significant associations between food insecurity, insurance coverage, and GD prevalence, although our cross-sectional analysis indicated that food insecurity may be the more salient factor. To combat GD's rise, policies should prioritize providing nutritious food access to pregnant women, potentially through mobile food units. Further research should explore whether food insecurity causally affects GD.

Neglected cardiometabolic risk factors and subclinical target organ damage in post-menopausal women with normal glucose tolerance.

Menopausal transition is a crucial step in the women's cardiovascular health, and the risk stratification in apparently health post-menopausal females has been rarely assessed. Heart ultrasonography, unusually performed in such subjects, would be able to detect initial signs of organ damage. We described the cardiovascular risk profile of non-diabetic post-menopausal women, evaluating how easily computed, biochemistry-derived scores were related to ultrasonographic measures of target organ damage. We analyzed the characteristics of a cohort of two-hundred and seventy-three women consecutively referring to a prevention program of Azienda Ospedaliero-Universitaria Pisana (years 2017-2022) who underwent clinical evaluation, complete routine biochemical analyses with proxies of insulin resistance, heart and carotid ultrasonography. The cohort was further divided into four groups according to presence of isolated hypercholesterolemia (HC, 37%), isolated hypertension (HT, 5%), both HC/HT (38%), or none of them. In HC and HC/HT, LDL cholesterol was sharply above the recommended values (149 [134-171] mg/dL and 141 [123-159] mg/dL, respectively). E/e' ratio and left atrium size were augmented in HT women and further worsened in HT/HC, with an independent effect of hypertension (E/e' ß=0.055, P=0.013, left atrium volume ß=0.059, P=0.003). Presence of carotid plaques was independently linked to hypertension (ß=0.474, P=0.003). In HC and HC/HT, the Triglycerides-Glucose Index, a surrogate of insulin resistance, was higher than in the other classes (P=0.0013), and it was associated with E/A in HC and HT/HC, with a significative interaction (P=0.0004) with hypertension. Past hormone replacement therapy did not influence clinical, biochemical or echocardiographic parameters. Postmenopausal women display a high cardiovascular risk burden; a simple clinical and biochemistry screening would be advisable to identify and treat those more at risk. Cardiac ultrasonographic parameters were worse in hypertensive, hypercholesterolemic and insulin-resistant subjects, who may also deserve a deep and early instrumental characterization, especially when these conditions are associated.

How Can We Expand Knowledge to Improve Women's Cardiovascular Health in Latin America?

How Can We Expand Knowledge to Improve Women's Cardiovascular Health in Latin America?

Women and Cardiovascular Health: Unraveling Gender-Specific Factors, Risks, and Therapeutic Approaches in Contemporary Medicine.

Background and objective Cardiovascular diseases (CVDs) constitute a significant global health challenge,causing millions of deaths annually and straining healthcare systems worldwide. This study aimed to investigate and elucidate gender-specific factors, risks, and therapeutic approaches related to cardiovascular health in women within the context of contemporary medicine. Methodology We conducted a prospective observational study spanning one year (November 2022 to October 2023)at the Peshawar Medical Complex Hospital, to meticulously explore the field of women's cardiovascular health. With a diverse cohort of 435 women (age range: 18-55 years), representing various socioeconomic backgrounds and geographic locations, our study aimed to elicit comprehensive insights. Through structured interviews covering reproductive history, lifestyle, and psychosocial aspects, coupled with clinical assessments, we gathered multifaceted data. Statistical analysis was done using SPSS Statisticsversion 23.0 (IBM Corp., Armonk, NY). By employing descriptive and t-tests for quantitative analysisand by thematically analyzing qualitative insights, our approach ultimately sought to provide a nuanced understanding of gender-specific factors impacting women's cardiovascular health. Results The study, involving 435 women, revealed various prevalent cardiovascular risk factors. Notable findings include a high incidence of a family history of CVD (n=213, 48.96%, p=0.013), hypertension (n=207, 47.58%), hypercholesterolemia (n=114, 26.21%), elevated triglycerides (n=162, 37.24%), and diabetes (n=64, 14.71%). Physical inactivity was also significantly more common (53.56%, p=0.004) compared to those engaging in regular activity. Women-specific risk factors comprised miscarriage (n=191, 43.91%). Therapeutic preferences varied, with a majority opting for lifestyle modifications (n=263, 60.39%) and pharmacological interventions (n=331, 76.33%). Conclusions This study provides a comprehensive understanding of prevalent cardiovascular risk factors, distinctive women-specific contributors, and diverse therapeutic preferences, highlighting the importance of personalized and targeted interventions to optimize women's cardiovascular health outcomes in contemporary medicine.

Women's cardiovascular health preventions: are we ready to change the road?

Women's cardiovascular health preventions: are we ready to change the road?

Where Do We Go From Here: Reflections on a Century in Women's Cardiovascular Health Research, 1924-2024.

Where Do We Go From Here: Reflections on a Century in Women's Cardiovascular Health Research, 1924-2024.

Age-Stratified Sex Differences in Heart Failure With Preserved Ejection Fraction Among Adult Hospitalizations.

There is evidence that heart failure with preserved ejection fraction (HFpEF)-related hospitalizations are increasing in the United States. However, there is a lack of knowledge about HFpEF-related hospitalizations among younger adults. The aims of this study were to perform a retrospective analysis using the Nationwide Inpatient Sample and to examine age-stratified sex differences in the prevalence, correlates, and outcomes of HFpEF-related hospitalization across the adult life span. Using the Nationwide Inpatient Sample (2002-2014), patient and hospital characteristics were determined. Joinpoint regression was used to describe age-stratified sex differences in the annual average percent change of hospitalizations with HFpEF. Survey logistic regression was used to estimate adjusted odds ratios representing the association of sex with HFpEF-related hospitalization and in-hospital mortality. There were 8 599 717 HFpEF-related hospitalizations (2.43% of all hospitalizations). Women represented the majority (5 459 422 [63.48%]) of HFpEF-related adult hospitalizations, compared with men (3 140 295 [36.52%]). Compared with men younger than 50 years, women within the same age group were 6% to 28% less likely to experience HFpEF-related hospitalization. Comorbidities such as hypertensive heart disease, renal disease, hypertension, obstructive sleep apnea, atrial fibrillation, obesity, anemia, and pulmonary edema explained a greater proportion of the risk of HFpEF-related hospitalization in adults younger than 50 years than in adults 50 years or older. Before the age of 50 years, women exhibit lower HFpEF-related hospitalization than men, a pattern that reverses with advancing age. Understanding and addressing the factors contributing to these sex-specific differences can have several potential implications for improving women's cardiovascular health.

How cy pres promotes transdisciplinary convergence science: an academic health center for women's cardiovascular and brain health.

Cardiovascular disease (CVD) is largely preventable, and the leading cause of death for men and women. Though women have increased life expectancy compared to men, there are marked sex disparities in prevalence and risk of CVD-associated mortality and dementia. Yet, the basis for these and female-male differences is not completely understood. It is increasingly recognized that heart and brain health represent a lifetime of exposures to shared risk factors (including obesity, hyperlipidemia, diabetes, and hypertension) that compromise cerebrovascular health. We describe the process and resources for establishing a new research Center for Women's Cardiovascular and Brain Health at the University of California, Davis as a model for: (1) use of the cy pres principle for funding science to improve health; (2) transdisciplinary collaboration to leapfrog progress in a convergence science approach that acknowledges and addresses social determinants of health; and (3) training the next generation of diverse researchers. This may serve as a blueprint for future Centers in academic health institutions, as the cy pres mechanism for funding research is a unique mechanism to leverage residual legal settlement funds to catalyze the pace of scientific discovery, maximize innovation, and promote health equity in addressing society's most vexing health problems.

Role of Sex in the Association of Socioeconomic Status With Cardiovascular Health in Black Americans: The Jackson Heart Study.

Socioeconomic status (SES) is associated with cardiovascular health (CVH). Potential differences by sex in this association remain incompletely understood in Black Americans, where SES disparities are posited to be partially responsible for cardiovascular inequities. The association of SES measures (income, education, occupation, and insurance) with CVH scores was examined in the Jackson Heart Study. American Heart Association CVH components (non-high-density-lipoprotein cholesterol, blood pressure, diet, tobacco use, physical activity, sleep, glycemia, and body mass index) were scored cross-sectionally at baseline (scale: 0-100). Differences in CVH and 95% CIs (Estimate, 95% CI) were calculated using linear regression, adjusting for age, sex, and discrimination. Heterogeneity by sex was assessed. Participants had a mean age of 54.8 years (SD 12.6 years), and 65% were women. Lower income, education, occupation (non-management/professional versus management/professional occupations), and insurance status (uninsured, Medicaid, Veterans Affairs, or Medicare versus private insurance) were associated with lower CVH scores (all P<0.01). There was heterogeneity by sex, with greater magnitude of associations of SES measures with CVH in women versus men. The lowest education level (<high school) versus highest (>high school) was associated with 8.8-point lower (95% CI: -10.2 to -7.3) and 5.4-point lower (95% CI: -7.2 to -3.6) CVH scores in women and men, respectively (interaction P=0.003). The lowest (<25 000) versus highest level of income (≥$75 000) was associated with a greater reduction in CVH scores in women than men (interaction P=0.1142). Among Black Americans, measures of SES were associated with CVH, with a greater magnitude in women compared with men for education and income. Interventions aimed to address CVH through SES should consider the role of sex.

Potential Roles of microRNAs for Assessing Cardiovascular Risk in Pre-Eclampsia-Exposed Postpartum Women and Offspring

Pre-eclampsia, which is part of the spectrum of hypertensive pregnancy disorders, poses a significant health burden, contributing to maternal and infant morbidity and mortality. Pre-eclampsia is widely associated with persistent adverse effects on the cardiovascular health of women with a history of pre-eclampsia. Additionally, there is increasing evidence demonstrating that offspring of pre-eclamptic pregnancies have altered cardiac structure and function, as well as different vascular physiology due to the decrease in endothelial function. Therefore, early detection of the likelihood of developing pre-eclampsia-associated cardiovascular diseases is vital, as this could facilitate the undertaking of the necessary clinical measures to avoid disease progression. The utilisation of microRNAs as biomarkers is currently on the rise as microRNAs have been found to play important roles in regulating various physiological and pathophysiological processes. In regard to pre-eclampsia, recent studies have shown that the expression of microRNAs is altered in postpartum women and their offspring who have been exposed to pre-eclampsia, and that these alterations may persist for several years. This review, therefore, addresses changes in microRNA expression found in postpartum women and offspring exposed to pre-eclampsia, their involvement in cardiovascular disease, and the potential role of microRNAs to be used as predictive tools and therapeutic targets in future cardiovascular disease research.

Polycystic Ovary Syndrome Fuels Cardiovascular Inflammation and Aggravates Ischemic Cardiac Injury.

Reducing cardiovascular disease burden among women remains challenging. Epidemiologic studies have indicated that polycystic ovary syndrome (PCOS), the most common endocrine disease in women of reproductive age, is associated with an increased prevalence and extent of coronary artery disease. However, the mechanism through which PCOS affects cardiac health in women remains unclear. Prenatal anti-Müllerian hormone treatment or peripubertal letrozole infusion was used to establish mouse models of PCOS. RNA sequencing was performed to determine global transcriptomic changes in the hearts of PCOS mice. Flow cytometry and immunofluorescence staining were performed to detect myocardial macrophage accumulation in multiple PCOS models. Parabiosis models, cell-tracking experiments, and in vivo gene silencing approaches were used to explore the mechanisms underlying increased macrophage infiltration in PCOS mouse hearts. Permanent coronary ligation was performed to establish myocardial infarction (MI). Histologic analysis and small-animal imaging modalities (eg, magnetic resonance imaging and echocardiography) were performed to evaluate the effects of PCOS on injury after MI. Women with PCOS and control participants (n=200) were recruited to confirm findings observed in animal models. Transcriptomic profiling and immunostaining revealed that hearts from PCOS mice were characterized by increased macrophage accumulation. Parabiosis studies revealed that monocyte-derived macrophages were significantly increased in the hearts of PCOS mice because of enhanced circulating Ly6C+ monocyte supply. Compared with control mice, PCOS mice showed a significant increase in splenic Ly6C+ monocyte output, associated with elevated hematopoietic progenitors in the spleen and sympathetic tone. Plasma norepinephrine (a sympathetic neurotransmitter) levels and spleen size were consistently increased in women with PCOS when compared with those in control participants, and norepinephrine levels were significantly correlated with circulating CD14++CD16- monocyte counts. Compared with animals without PCOS, PCOS animals showed significantly exacerbated atherosclerotic plaque development and post-MI cardiac remodeling. Conditional Vcam1 silencing in PCOS mice significantly suppressed cardiac inflammation and improved cardiac injury after MI. Our data documented previously unrecognized mechanisms through which PCOS could affect cardiovascular health in women. PCOS may promote myocardial macrophage accumulation and post-MI cardiac remodeling because of augmented splenic myelopoiesis.

Abstract 12521: Assessment of Women's Cardiovascular Health Awareness in Lombardy Using Population-Based Web-Survey: The "Call for Women" Project

Introduction: In Italy, despite the improvements in outcomes, cardiovascular disease (CVD) continue to be the leading cause of death in women. Hypothesis: The majority of women has no perception of this risk. Goals: Raising awareness among women about their main health threat. Methods: Women (≥18 years) living in the Lombardy region were invited from September 2022 to February 2023 to fill in a web-survey distributed in the general population through a public, anonymous link. Results: Of 2802 women who answered the call, 2217 (94%) completed the survey, including 107(5%) of women not born in Italy. The mean body mass index was 23.5±4.5 kg/m 2 , with 25,8% of responders being overweight. Despite the perception of that weight gain was a serious problem in a high percentage women (42%), 26.4% of them did not perform any physical activity and 38.7% practiced less than the recommended 150 minutes a week. Nearly half (46.8%) checked their blood pressure annually and 38.2% have never had any CV test. Only 35.5% were aware of CVD as the leading cause of death (LCOD) in women and 2.5% indicated stroke as LCOD, while 40.9% still considered cancer as the greatest health threat for women. Awareness was greater with older age and increasing education and lower among unemployed and menopausal women. The main sources of information about health were considered general practitioner (51.6%) and the web (27.0%). Counterintuitively, women not born in Italy mostly use the Internet (40%, p=0.001). Finally, the survey showed that women were aware of seeing public health education campaigns about breast cancer (72.4%) and violence (19.7%) more frequently than of campaigns about CVD prevention(1.3%). Conclusions: Only one-third of all women in this pilot study are aware that CVD is their number one killer. Increasing awareness of CVD as the LCOD among women is a priority, requiring collaboration of healthcare practitioners, professional health organizations, as well as dedication of financial resources.

Short communication: Where is women's cardiovascular health taught in Australian and New Zealand medical schools?

Cardiovascular disease is a major cause of mortality in women and is the leading cause of pregnancy-related mortality in Australia. This study aims to discover the extent of teaching regarding women's cardiovascular health in Australian and New Zealand medical schools. All 22 medical schools in Australia and New Zealand were approached for participation in completing this survey. Seven medical schools (32%) completed the survey and demonstrated that within our sample population, findings suggest that while women's cardiovascular health is present in medical curricula, there is a large variability in the rigour and depth as to which it is taught, as well as possible lack of explicit teaching and examination regarding this topic.

Repeated witness social stress causes cardiomyocyte contractile impairment and intracellular Ca2+ derangement in female rats

The impact of psychosocial stressors on cardiovascular health in women is of growing interest in both the popular and scientific literature. Rodent models are useful for providing direct experimental evidence of the adverse cardiovascular consequences of psychosocial stressors, yet studies in females are scarce. Here, we investigated the effects of repeated exposure to witness social defeat stress (WS) on cardiomyocyte contractile function and intracellular Ca2+ homeostasis in young adult wild-type Groningen female rats. Female rats bore witness to an aggressive social defeat episode between two males for nine consecutive days or were exposed to a control procedure. Stress-related behaviors were assessed during the first and last WS/control exposure. Twenty-four hours after the last exposure, plasma corticosterone levels were measured, and cardiomyocytes were isolated for analyses of contractile properties and Ca2+ transients, and expression levels of proteins involved in intracellular Ca2+dynamics. The results show an impairment of the intrinsic cardiac mechanical properties and prolonged intracellular Ca2+decay in WS female rats showing social stress-related behavioral (larger amounts of burying behavior) and neuroendocrine (elevated plasma corticosterone levels) phenotypes. Further, the results implicate alterations in the sarcoplasmic reticulum Ca2+-ATPase/phospholamban complex in the contractile defects described in cardiomyocytes of WS female rats. In conclusion, this study highlights the utility of the WS model as an ethologically relevant social stressor for investigating pathophysiological processes that occur in the heart of female subjects and may increase vulnerability to social stress-related cardiovascular risk.

Non-conventional Determinants of Cardiovascular Health in Latin American Women

Background: Besides traditional risk factors (RF), non-conventional determinants (NCD) of cardiovascular (CV) health are additional risk factors in women. Therefore, they should be explored to establish their prevalence and association with the female gender. Objective: The aim of this study is to know the prevalence of socioeconomic (SE) and psychosocial (PS) factors as NCD in CV health in Latin American (LATAM) women. Methods: We conducted an observational, cross-sectional study using an anonymous survey distributed among LATAM women between May and June 2022. The information gathered included SE and PS NCD, traditional RF and cardiovascular disease (CVD). Results: A total of 4915 women participated; mean age was 49 ± 13 years. Most respondents (49.6%) lived in Argentina, 55.8% in large cities; 94.4% reported adequate access to healthcare services and 89% had access to some level of education. Although 79.9% had a paid job, more than half reported their salary was not commensurate (59.5%) and 26.7% reported exposure to violence at the workplace. The most prevalent PS factors were low to moderate level of satisfaction (68.3%), anxiety or irritability (51.9%), apathy, negative thoughts, or unhappiness (41.7%). Age &gt; 45 years was significantly associated with overweight, obesity, unemployment, and violence at the workplace. On multivariate analysis, sleep disorders (OR 1.7; p = 0.001), living in a city with low population density (OR 0.5; p &lt; 0.001), violence at the workplace (OR 1.8; p = 0.001), anxiety (OR 1.5; p = 0.001) and a history of pregnancy complications (OR 1.6; p = 0.022) were independently associated with CVD. Conclusion: The prevalence of PS and SE factors affecting the CV health of LATAM women was significant. Variables such as violence at the workplace, anxiety, or irritability, living in cities with low population density, sleep disorders and pregnancy complications were independently associated with CVD. This survey shows the impact of SE and PS factors as NCD on the cardiometabolic burden and CV health of women in LATAM, mainly in those &gt; 45 years.

Association of Early Hysterectomy With Risk of Cardiovascular Disease in Korean Women

Women who undergo surgical hysterectomy before natural menopause may have an earlier increase in hematocrit and storage iron levels than those who continue menstruation, thereby increasing the risk of cardiovascular disease (CVD) at ages younger than usually seen. Examining this issue may provide important implications for women's cardiovascular health to both physicians and patients. To evaluate the association of hysterectomy with the risk of incident CVD among women before age 50 years. In this Korean population-based cohort study, 135 575 women aged 40 to 49 years were evaluated from January 1, 2011, to December 31, 2014. After propensity score matching in covariates including age, socioeconomic status, region, Charlson Comorbidity Index, hypertension, diabetes, dyslipidemia, menopause, menopausal hormone therapy, and adnexal surgery before inclusion, 55 539 pairs were included in the hysterectomy and nonhysterectomy groups. Participants were followed up until December 31, 2020. Data analysis was conducted from December 20, 2021, to February 17, 2022. The primary outcome was an incidental CVD, a composite of myocardial infarction, coronary artery revascularization, and stroke. The individual components of the primary outcome were also evaluated. A total of 55 539 pairs were included; median age in the combined groups was 45 (IQR, 42-47) years. During median follow-up periods in the hysterectomy group of 7.9 (IQR, 6.8-8.9) years and nonhysterectomy group of 7.9 (IQR, 6.8-8.8) years, the incidence of CVD was 115 per 100 000 person-years for the hysterectomy group and 96 per 100 000 person-years for the nonhysterectomy group. After adjusting for confounding factors, the hysterectomy group had an increased risk of CVD compared with the nonhysterectomy group (hazard ratio [HR], 1.25; 95% CI, 1.09-1.44). The incidences of myocardial infarction and coronary artery revascularization were comparable between the groups, whereas the risk of stroke was significantly higher in the hysterectomy group (HR, 1.31; 95% CI, 1.12-1.53). Even after excluding women who underwent oophorectomy, the hysterectomy group had higher risks of CVD (HR, 1.24; 95% CI, 1.06-1.44). The findings of this cohort study suggest early menopause owing to hysterectomy was associated with increased risks for a composite of CVD, particularly stroke.

Can exercise prevent the age‐related decline in adaptive homeostasis? Evidence across organisms and tissues

Can exercise prevent the age‐related decline in adaptive homeostasis? Evidence across organisms and tissues

Interplay between the (Poly)phenol Metabolome, Gut Microbiome, and Cardiovascular Health in Women: A Cross-Sectional Study from the TwinsUK Cohort.

Dietary (poly)phenol consumption is inversely associated with cardiovascular disease (CVD) risk in epidemiological studies, but little is known about the role of the gut microbiome in this relationship. In 200 healthy females, aged 62.0 ± 10.0 years, from the TwinsUK cohort, 114 individual (poly)phenol metabolites were measured from spot urine using ultra-high-performance liquid chromatography-mass spectrometry. The associations between metabolites, the gut microbiome (alpha diversity and genera), and cardiovascular scores were investigated using linear mixed models adjusting age, BMI, fibre, energy intake, family relatedness, and multiple testing (FDR < 0.1). Significant associations were found between phenolic acid metabolites, CVD risk, and the gut microbiome. A total of 35 phenolic acid metabolites were associated with the Firmicutes phylum, while 5 metabolites were associated with alpha diversity (FDR-adjusted p < 0.05). Negative associations were observed between the atherosclerotic CVD (ASCVD) risk score and five phenolic acid metabolites, two tyrosol metabolites, and daidzein with stdBeta (95% (CI)) ranging from -0.05 (-0.09, -0.01) for 3-(2,4-dihydroxyphenyl)propanoic acid to -0.04 (-0.08, -0.003) for 2-hydroxycinnamic acid (FDR-adjusted p < 0.1). The genus 5-7N15 in the Bacteroidetes phylum was positively associated with the same metabolites, including 3-(3,5-dihydroxyphenyl)propanoic acid, 3-(2,4-dihydroxyphenyl)propanoic acid, 3-(3,4-dihydroxyphenyl)propanoic acid), 3-hydroxyphenylethanol-4-sulfate, and 4-hydroxyphenylethanol-3-sulfate)(stdBeta (95% CI): 0.23 (0.09, 0.36) to 0.28 (0.15, 0.42), FDR-adjusted p < 0.05), and negatively associated with the ASCVD score (stdBeta (95% CI): -0.05 (-0.09, -0.01), FDR-adjusted p = 0.02). Mediation analysis showed that genus 5-7N15 mediated 23.8% of the total effect of 3-(3,4-dihydroxyphenyl)propanoic acid on the ASCVD score. Coffee, tea, red wine, and several vegetables and fruits, especially berries, are the most abundant food sources of phenolic acids that have the strongest associations with CVD risk. We found that the gut microbiome, particularly the genus 5-7N15, partially mediates the negative association between urinary (poly)phenols and cardiovascular risk, supporting a key role of the gut microbiome in the health benefits of dietary (poly)phenols.

Abstract 58: Timing of Outpatient Postpartum Care Utilization Among Women With Chronic Hypertension and Hypertensive Disorders of Pregnancy

Objectives: The postpartum period represents an opportunity to intervene on the cardiovascular health of women who experience chronic hypertension in pregnancy or hypertensive disorders of pregnancy (HDP), including gestational hypertension, preeclampsia or eclampsia, and chronic hypertension with superimposed preeclampsia. This study sought to determine whether women who experience chronic hypertension or HDP access timely postpartum care compared to women with no documented hypertension. Methods: We used insurance claims data from the IBM MarketScan® Commercial Claims and Encounters Database. We included n=274,714 women 12-55 years old with a delivery hospitalization between 2017-2018 with continuous insurance enrollment from 3 months before the estimated start of pregnancy to 6 months after delivery discharge. Chronic hypertension and HDP were identified using International Classification of Diseases 10th Revision Clinical Modification codes. Distributions of time-to-event survival curves (time to first outpatient postpartum visit with a women’s health, primary care, or cardiology provider) were compared between the hypertension types using Kaplan-Meier estimators and logrank tests. Cox proportional hazards models were used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CI). Time points of interest (3, 6, and 12 weeks) were consistent with visit benchmarks in traditional and updated postpartum care guidelines. Results: The prevalences of HDP, chronic, and no documented hypertension were 11.7%, 2.6%, and 85.7%, respectively. The proportions of women with a visit within 3 weeks of delivery discharge were 28.0%, 26.8%, and 15.8% for HDP, chronic, and no documented hypertension, respectively. By 12 weeks, the proportions increased to 59.6%, 61.3%, and 51.5%, respectively. Kaplan-Meier analyses indicated significant differences in utilization by hypertension type and interaction between hypertension type and time before and after 6 weeks. In adjusted Cox proportional hazards models, the utilization rate before 6 weeks among women with HDP was 1.42 times the rate for women with no documented hypertension (aHR=1.42, 95% CI: 1.40, 1.45). Women with chronic hypertension had similarly higher rates compared to women with no documented hypertension (aHR=1.29, 95% CI: 1.24, 1.35). There were no significant associations by hypertension type after 6 weeks. Conclusions: Women with HDP and chronic hypertension attend outpatient postpartum care visits faster than women with no documented hypertension. However, there were no significant associations by hypertension type after 6 weeks due to interaction with time before and after the traditional 6-week visit. Overall, utilization remains low in all groups. Addressing barriers to postpartum care attendance can ensure timely care for women at high risk for cardiovascular disease.