Long-term cardiovascular risks greater than expected in gestational diabetes

A greater risk for long-term cardiovascular outcomes was associated with the development of gestational diabetes than previously thought, according to prospective data presented at The Pregnancy Meeting.

“Previous studies suggested that a history of [gestational diabetes mellitus (GDM)] can be a risk factor for subsequent diabetes, hypertension, dyslipidemia and atherosclerotic cardiovascular diseases (ASCVDs), such as myocardial infarction or ischemic stroke,” Seung Mi Lee, MD, PhD, clinical associate professor of obstetrics and gynecology at Seoul National University College of Medicine in Korea, told Healio.

However, these studies left gaps in our understanding of the risk for cardiovascular outcomes in older women, the risk for non-ASCVD and the impact of chronic metabolic comorbidities on cardiovascular outcomes, Lee said.

The researchers analyzed follow-up data from 219,330 women aged 40 to 69 years enrolled in the U.K. Biobank cohort study between 2006 and 2010 who had at least one live birth during that time. They noted onset of cardiovascular outcomes following GDM development and conducted a causal mediation analysis to determine the impact of known risk factors for cardiovascular outcomes.

According to the study, 13,094 (6%) women developed new cardiovascular outcomes, although the incidence rate was higher among those with a history of GDM (7.8 vs. 5.81 new incidences per 1,000 women-years; P < .001).

“GDM increased the risk of diverse cardiovascular outcomes, including coronary artery disease, myocardial infarction, ischemic stroke, peripheral artery disease, heart failure, mitral regurgitation and atrial fibrillation/flutter in elderly women,” Lee told Healio.

She added: “Chronic metabolic comorbidities partly explained the onset of cardiovascular outcomes after GDM history,” with overt diabetes linked to 23% of outcomes, hypertension linked to 10% and dyslipidemia linked to 10%, according to the study.

“Further studies are needed to determine whether these pathophysiologic mechanisms might also be applicable to the relationship between GDM and diverse cardiovascular outcomes,” Lee told Healio. “In addition, the result of the current study evokes the next question, whether women with GDM history may benefit from cardiovascular preventive strategies, such as intensive lifestyle modification [or] pharmacologic treatment including statin or aspirin therapy.”