Hypertensive disorders of pregnancy tied to risk for nonobstructive, earlier heart attacks
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Key takeaways:
- Hypertensive disorders of pregnancy are sex-specific risk factors for CVD.
- Women with hypertensive disorders of pregnancy are more susceptible to myocardial infarction with nonobstructive coronary arteries.
Women with hypertensive disorders of pregnancy history were more likely to experience coronary artery disease years earlier and have a greater risk for myocardial infarction with both obstructive and nonobstructive coronary arteries.
“Women with a history of hypertensive disorders of pregnancy (HDP) were, on average, 7 years younger than normotensive women at the time of myocardial infarction (MI). Based on the analysis of their coronary angiograms, they had higher rates of MI due to both obstructive and nonobstructive coronary arteries,” Vesna D. Garovic, MD, PhD, FAHA, FASN, professor of medicine, foundation professor in clinical medicine, chair of the division of nephrology and hypertension, director of the Mayo Clinic Center for Clinical and Translational Science and dean of translational science at Mayo Clinic, told Healio. “Screening for, and treatment of, heart disease in women with a history of HDP should be performed timely and should cover both atherosclerotic and nonobstructive coronary artery disease (CAD).”
An underlying cause of CVD
Garovic and colleagues conducted a population-based cohort study, published in the Journal of the American College of Cardiology, with 506 parous women (mean age, 71 years) with incident CAD (MI, percutaneous coronary intervention or coronary artery bypass grafting) who underwent coronary angiography between November 2002 and December 2016. All women lived in Olmsted County, Minnesota, and were age-matched with controls. Researchers evaluated SYNTAX score to denote CAD severity and diagnosed MI with nonobstructive coronary arteries (MINOCA) as acute MI without obstructive CAD.
Among a subset of 373 women with CAD matched with 746 controls, 77 women had a history of a HDP. Of controls, 112 HDP cases occurred with eight chronic hypertension and 104 gestational hypertension or preeclampsia cases.
When diagnosed with an incident CAD event, women with vs. without HDP were, on average, 7 years younger (median age, 64.8 years vs. 71.8 years; P = .03).
Researchers observed higher odds for overall HDP for women with acute coronary syndrome in unadjusted models (OR = 1.48; 95% CI, 1.07-2.05; P = .018). These results remained significant after adjusting for covariates.
Compared with women without, those with HDP were more likely to have higher SYNTAX scores, indicating more complex CAD (OR = 2.28; 95% CI, 1.02-5.12; P = .046), and a MINOCA diagnosis (OR = 2.08; 95% CI, 1.02-4.25; P = .044).
“It has been long recognized that MINOCA is more common in women than in men, but the role of the sex-specific risk factors was not well understood,” Garovic told Healio. “Our study provides first population-based evidence regarding the role of HDP as a reproductive, sex-specific risk for MINOCA in affected women years after their pregnancies.”
Garovic said researchers must better understand the underlying causes of MINOCA in women with a history of HDP to optimize their management.
“This can be achieved using a multimodality cardiac imaging approach, which includes both invasive and noninvasive modality testing, such as intracoronary imaging, coronary physiology testing and cardiac MRI,” Garovic told Healio.
Pregnancy as opportunity to ‘optimize’ health
In an accompanying editorial, Michael C. Honigberg, MD, MPP, cardiologist and researcher at Massachusetts General Hospital and assistant professor of medicine at Harvard Medical School, noted that these findings reaffirm that women with HDP develop accelerated atherosclerosis, including in the form of acute coronary syndromes.
“How best to translate this knowledge into practice to prevent cardiovascular disease in affected women remains incompletely defined, and novel preventive strategies in this population should be rigorously studied,” Honigberg wrote. “Further ‘upstream’ in the life course, the preconception period and interpregnancy interval should ideally be viewed as opportunities to optimize cardiometabolic health, both to prevent hypertensive disorders of pregnancy and other adverse pregnancy outcomes and to promote long-term cardiovascular health.”
For more information:
Vesna D. Garovic, MD, PhD, FAHA, FASN, can be reached at garovic.vesna@mayo.edu; X(Twitter): @GarovicVesna.
Reference:
- Honigberg MC. J Am Coll Cardiol. 2024;doi:10.1016/j.jacc.2024.07.058.