Preeclampsia and future cardiovascular disease: potential role of altered angiogenesis and insulin resistance.
Altered angiogenesis and insulin resistance are associated with preeclampsia and cardiovascular disease (CVD), and women with preeclampsia appear to be at increased risk of future CVD. We hypothesized that these factors are detectable in asymptomatic postpartum women with a history of preeclampsia and may represent pathophysiological mechanisms bridging preeclampsia and future CVD. We measured fasting insulin, glucose, vascular endothelial growth factor, and its circulating inhibitor, soluble fms-like tyrosine kinase (sFlt-1) in 29 normotensive women with a history of preeclampsia and 32 women with prior normotensive pregnancies at 18.0 +/- 9.7 months postpartum. The homeostasis model of insulin resistance (HOMA(IR)) [(insulin [microunits per milliliter] x glucose [millimoles per liter])/22.5] was calculated. Compared with women with normal pregnancies, women with prior preeclampsia had significantly increased levels of sFlt-1 (41.6 +/- 6.7 vs. 30.4 +/- 10.2; P < 0.01) and median HOMA(IR) (2.8 vs. 1.9; P = 0.04). Membership in the upper quartile of either sFlt-1 or HOMA(IR) was associated with prior preeclampsia (odds ratio 5.7; 95% confidence interval 1.7, 20.0; P < 0.01), and all five women in the upper quartiles of both sFlt-1 and HOMA(IR) had a history of preeclampsia. Women with a history of preeclampsia demonstrate altered expression of angiogenesis-related proteins and increased HOMA(IR) more than 1 yr postpartum. These factors may contribute to their risk of future CVD.
Wolf
Myles
M
Renal Unit, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Hubel
Carl A
CA
Lam
Chun
C
Sampson
Marybeth
M
Ecker
Jeffrey L
JL
Ness
Roberta B
RB
Rajakumar
Augustine
A
Daftary
Ashi
A
Shakir
Alia S M
AS
Seely
Ellen W
EW
Roberts
James M
JM
Sukhatme
Vikas P
VP
Karumanchi
S Ananth
SA
Thadhani
Ravi
R
D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D002318:Cardiovascular Diseases / Q000209:etiology*; D016022:Case-Control Studies; D005215:Fasting / Q000097:blood; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D009389:Neovascularization, Pathologic / Q000150:complications* / Q000209:etiology*; D011225:Pre-Eclampsia / Q000097:blood / Q000150:complications* / Q000503:physiopathology*; D011247:Pregnancy; D012995:Solubility; D042461:Vascular Endothelial Growth Factor A / Q000097:blood; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000097:blood / Q000737:chemistry
D001786:Blood Glucose; D007328:Insulin; D042461:Vascular Endothelial Growth Factor A; D040281:Vascular Endothelial Growth Factor Receptor-1