Cardiovascular risk factors in healthy women with previous gestational hypertension.
BACKGROUND
Epidemiological studies indicate that gestational hypertension (Gh) during pregnancy is associated with increased risk of cardiovascular disease in later life. However, it is unclear whether particular metabolic and hemodynamic characteristics are related to this risk.


OBJECTIVE
The objective of this study was to investigate endothelial function and carbohydrate and lipid metabolism in healthy, normotensive women with previous pregnancy complicated by Gh.


METHODS
Brachial artery flow-mediated dilatation (FMD; endothelium dependent) and nitroglycerin-induced dilatation (endothelium independent) were measured in 15 subjects with previous Gh and in 15 controls with previous normal pregnancies. Lipid panel, glucose, insulin, homocysteine, and androgens were also measured.


RESULTS
FMD was significantly reduced in women with previous Gh compared with controls (P < 0.0001), whereas nitroglycerin-induced dilatation was comparable in both groups. Gh women showed increased fasting insulin (P = 0.011), insulin resistance measured by homeostasis model assessment (P = 0.018), free fatty acids (P = 0.0018), and testosterone (P = 0.0012) and decreased high-density lipoprotein cholesterol (P = 0.0017) compared with controls. Across all subjects, FMD showed a strong independent negative correlation with testosterone and homeostasis model assessment and a positive correlation with high-density lipoprotein cholesterol (r = -0.60, P = 0.0003; r = -0.43, P = 0.016; and r = 0.58, P = 0.0005, respectively).


CONCLUSIONS
Endothelial dysfunction and early alteration of carbohydrate and lipid metabolism are present in otherwise healthy women with previous Gh. These abnormalities along with a relative hyperandrogenism could explain, at least in part, the increased risk for cardiovascular disease in later life in these women.
Paradisi
Giancarlo
G
Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Via Servilio IV 4, 00178 Rome, Italy. giancarlo.paradisi@tin.it
Biaggi
Arabella
A
Savone
Rosa
R
Ianniello
Francesca
F
Tomei
Claudia
C
Caforio
Leonardo
L
Caruso
Alessandro
A
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D001823:Body Composition / Q000502:physiology; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000502:physiology; D050260:Carbohydrate Metabolism; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D004730:Endothelium, Vascular / Q000502:physiology; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D050356:Lipid Metabolism / Q000502:physiology; D005996:Nitroglycerin; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology*; D012307:Risk Factors; D014463:Ultrasonography; D014664:Vasodilation / Q000502:physiology; D014665:Vasodilator Agents
D001786:Blood Glucose; D007328:Insulin; D014665:Vasodilator Agents; D005996:Nitroglycerin