title: Cardiovascular risk, lipids and pregnancy: preeclampsia and the risk of later life cardiovascular disease.
abstract: It has been widely thought that the effects of hypertension in pregnancy reversed after delivery and hypertension values returned to their pre-pregnancy level as it was seen as a disease of short duration in otherwise healthy young women. However, recent studies have demonstrated that the principal underlying abnormality, endothelial dysfunction, remains in women who had preeclampsia and that it is this damage that increases the risk of developing cardiovascular disease (CVD) in later life. The contributions of hypertension and dyslipidaemia before and during the pregnancy are also important and contribute to future risk. Serum lipids are complex and change dramatically in pregnancy. In general there is an increase in most plasma lipid components, notably triglycerides, total cholesterol and the major particles of HDL and LDL. Aberrations or exaggerations in this shift (i.e. decrease HDL and a greater increase in LDL) are associated with poor outcomes of pregnancy such as preeclampsia. Long term cardiovascular disease is influenced by preeclampsia and in part potentially by the lipid changes which escalate late in disease. Whether we can influence the risk of preeclampsia by controlling cardiovascular risk factors preceding or during preeclampsia, or cardiovascular disease after preeclampsia is yet to be determined. Ultimately, strategies to control lipid concentrations will only be viable when we understand the safety to the mother at the time of the pregnancy, and to the foetus both immediately and in the very long term. Strategies to control blood pressure are well established in the non-pregnant population, and previous preeclampsia and gestational hypertension should be considered in any cardiovascular risk profile. Whether control of blood pressure in the pregnancy per se is of any longer term benefit is also yet to be determined.
authors.affiliation: Lipid Research Group and Vascular Immunology Research Group, Heart Research Institute, and the School of Medicine, University of Western Sydney, Australia.
authors.forename: Francesca
authors.initials: F
authors.lastname: Charlton
authors.affiliation: Lipid Research Group and Vascular Immunology Research Group, Heart Research Institute, and the School of Medicine, University of Western Sydney, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Tooher
authors.affiliation: Lipid Research Group and Vascular Immunology Research Group, Heart Research Institute, and the School of Medicine, University of Western Sydney, Australia.
authors.forename: Kerry-Anne
authors.initials: KA
authors.lastname: Rye
authors.affiliation: Lipid Research Group and Vascular Immunology Research Group, Heart Research Institute, and the School of Medicine, University of Western Sydney, Australia. Electronic address: An.hennessy@uws.edu.au.
authors.forename: Annemarie
authors.initials: A
authors.lastname: Hennessy
mesh_terms: D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D005260:Female; D006801:Humans; D008055:Lipids / Q000097:blood*; D011225:Pre-Eclampsia / Q000097:blood / Q000503:physiopathology / Q000628:therapy; D011247:Pregnancy; D011256:Pregnancy Outcome
chemical_list: D008055:Lipids
keywords: Cardiovascular disease; Hypertension; Lipids; Preeclampsia; Pregnancy