title: Previous gestational diabetes history is associated with impaired coronary flow reserve.
abstract: BACKGROUND
  Gestational diabetes mellitus (GDM) is a prediabetic state that is known to increase the risk of cardiovascular diseases. We have investigated coronary flow velocity reserve (CFVR) and epicardial fat thickness (EFT), and left ventricular diastolic function in patients with a history of previous GDM (p-GDM).
  
  
  METHODS
  Ninety-three women with GDM history and 95 healthy women without GDM history were recruited. We used transthoracic Doppler echocardiography to assess CFVR, EFT, and left ventricular diastolic function. Insulin resistance of each subject was assessed with homeostasis model assessment insulin resistance (HOMA-IR). Hemoglobin A1c and high-sensitivity C-reactive protein (hsCRP) were also measured in all patients.
  
  
  RESULTS
  CFVR values were significantly lower (2.34 ± 0.39 versus 2.80 ± 0.24, p < 0.001) and EFT values were significantly higher in patients with p-GDM than the control group (5.5 ± 1.3 versus 4.3 ± 1.1, p < 0.001). E/E' ratio (7.21 ± 1.77 versus 6.53 ± 1.38, p = 0.003), hemoglobin A1c (5.2 ± 0.4 and 5.0 ± 0.3, p = 0.001), HOMA-IR (2.8 ± 1.4 versus 1.7 ± 0.9, p = 0.04), and hsCRP levels were significantly higher in the p-GDM group than the control group. Multivariate analysis revealed that gestational diabetes history is independently associated with CFVR.
  
  
  CONCLUSIONS
  Women with a GDM history may be at more risk regarding coronary microvascular dysfunction compared to the healthy ones.
authors.affiliation: a Istanbul Medeniyet University , Cardiology and Internal Medicine Department , Istanbul , Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Caliskan
authors.affiliation: b Konya Education and Research Hospital , Cardiology and Endocrinology Department , Konya , Turkey.
authors.forename: Yasar
authors.initials: Y
authors.lastname: Turan
authors.affiliation: c Baskent University, Ankara Teaching and Medical Research Center , Internal Medicine, Obstetric and Gynecology and Cardiology Department , Konya , Turkey.
authors.forename: Zuhal
authors.initials: Z
authors.lastname: Caliskan
authors.affiliation: c Baskent University, Ankara Teaching and Medical Research Center , Internal Medicine, Obstetric and Gynecology and Cardiology Department , Konya , Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Gullu
authors.affiliation: c Baskent University, Ankara Teaching and Medical Research Center , Internal Medicine, Obstetric and Gynecology and Cardiology Department , Konya , Turkey.
authors.forename: Faika Ceylan
authors.initials: FC
authors.lastname: Ciftci
authors.affiliation: c Baskent University, Ankara Teaching and Medical Research Center , Internal Medicine, Obstetric and Gynecology and Cardiology Department , Konya , Turkey.
authors.forename: Enver
authors.initials: E
authors.lastname: Avci
authors.affiliation: b Konya Education and Research Hospital , Cardiology and Endocrinology Department , Konya , Turkey.
authors.forename: Cevdet
authors.initials: C
authors.lastname: Duran
authors.affiliation: a Istanbul Medeniyet University , Cardiology and Internal Medicine Department , Istanbul , Turkey.
authors.forename: Osman
authors.initials: O
authors.lastname: Kostek
authors.affiliation: a Istanbul Medeniyet University , Cardiology and Internal Medicine Department , Istanbul , Turkey.
authors.forename: Ozge
authors.initials: O
authors.lastname: Telci Caklili
authors.affiliation: b Konya Education and Research Hospital , Cardiology and Endocrinology Department , Konya , Turkey.
authors.forename: Harun
authors.initials: H
authors.lastname: Koca
authors.affiliation: d Selcuk University , Endocrinology Department , Konya , Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Kulaksizoglu
mesh_terms: D000328:Adult; D002097:C-Reactive Protein / Q000378:metabolism; D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000453:epidemiology*; D003326:Coronary Circulation / Q000502:physiology; D016640:Diabetes, Gestational / Q000453:epidemiology*; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007333:Insulin Resistance; D015999:Multivariate Analysis; D010496:Pericardium / Q000000981:diagnostic imaging; D011247:Pregnancy; D012306:Risk; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D002097:C-Reactive Protein; D006442:Glycated Hemoglobin
keywords: Coronary flow reserve; HOMA-IR; HbA1c; diastolic function; epicardial fat thickness; gestational diabetes