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By Caitlin Doran / Mayo Clinic News Network
A new study has revealed a significant link between a common pregnancy complication and early heart disease in women.
Researchers found that women with a history of hypertensive disorders of pregnancy (HDP) were at higher risk of developing coronary artery disease at an earlier age. In addition, they found that women with these disorders were at higher risk of myocardial infarction with non-obstructive coronary arteries (MINOCA) — heart attacks that occur when the coronary arteries appear normal.
Hypertensive disorders of pregnancy (HDP) — such as gestational hypertension, chronic hypertension and preeclampsia — affect 15% of women during their reproductive years. Marked by high blood pressure, the effects of these disorders continue to impact the health of mothers and babies well after pregnancy.
| Compared to women with a history of normotensive (normal blood pressure) pregnancies, women in this study with a history of HDP were at greater risk for: |
| Early onset of coronary artery disease: Occurring on average seven years earlier among women with a history of HDP. |
| More severe atherosclerotic coronary artery disease: Twice as likely among women with a history of HDP. |
| Increased risk of MINOCA: Twice as likely among women with a history of HDP. |
“This research highlights the need for earlier screening for heart disease among women with a history of high blood pressure in pregnancy, particularly for MINOCA, which is up to five times more common in women than in men,” says Vesna Garovic, M.D., Ph.D., a Mayo Clinic nephrologist and senior author of the study.
To improve patient care and outcomes for women, the researchers say clinicians should not only screen for traditional coronary artery disease risk factors, but they should also screen for non-traditional risk factors associated with MINOCA and other non-obstructive types of coronary artery disease, such as stress, autoimmune diseases — and now, HDP.
How does high blood pressure in pregnancy lead to coronary artery disease?
| According to the researchers, there are two related types of small vessel heart diseasethat may make it more likely for women to develop HDP and coronary artery disease: |
| Microvascular dysfunction: Women with a history of HDP often have this underlying problem, which occurs when the small blood vessels that feed the heart stop working as they should, decreasing blood flow to the heart. |
| Endothelial dysfunction: This is a problem common to both HDP and coronary artery disease. It occurs when the cells that line the inside of blood vessels malfunction, narrowing instead of dilating. |
Together, these dysfunctions clog or narrow the arteries and small blood vessels that supply blood to the heart, which can lead to coronary artery disease without any physical blockage (non-obstructive). The researchers think it’s possible that these processes may feed on one another, creating an environment where coronary artery disease is more likely to occur.
Further research, including large prospective studies, are needed to understand the mechanisms linking HDP to coronary artery disease, such as specific biomarkers and genetic factors that contribute to increased risk.
Read the paper to learn more about the study, including funding and disclosures.
A growing body of research on high blood pressure in pregnancy
| Research led by Dr. Garovic, a Mayo Clinic nephrologist, has shown links between HDP and a greater risk for a wide range of health concerns including: |
| Atherosclerosis and stroke |
| Renal disease |
| Brain cell damage and inflammation |
| Accelerated aging and the markers of cellular senescence |
| Early-onset hypertension in children |
The overall goal of Dr. Garovic’s research is to increase understanding of the causes and mechanisms that play a role in the process that leads to HDP. The potential to identify targeted therapies that address the underlying causes of disease may improve treatment options for diseases, such as preeclampsia, that have seen few therapeutic advances in recent decades.
