Association of Gestational Diabetes With Subclinical Cardiovascular Disease

Anum S. Minhas, MD, MHS; Malamo Countouris, MD, MS; Chiadi E. Ndumele, MD, PhD; Elizabeth Selvin, PhD, MPH; Arthur J. Vaught, MD; Robin Gandley, PhD; Allison G. Hays, MD; Pamela Ouyang, MBBS; Flordeliza Santos Villanueva, MD; Wendy L. Bennett, MD, MPH; Erin D. Michos, MD, MHS; Janet M. Catov, PhD, MS

JACC: Advances (Aug 2024)

Association of Gestational Diabetes With Subclinical Cardiovascular Disease

Anum S. Minhas, MD, MHS,
Malamo Countouris, MD, MS,
Chiadi E. Ndumele, MD, PhD,
Elizabeth Selvin, PhD, MPH,
Arthur J. Vaught, MD,
Robin Gandley, PhD,
Allison G. Hays, MD,
Pamela Ouyang, MBBS,
Flordeliza Santos Villanueva, MD,
Wendy L. Bennett, MD, MPH,
Erin D. Michos, MD, MHS,
Janet M. Catov, PhD, MS

Affiliations

Anum S. Minhas, MD, MHS: Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, Maryland, USA; Address for correspondence: Dr Anum S. Minhas, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 1800 Orleans Street, Carnegie 591A, Baltimore, Maryland 21287, USA.
Malamo Countouris, MD, MS: Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Chiadi E. Ndumele, MD, PhD: Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, Maryland, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
Elizabeth Selvin, PhD, MPH: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
Arthur J. Vaught, MD: Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Surgery, Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Robin Gandley, PhD: Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Magee Women’s Research Institute and Foundation, Pittsburgh, Pennsylvania, USA
Allison G. Hays, MD: Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Pamela Ouyang, MBBS: Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Flordeliza Santos Villanueva, MD: Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Wendy L. Bennett, MD, MPH: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Division of General Internal Medicine, Department of Medicine, Baltimore, Maryland, USA
Erin D. Michos, MD, MHS: Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, Maryland, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
Janet M. Catov, PhD, MS: Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Magee Women’s Research Institute and Foundation, Pittsburgh, Pennsylvania, USA

Journal volume & issue: Vol. 3, no. 8
p. 101111

Abstract

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Background: Gestational diabetes mellitus (GDM) is associated with increased long-term risk of cardiovascular disease but the cardiovascular structural and functional changes that contribute to risk are not well understood. Objectives: The purpose of this study was to determine whether GDM is associated with adverse cardiac remodeling and endothelial dysfunction a decade after delivery, independent of type 2 diabetes. Methods: Women with deliveries between 2008 and 2009 were initially selected from a prospective clinical cohort. Pregnancy history was chart abstracted and a follow-up study visit was conducted at 8 to 10 years postpartum. Cardiac structure and function were assessed with echocardiography. Endothelial function was measured with peripheral arterial tonometry and glycocalyx analysis. Results: Among 254 women assessed at an average age of 38 years, 53 (21%) had prior GDM. At follow-up, women with GDM had more incident prediabetes or diabetes (58% vs 20% without GDM), more impairment in peripheral arterial tonometry (reactive hyperemia 1.58 vs 1.95; P = 0.01) and reduced perfusion, a marker of glycocalyx assessment (red blood cell filling 0.70 ± 0.04 vs 0.72 ± 0.05; P < 0.01). Despite adjustment for demographic and reproductive characteristics, women with GDM had great septal wall thickness by 8% (95% CI: 2.3%-14.7%) and worse diastology with higher E/E’ by 11% (95% CI: 1.1%-21.5%). After additional adjustment for diabetes and prediabetes, several parameters remained significantly impaired. Conclusions: Having GDM within the past decade was associated with more adverse cardiac structure/function and vascular endothelial function. Some, but not all, risks may be mediated through the development of prediabetes or type 2 diabetes. Enhanced preventive efforts are needed to mitigate cardiovascular risk among women with GDM.

Published in JACC: Advances

ISSN: 2772-963X (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system; Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://www.sciencedirect.com/journal/jacc-advances

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