RESUMEN
There is an association between preeclampsia (PE) and excessive morbidity and mortality. Some recent studies have revealed the presence of endothelial dysfunction in PE patients with inflammatory activity. Moreover, it has been argued that the chronic inflammatory state involved in PE leads to an acceleration in atherosclerosis. Accordingly, our goal in this study is to determine whether there is any coronary microvascular dysfunction and increase in the intima-media thickness in patients who had mild PE 5 years before, without the presence of any traditional cardiovascular risk factors. The study included 33 mild PE patients (mild preeclampsia is classified as a blood pressure (BP) of 140/90 mm Hg or higher with proteinuria of 0.3 to 3 g/d) whose mean age was 33.7 years old, and 29 healthy women volunteers whose mean age was 36.1 years old. Each subject was examined using transthoracic echocardiography 5 years after their deliveries. During the echocardiographic examination, coronary flow reserve (CFR) and carotid intima-media thickness (IMT) were measured. There was a statistically lower CFR value in PE patients as compared with controls (2.39 ± 0.48 vs. 2.90 ± 0.49; P < .001). On the other hand, there was a significant increase in their IMT and high-sensitivity C-reactive protein (hs-CRP) values (respectively, 0.59 ± 0.15 vs. 0.46 ± 0.10; P < .001 and 3.80 ± 2.10 vs. 2.33 ± 1.79; P = .004). There was a negative correlation between the CFR values of the PE patients and hs-CRP (r = -0.568; P = .001) and IMT (r = -0.683, P < .001) results.We determined in the study that there was impaired CFR and increased carotid IMT in patients with PE, and, moreover, that these adverse effects were significantly correlated with hs-CRP.
Asunto(s)
Enfermedades Cardiovasculares/fisiopatología , Grosor Intima-Media Carotídeo , Circulación Coronaria/fisiología , Preeclampsia/fisiopatología , Túnica Media/diagnóstico por imagen , Adolescente , Adulto , Enfermedades Cardiovasculares/epidemiología , Estudios de Casos y Controles , Ecocardiografía , Femenino , Estudios de Seguimiento , Humanos , Microcirculación/fisiología , Preeclampsia/epidemiología , Embarazo , Valores de Referencia , Medición de Riesgo , Sensibilidad y Especificidad , Túnica Media/parasitología , Adulto JovenRESUMEN
BACKGROUND: Gestational diabetes mellitus (GDM) is defined as glucose intolerance that has begun during pregnancy. Recent studies have proven that development of atherosclerosis may be established in this population even without presence of type 2 diabetes. For assessment of atherosclerosis, epicardial fat thickness (EFT) is recently being used as a surrogate marker. In this study, we aimed to prove that women with GDM history are more inclined to have higher EFT levels than women without GDM history. METHODS: Sixty-two patients with previous GDM and 33 age- and sex-matched controls were allocated. Epicardial fat thicknesses of the subjects were measured with transthorasic echocardiography and carotid intima media thickness (c-IMT) was measured with ultrasound. Insulin resistance (IR) of each subject was assessed with Homeostasis model of assessment-insulin resistance (HOMA-IR). RESULTS: Carotid IMT and EFT were significantly higher in previous GDM group than controls. Serum gamma-glutamyl transferase (GGT), uric acid, and high-sensitivity C-reactive protein (hs-CRP) levels were also found significantly higher in the patients with previous GDM as compared to the controls. We observed that carotid IMT (ß = 310, P = 0.003), total cholesterol (ß = 315, P = 0.002), BMI (ß = 308, P = 0.002), HbA1c (ß = 227, P = 0.018), and HOMA-IR (ß = 184, P = 0.049) were independently correlated with EFT. CONCLUSIONS: Although the number of patients included in this study is limited, high EFT results may indicate presence of atherosclerosis in women with previous GDM.