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Precision test for precision medicine: opportunities, challenges and perspectives regarding pre-eclampsia as an
Xin Zhou1, Jian-Min Niu2, Wen-Jie Ji1
1Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Logistics University of PAPF Tianjin 300162, China.
Insights
Hypertensive disorders of pregnancy, like pre-eclampsia, are linked to future cardiovascular disease (CVD) risk. Early identification and intervention offer opportunities for improved maternal and infant health outcomes.
Area of Science:
- Obstetrics and Gynecology
- Cardiology
- Genetics and Genomics
Background:
- Hypertensive disorders of pregnancy (HDP) affect 2-10% of pregnancies globally, posing significant maternal and infant health risks.
- Cardiovascular disease (CVD) is a leading cause of mortality in women, with diagnosis often challenging due to non-obstructive coronary artery disease.
- A history of pre-eclampsia (PE) is strongly associated with increased future CVD risk, suggesting PE may serve as an early indicator of cardiovascular risk.
Purpose of the Study:
- To review the association between pre-eclampsia and future cardiovascular disease.
- To explore the potential of pre-eclampsia as a "precision" test for cardiovascular risk.
- To propose a stage-specific, pre-eclampsia-targeted algorithm for improved prediction, prevention, and management of cardiovascular risk.
Main Methods:
- Literature review of studies investigating hypertensive disorders of pregnancy and cardiovascular disease.
- Analysis of pre-eclampsia as a predictor of future cardiovascular risk.
- Development of a conceptual algorithm for precision medicine approaches in pre-eclampsia and cardiovascular health.
Main Results:
- Accumulating evidence consistently links a history of pre-eclampsia to elevated future cardiovascular disease risk.
- Pre-eclampsia represents a critical window of opportunity for early cardiovascular risk assessment and intervention.
- Current understanding of pre-eclampsia pathogenesis is incomplete, necessitating precision medicine strategies.
Conclusions:
- Pre-eclampsia serves as a significant early warning sign for future cardiovascular disease in women.
- A precision medicine approach, utilizing a stage-specific algorithm, is needed for better prediction, prevention, and management of pre-eclampsia and associated cardiovascular risks.
- Bridging big data research with clinical practice is crucial for advancing pre-eclampsia and cardiovascular health outcomes.
Abstract:
Hypertensive disorders of pregnancy (HDP) comprise a spectrum of syndromes that range in severity from gestational hypertension and pre-eclamplsia (PE) to eclampsia, as well as chronic hypertension and chronic hypertension with superimposed PE. HDP occur in 2% to 10% of pregnant women worldwide, and impose a substantial burden on maternal and fetal/infant health. Cardiovascular disease (CVD) is the leading cause of death in women. The high prevalence of non-obstructive coronary artery disease and the lack of an efficient diagnostic workup make the identification of CVD in women challenging. Accumulating evidence suggests that a previous history of PE is consistently associated with future CVD risk. Moreover, PE as a maladaptation to pregnancy-induced hemodynamic and metabolic stress may also be regarded as a "precision" testing result that predicts future cardiovascular risk. Therefore, the development of PE provides a tremendous, early opportunity that may lead to changes in maternal and infant future well-being. However, the underlying pathogenesis of PE is not precise, which warrants precision medicine-based approaches to establish a more precise definition and reclassification. In this review, we proposed a stage-specific, PE-targeted algorithm, which may provide novel hypotheses that bridge the gap between Big Data-generating approaches and clinical translational research in terms of PE prediction and prevention, clinical treatment, and long-term CVD management.
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