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Hypertensive Disorders of Pregnancy Increase the Risk for Myocardial Infarction: A Population-Based Study
Lisa E Vaughan1, Yoshihisa Kanaji2, Sonja Suvakov3
1Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA.
Insights
A history of hypertensive disorders of pregnancy (HDP) is linked to earlier coronary artery disease (CAD) and increased risk of myocardial infarction. This highlights the importance of managing nonobstructive coronary artery disease alongside traditional risk factors.
Area of Science:
- Cardiovascular Medicine
- Obstetrics and Gynecology
- Epidemiology
Background:
- Hypertensive disorders of pregnancy (HDP) impact women's long-term cardiovascular health.
- Limited data exists on coronary artery anatomy and lesion types in women with HDP history.
- Understanding HDP's role in early coronary artery disease (CAD) is crucial.
Purpose of the Study:
- To investigate hypertensive disorders of pregnancy (HDP) as a unique risk factor for early coronary artery disease (CAD).
- To determine the association between HDP history and the type of acute coronary syndrome (ACS), including atherosclerotic ACS and myocardial infarction with nonobstructive coronary arteries (MINOCA).
Main Methods:
- A population-based cohort study of women with incident CAD who underwent coronary angiography.
- Age-matched control subjects were used for comparison.
- SYNTAX score assessed CAD complexity; MINOCA diagnosis required clinical acute myocardial infarction without obstructive coronary disease.
Main Results:
- Women with HDP history were younger at the time of CAD event (median 64.8 vs 71.8 years).
- HDP history showed a strong association with acute coronary syndrome (ACS).
- Women with HDP history had higher odds of a higher SYNTAX score (OR 2.28) and MINOCA (OR 2.08).
Conclusions:
- A history of hypertensive disorders of pregnancy (HDP) is associated with earlier onset of coronary artery disease (CAD).
- HDP history increases the future risk for myocardial infarction, encompassing both obstructive and nonobstructive coronary artery disease.
- Emphasizes the need for early detection and management of nonobstructive coronary artery disease in women with HDP history.
Background:
Angiographic evidence of the anatomy of coronary arteries and the type of coronary artery lesions in women with a history of hypertensive disorders of pregnancy (HDP) are poorly documented.
Objectives:
This study sought to determine the role of a history of HDP as a unique risk factor for early coronary artery disease (CAD) and type of acute coronary syndrome (ACS) (ie, atherosclerotic vs myocardial infarction with nonobstructive coronary arteries [MINOCA]) in women who underwent coronary angiography.
Methods:
This study used a population-based cohort of parous female patients with incident CAD who underwent coronary angiography and age-matched control subjects. The SYNTAX (Synergy between PCI [percutaneous coronary intervention] with TAXUS [Boston Scientific] and Cardiac Surgery) score was assessed to determine the complexity and degree of CAD; MINOCA was diagnosed in the presence of clinical acute myocardial infarction in the absence of obstructive coronary disease.
Results:
A total of 506 parous female Olmsted County, Minnesota (USA) residents had incident CAD and angiographic data from November 7, 2002 to December 31, 2016. Women with HDP were younger than normotensive women at the time of the event (median: 64.8 years vs 71.8 years; P = 0.030). There was a strong association between HDP and ACS (unadjusted P = 0.018). Women with HDP compared with women with normotensive pregnancies were more likely to have a higher SYNTAX score (OR: 2.28; 95% CI: 1.02-5.12; P = 0.046), and MINOCA (OR: 2.08; 95% CI: 1.02-4.25; P = 0.044).
Conclusions:
A history of HDP is associated with CAD earlier in life and with a future risk for myocardial infarction with both obstructive and nonobstructive coronary arteries. This study underscores the need for timely detection and treatment of nonobstructive disease, in addition to traditional risk factors.
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