Combined Past Preeclampsia and Gestational Diabetes is Associated with a Very High Frequency of Coronary Microvascular Dysfunction.

BACKGROUND A history of preeclampsia (pPE) and gestational diabetes (pGDM) are female-specific risk markers for atherosclerosis and future cardiovascular risk. In addition to increasing the risk of established risk factors for atherosclerosis, such as hypertension or diabetes, evidence suggests that pregnancy-related complications can also directly accelerate atherosclerosis by inducing endothelial dysfunction. A combination of both conditions is seen in a subset of patients with pregnancy, though it is not known whether this combination increases the overall risk for cardiovascular events. AIMS Present study aimed to find the impact of combined pPE/pGDM on the prevalence of coronary microvascular dysfunction (CMD). METHODS A total of 24 patients with combined pPE/pGDM, 19 patients with isolated pPE and 63 patients with pGDM were included to the present study and a further 36 healthy women with no previous pregnancy-related complications served as controls. Coronary flow reserve was measured using echocardiography and CMD was defined as a coronary flow reserve ≤2.5. RESULTS Patiens with combined pPE/pGDM had a high prevalence of CMD (91%), which was significantly higher than controls (5.6%, p<0.001) and patients with pGDM (55%, p=0.01). A history of pPE on top of pGDM was associated with an increased risk of CMD (HR:6.28, 95%CI:1.69-23.37, p=0.006) after multivariate adjustment, but pGDM did not increase the odds for CMD in those with pPE. CONCLUSIONS Combined pPE/pDM is associated with a very high prevalence of CMD, which indicates a very high risk for future cardiovascular events. CENTRAL ILLUSTRATION Possible pathophysiologic mechanisms leading to coronary microvascular dysfunction in patients with combined preeclampsia and gestational diabetes. While hypertension and diabetes are transient, they lead to subclinical organ damage during pregnancy with consequent microvascular dysfunction in the coronary vascular bed. Moreover, initial pathophysiologic processes that lead to preeclampsia and gestational diabetes persist after pregnancy, as evidenced by a higher blood pressure, abnormalities in the glucose metabolism, endothelial dysfunction and inflammatory activation in these patients. These processes could further microvascular dysfunction, thus causing a reduced coronary flow reserve observed years after the index events.