Prepregnancy CV Health Portends Midlife Risks: CARDIA Analysis – TCTMD.com

Optimizing Cardiovascular Risk Factors Before Pregnancy: A Key Strategy for Long-Term Heart Disease Prevention

Introduction

Recent analysis from the CARDIA study emphasizes the critical importance of optimizing cardiovascular health (CVH) before pregnancy to prevent heart disease decades later. This report highlights findings that poor prepregnancy CVH is a stronger predictor of subclinical atherosclerosis in midlife than adverse pregnancy events such as gestational diabetes, aligning with several Sustainable Development Goals (SDGs), including SDG 3 (Good Health and Well-being) and SDG 5 (Gender Equality).

Study Overview and Findings

1. Population and Methodology
   • Over 1,000 women from the CARDIA study, initiated in 1985, were followed for decades.
   • Prepregnancy CVH was assessed using the American Heart Association’s Life’s Simple 7 score (now Life’s Essential 8).
   • Coronary artery calcium (CAC) scores were measured at 15, 20, and 25 years postpartum to detect subclinical cardiovascular disease (CVD).
2. Key Results
   • Women with poor prepregnancy CVH were 1.7 times more likely to have subclinical CVD (CAC score > 0) at 20 years postpartum compared to those with good CVH.
   • Gestational diabetes accounted for only about 6% of coronary artery calcium cases, indicating a smaller role in long-term heart disease risk.
   • Low/moderate prepregnancy CVH was associated with higher incidence and earlier onset of CAC, as well as higher CAC levels.
   • Gestational diabetes was more common in women with low/moderate CVH and correlated with increased CAC incidence and severity.

Implications for Sustainable Development Goals

• SDG 3: Good Health and Well-being
  • Improving cardiovascular health before pregnancy supports long-term maternal health and reduces the burden of heart disease.
  • Early identification and management of CV risk factors can prevent adverse pregnancy outcomes and chronic diseases.
• SDG 5: Gender Equality
  • Addressing women’s health before and during pregnancy promotes equitable access to preventive care and health education.
  • Empowering women with knowledge and resources to improve CVH aligns with gender-responsive health strategies.
• SDG 10: Reduced Inequalities
  • The study highlights disparities, as women with low/moderate CVH were more likely to be non-Hispanic Black and have lower educational attainment.
  • Targeted interventions can reduce health inequalities related to cardiovascular disease risk.

Discussion: Pregnancy as a Cardiovascular Stress Test

The research supports two hypotheses regarding adverse pregnancy outcomes and heart disease:

1. Causal Pathway Hypothesis: Adverse pregnancy outcomes trigger metabolic or cardiovascular changes that lead to future heart disease.
2. Stress Test Hypothesis: Pregnancy reveals preexisting cardiovascular risk factors, such as obesity, prediabetes, or hypertension, which predispose women to adverse outcomes and later heart disease.

The findings favor the stress test hypothesis, suggesting that underlying CV risk factors before pregnancy are the primary drivers of long-term cardiovascular disease.

Recommendations and Future Directions

• Focus on improving cardiovascular health prior to pregnancy to prevent gestational diabetes and reduce future heart disease risk.
• Develop postpartum cardiovascular health monitoring strategies, including assessment of risk factor changes and lactation impact.
• Expand research to include diverse racial and ethnic groups to enhance generalizability and equity in cardiovascular prevention.
• Address intergenerational cardiovascular risk by improving maternal health, which may benefit offspring’s cardiovascular outcomes.

Conclusion

This analysis underscores the importance of optimizing cardiovascular health before pregnancy as a critical intervention point to prevent heart disease later in life. Aligning with the Sustainable Development Goals, particularly SDG 3, SDG 5, and SDG 10, these findings advocate for enhanced preconception care and targeted public health strategies to improve maternal and intergenerational cardiovascular outcomes.

1. Sustainable Development Goals (SDGs) Addressed or Connected to the Issues Highlighted in the Article

1. SDG 3: Good Health and Well-being
   • The article focuses on cardiovascular health (CVH) and the prevention of heart disease, which directly relates to ensuring healthy lives and promoting well-being at all ages.
   • It discusses maternal health, gestational diabetes, and long-term cardiovascular risks, which are critical components of SDG 3.
2. SDG 5: Gender Equality
   • The article centers on women’s health before, during, and after pregnancy, highlighting the importance of addressing gender-specific health issues.
   • Improving prepregnancy cardiovascular health and managing gestational diabetes contribute to empowering women to have better health outcomes.
3. SDG 10: Reduced Inequalities
   • The study notes disparities in cardiovascular health outcomes among racial groups (e.g., non-Hispanic Black women), indicating relevance to reducing inequalities in health.

2. Specific Targets Under Those SDGs Identified Based on the Article’s Content

1. SDG 3: Good Health and Well-being
   • Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
   • Target 3.1: Reduce the global maternal mortality ratio.
   • Target 3.8: Achieve universal health coverage, including access to quality essential health-care services and access to safe, effective, quality, and affordable essential medicines and vaccines for all.
2. SDG 5: Gender Equality
   • Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the International Conference on Population and Development.
3. SDG 10: Reduced Inequalities
   • Target 10.2: Empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.

3. Indicators Mentioned or Implied in the Article to Measure Progress Towards the Identified Targets

1. Cardiovascular Health Metrics
   • Life’s Simple 7 / Life’s Essential 8 score by the American Heart Association (AHA) to quantify prepregnancy cardiovascular health.
   • Coronary artery calcium (CAC) score > 0 measured at 15, 20, and 25 years postpartum as an indicator of subclinical cardiovascular disease.
2. Gestational Diabetes Incidence
   • Percentage of women diagnosed with gestational diabetes (7.5% overall in the study), which relates to maternal health and risk factors.
3. Demographic and Socioeconomic Indicators
   • Racial/ethnic identification (e.g., non-Hispanic Black women) and education level (less than high school) as factors associated with cardiovascular health disparities.
4. Other Health Risk Factors
   • Prevalence of overweight, obesity, prediabetes, high cholesterol, and high blood pressure prior to pregnancy as implied risk factors.

4. Table of SDGs, Targets, and Indicators

Source: tctmd.com