Gestational diabetes may flag early HF risk
medwireNews: The presence of gestational diabetes mellitus (GDM) may identify women at an increased risk for experiencing hospitalization for heart failure (HHF) within the next few years, research suggests.
“Despite the understandably low HHF event rates in young women (mean age 34 years at the time of HHF event), we observed robust associations, which suggest the potential potency of GDM as a predictor of future HHF,” write the researchers in Diabetes Care.
At the time of pregnancy, the 906,319 women in the study, who were identified in Canadian healthcare databases and gave birth during 2007–2018, were aged an average of 29.7 years, although the 5.5% who had GDM were older than those who did not, at 32.3 versus 29.6 years.
During a median 7 years of follow-up, 763 women had an incident HHF event, at rates per 10,000 person–years of 2.58 versus 1.14 in women with and without GDM, respectively.
This equated to a significant 39% risk increase associated with GDM after accounting for multiple variables including age, ethnicity, neighborhood affluence, parity, and pre- and post-pregnancy hypertension and cardiovascular disease.
Of note, this association was also independent of progression to type 2 diabetes after pregnancy.
Justin Echouffo-Tcheugui (Johns Hopkins University, Baltimore, Maryland, USA) and study co-authors also note that 7 years is likely too short a follow-up period for the development of post-pregnancy diabetes to account for the increased HF risk in women with GDM.
“Women who develop GDM most probably have an adverse pregravid cardiovascular risk factor profile, with pregnancy actually uncovering a high-risk cardiometabolic phenotype early in its natural history,” they write.
However, they also cite some small studies linking GDM to adverse changes in left ventricular mass that persist after pregnancy – which could then lead to cardiac dysfunction – and to diastolic dysfunction during pregnancy.
Indeed, in the current study GDM was associated with a significant 83% increased risk for peripartum cardiomyopathy after adjusting for confounders.
The team concludes that the “findings hold potential future implications for clinical practice” and “suggest that implementation of universal screening for GDM during pregnancy offers a unique widow of opportunity for HF prevention.”
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