Author + information
- Received June 25, 2018
- Revision received November 16, 2018
- Accepted December 2, 2018
- Published online April 22, 2019.
- Abbi D. Lane-Cordova, PhDa,b,
- Sadiya S. Khan, MD, MSca,c,
- William A. Grobman, MDd,
- Philip Greenland, MDa and
- Sanjiv J. Shah, MDc,∗ (, )@HFpEF
- aDepartment of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- bDepartment of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- cDivision of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- dDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- ↵∗Address for correspondence:
Dr. Sanjiv J. Shah, Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 600, Chicago, Illinois 60611.
• APOs are a group of interrelated disorders that share clinical features and risk factors with CVD.
• Women with a history of APOs have higher risk of future development of CVD risk factors and overt CVD compared to women with no history of APOs.
• Several potential APO-specific mechanisms may contribute to excess post-partum CVD risk and suggest research directions aimed at interrupting the progression from APO to CVD.
Adverse pregnancy outcomes (APOs)—including pre-term birth, pre-eclampsia, and intrauterine growth restriction—are common interrelated disorders caused by placental dysfunction and maternal vascular abnormalities (endothelial activation, inflammation, and vasospasm) that occur in approximately 10% to 20% of pregnancies. Women who experience APOs are at increased risk for future cardiovascular disease (CVD). APOs are associated with increased risk of development of hypertension, left ventricular hypertrophy/dysfunction, vascular dysfunction, and renal dysfunction. The vascular abnormalities that are present during an APO also underlie common, difficult-to-treat forms of CVD in women as they age (e.g., cardiac microvascular dysfunction, heart failure with preserved ejection fraction), suggesting shared mechanistic pathways for APOs and CVD. Here, the authors synthesize the current information and knowledge gaps regarding the progression from APO to CVD. Understanding the risk factors for and pathogenesis of APO-related cardiovascular dysfunction is a critical unmet need that could inform efforts to prevent and more effectively treat CVD in women.
Drs. Lane-Cordova and Greenland were funded through the American Heart Association (AHA)’s Strategically Focused Research Network (SFRN) in Prevention grant 14SFRN20480260. Dr. Khan was funded by the National Institutes of Health (NIH) National Center for Advancing Translational Sciences grant KL2TR001424. Drs. Grobman and Greenland were funded by NIH grant U10 HL119992. Dr. Shah was funded by NIH grants R01 HL127028, R01 HL107577, and R01 HL140731, and an AHA Go Red for Women SFRN grant (16SFRN28780016).
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received June 25, 2018.
- Revision received November 16, 2018.
- Accepted December 2, 2018.
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