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      Prevention Starts in the Womb: Opportunities for Addressing Cardiovascular Risk Factors During Pregnancy and Beyond

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          Abstract

          Early identification and mitigation of sex-specific cardiovascular disease risk factors is a potential trajectory-changing strategy to improve lifelong cardiovascular health in women. These sex-specific risk factors include adverse pregnancy outcomes, polycystic ovarian syndrome, and premature menopause. We start by discussing the impact and management of risk factors for adverse pregnancy outcomes as an upstream intervention for cardiovascular disease risk reduction and then address the long-term effect and mitigation of sex-specific risk factors for cardiovascular disease.

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          2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol

          Scott M. Grundy, Neil J Stone, Alison L Bailey … (2019)
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            2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary

            Donna K. Arnett, Roger S. Blumenthal, Michelle A Albert … (2019)
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              Pre-eclampsia: pathogenesis, novel diagnostics and therapies

              Elizabeth Phipps, Ravi I. Thadhani, Thomas Benzing … (2019)
              Pre-eclampsia is a complication of pregnancy that is associated with substantial maternal and fetal morbidity and mortality. The disease presents with new-onset hypertension and often proteinuria in the mother, which can progress to multi-organ dysfunction, including hepatic, renal and cerebral disease, if the fetus and placenta are not delivered. Maternal endothelial dysfunction due to circulating factors of fetal origin from the placenta is a hallmark of pre-eclampsia. Risk factors for the disease include maternal comorbidities, such as chronic kidney disease, hypertension and obesity; a family history of pre-eclampsia, nulliparity or multiple pregnancies; and previous pre-eclampsia or intrauterine fetal growth restriction. In the past decade, the discovery and characterization of novel antiangiogenic pathways have been particularly impactful both in increasing understanding of the disease pathophysiology and in directing predictive and therapeutic efforts. In this Review, we discuss the pathogenic role of antiangiogenic proteins released by the placenta in the development of pre-eclampsia and review novel therapeutic strategies directed at restoring the angiogenic imbalance observed during pre-eclampsia. We also highlight other notable advances in the field, including the identification of long-term maternal and fetal risks conferred by pre-eclampsia.
              Article 0 comments Cited 260 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Garima Sharma:
                ORCID: https://orcid.org/0000-0001-7254-2077
                Journal
                Journal ID (nlm-ta): Methodist Debakey Cardiovasc J
                Journal ID (iso-abbrev): Methodist Debakey Cardiovasc J
                Journal ID (issn): 1947-6108
                Title: Methodist DeBakey Cardiovascular Journal
                Publisher: Houston Methodist DeBakey Heart & Vascular Center
                ISSN (Print): 1947-6094
                ISSN (Electronic): 1947-6108
                Publication date (Electronic, pub): 24 September 2021
                Publication date Collection: 2021
                Volume: 17
                Issue: 4
                Pages: 48-59
                Affiliations
                [1 ]Johns Hopkins University School Of Medicine, Baltimore, Maryland, US
                Author notes
                CORRESPONDING AUTHOR: Garima Sharma, MD Johns Hopkins University School Of Medicine, Baltimore, Maryland, US gsharma8@ 123456jhmi.edu
                Author information
                https://orcid.org/0000-0003-2138-1589
                https://orcid.org/0000-0003-1910-3168
                https://orcid.org/0000-0001-8320-0806
                https://orcid.org/0000-0001-7254-2077
                Article
                DOI: 10.14797/mdcvj.696
                PMC ID: 8588699
                SO-VID: e6656cef-1f20-471c-9100-3e5e515e23bc
                Copyright © Copyright: © 2021 The Author(s)
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/.

                History
                Date received : 01 September 2021
                Date accepted : 01 September 2021
                Funding
                Dr. Sharma is supported by the Blumenthal Scholarship in Preventive Cardiology.
                Categories
                Subject: Review

                Keywords: cardiovascular disease,prevention,pregnancy,post-partum,sex-specific risk factors,women’s health
                Data availability:
                Keywords: cardiovascular disease, prevention, pregnancy, post-partum, sex-specific risk factors, women’s health

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