Women with high-risk preg­nan­cies far more prone to heart dis­ease

The Hamilton Spectator - - HEALTH - ANNA GOR­MAN Kaiser Health News

Women who have high-risk preg­nan­cies or com­pli­ca­tions in child­birth are up to eight times more likely to suf­fer heart dis­ease later in life. And many moth­ers — and their doc­tors — are un­aware of the dan­ger.

Emerg­ing re­search shows heart dis­ease is a long-term threat for women who de­velop di­a­betes or high blood pres­sure dur­ing preg­nancy, for ex­am­ple, or those whose ba­bies are born pre­ma­turely or pre­car­i­ously small.

Yet doc­tors do not typ­i­cally ad­vise women about their risk or coun­sel them to watch for symp­toms, said Noel Bairey Merz, a car­di­ol­o­gist and di­rec­tor of the Bar­bra Streisand Women’s Heart Cen­ter at Cedars-Si­nai Heart In­sti­tute in Los An­ge­les.

Bairey Merz said doc­tors can see heart at­tacks and strokes com­ing, of­ten 10 or 20 years ahead of time, if they are on the look­out. “This isn’t rocket science,” she said.

“We just have to fig­ure out how we can find the women who are at risk.”

Height­ened aware­ness of the link be­tween preg­nancy com­pli­ca­tions and heart dis­ease is prompt­ing greater out­reach to the pub­lic and col­lab­o­ra­tive re­search be­tween car­di­ol­o­gists and ob­ste­tri­cians. That could help “make tremen­dous strides to­ward re­duc­ing and pre­vent­ing heart dis­ease in women,” said Bairey Merz.

Cedars-Si­nai re­cently started fol­low­ing a small group of women who’ve had preg­nancy or labour com­pli­ca­tions to fur­ther ex­plore the heart dis­ease con­nec­tion. In a sep­a­rate study, Bairey Merz and other re­searchers funded by the Na­tional In­sti­tutes of Health are track­ing 5,000 new moms at eight sites na­tion­wide — in­clud­ing Cedars — to fill gaps in knowl­edge about heart health and de­velop rec­om­men­da­tions for physi­cians.

The Women’s Heart Al­liance, an ad­vo­cacy group started by Cedars-Si­nai and New York-Pres­by­te­rian Hospi­tal/Weill Cor­nell Med­i­cal Cen­ter, also works with ob­ste­tri­cians and other providers to raise aware­ness among women and their doc­tors.

“We’ve got a big ad­vo­cacy and ed­u­ca­tion piece that we should be do­ing to­gether,” said Bar­bara Levy, vice-pres­i­dent of health pol­icy for the Amer­i­can Congress of Ob­ste­tri­cians and Gy­ne­col­o­gists.

Levy said ed­u­ca­tion is crit­i­cal be­cause it re­duces the like­li­hood that women or their doc­tors will dis­miss symp­toms and con­cerns that should be taken se­ri­ously. Car­di­ol­o­gists and women’s health care providers are in a unique po­si­tion to drive the re­search agenda, Levy said. Re­searchers are still try­ing to de­ter­mine why such com­pli­ca­tions are linked to later heart prob­lems. Among hy­pothe­ses: Preg­nancy might con­trib­ute to vas­cu­lar prob­lems or un­leash pre-ex­ist­ing ten­den­cies.

“Preg­nancy can re­ally mimic the stres­sors of age,” said Margo Minis­sian, a nurse sci­en­tist and re­searcher at the Cedars-Si­nai Heart In­sti­tute. “Preg­nancy could es­sen­tially be serv­ing as a woman’s first phys­i­o­log­i­cal stress test.”

The Amer­i­can Heart As­so­ci­a­tion and Amer­i­can Stroke As­so­ci­a­tion rec­om­mend, for ex­am­ple, that women who have had preeclamp­sia — a po­ten­tially lifethreat­en­ing spike in blood pres­sure dur­ing preg­nancy — be eval­u­ated for heart dis­ease risk within one year of giv­ing birth. But most women who have had com­pli­cated preg­nan­cies need not see a car­di­ol­o­gist right af­ter giv­ing birth, Levy said — they should just eat health­fully, be ac­tive and get enough sleep.

One of Minis­sian’s pa­tients, Lara Ho­gan, gave birth to her son, Zion, in May 2016.

Sit­ting in her liv­ing room in Topanga, Calif., Ho­gan re­counted how she had been mon­i­tor­ing her blood pres­sure dur­ing the preg­nancy be­cause she was treated for hy­per­ten­sion in the past. Then, dur­ing her 36th week, her pres­sure spiked — a sign of pre-eclamp­sia.

Ho­gan and her hus­band, Chad, headed to Cedars-Si­nai, where doc­tors told her they needed to de­liver the baby that night. But her blood pres­sure did not come down af­ter giv­ing birth. In fact, it kept ris­ing.

“They had some­one stand­ing at my bed­side mon­i­tor­ing me in case any­thing hap­pened,” Ho­gan re­called.

Zion stayed in the neona­tal in­ten­sive care unit for eight days be­fore he was re­leased. Ho­gan went in and out of the hospi­tal as doc­tors tried to lower her pres­sure.

Fi­nally, doc­tors suc­ceeded in bring­ing her pres­sure down and re­ferred her to a post­par­tum heart health pro­gram that Minis­sian leads. Over the next sev­eral weeks, Minis­sian and oth­ers helped Ho­gan take the right dose of med­i­ca­tion and avoid the hospi­tal.

Now, Ho­gan checks her pres­sure on most days and plans to con­tinue see­ing doc­tors to man­age her long-term car­diac risk.

Ho­gan hopes to have an­other baby soon, so she has been see­ing Minis­sian to en­sure her pres­sure is well-con­trolled be­fore she gets preg­nant again. She knows she is at risk for heart dis­ease later in life be­cause of her com­pli­ca­tions in preg­nancy.

ANNA GOR­MAN, CAL­I­FOR­NIA HEALTH­LINE

Lara Ho­gan with her son, Zion. Ho­gan said she mon­i­tors her blood pres­sure reg­u­larly and is de­ter­mined to stay on top of her health.

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