Cardiovascular disease (CVD), or heart disease, is the number one killer of women in the United States, causing one in four deaths. The majority of women who die suddenly from CVD, 64 percent, never knew they had it because they had no symptoms. As we recently reported, many women aren’t aware of their risk of CVD, even if they do fall into a higher risk category. And while the mortality rates for other diseases, like breast cancer, are dropping, more young women are dying from CVD than ever before.
Women don’t know their risks and most physicians are not talking about them either. A 2013 survey published in the journal Circulation, noted that only 21 percent of women have ever had this discussion with their doctors. Yet, women have unique risk factors, which may include having had preeclampsia or gestational diabetes during pregnancy, what some note as failing “nature’s stress tests.” Between 4 percent and 8 percent of pregnant women develop preeclampsia (high blood pressure and protein in the urine) and up to 9 percent of pregnant women develop gestational diabetes (diabetes that only occurs during pregnancy).
A study published in the January/February 2016 issue of the American Journal of Maternal Child Nursing, suggested that women with preeclampsia be evaluated every year for CVD, and a study published last year in the Journal of the American Heart Association, concluded that women who had gestational diabetes should be monitored for CVD as well, even if they had not gone on to develop type 2 diabetes or metabolic syndrome.
The usual risk assessments for CVD for both men and women include evaluating lifestyle habits such as smoking, nutrition, and physical activity as well as consideration of family history and clinical presentation – are they overweight or do they have hypertension, for example. With women though, physicians should probe a bit further, asking them if they had ever been pregnant and if so, if they had had preeclampsia or gestational diabetes. A diagnosis of either should raise red flags and warrant further investigation of cardiovascular risk.
How Do Preeclampsia and Gestational Diabetes Increase Risk Later in Life?
Even though both preeclampsia and gestational diabetes end when the pregnancy ends, the two conditions may have set the stage for complications to appear later in life. High blood pressure and high blood sugar levels (diabetes), even for short periods of time, can cause microscopic damage to the lining of the blood vessel walls, called the endothelium. When the cells of this lining are damaged, they become inflamed and release certain proteins and enzymes. As women age, this damage may worsen, increasing their CVD risk, especially if they also have other risk factors for heart disease.
Cleveland Heart Lab has tests specifically designed to detect or indicate early endothelial damage. Women with a history of preeclampsia or gestational diabetes may benefit from a closer look at endothelial health. For example, a blood biomarker test for ADMA provides information about the health of the endothelium by measuring a chemical marker related to nitric oxide. A urine test, called microalbumin provides structural information related to the health of the endothelial lining in the arteries of the kidneys. A healthy endothelium will not allow microalbumin to leak into the urine. These inflammation tests can help women (and men) know more about the health of their endothelium.
Reducing CVD Risk
If you have had preeclampsia or gestational diabetes, or both, make sure your doctor knows and ask if you would benefit from inflammation testing. In addition, you can check to see if you have any other risks for CVD, and discuss these with your doctor as well. Make knowing your risks for heart disease part of the conversation so that you can work with your practitioner to lower your risk of heart attack and sudden death.