Investigating the Relationship Between Pregnancy Complications & Coronary Disease

Dr. Brown:
Welcome to Heart Matters on ReachMD. I'm Dr. Alan Brown, and on this episode, Dr. Nanette Wenger, a Professor of Medicine in the division of cardiology at the Emory University School of Medicine, will be discussing her study on the relationship between pregnancy complications and subsequent coronary disease in black women. Here's Dr. Wenger now. 

Dr. Wenger:
The study of the relationship between pregnancy complications and subsequent coronary disease in black women was done with my colleagues in South Carolina, predominantly imaging colleagues. And there are a certain number of things that are known. We certainly know that black women are at higher risk for coronary disease than their Caucasian counterparts. So, what was done is to look at the images at the coronary CTAs and then to go back and in those women and it was a good size population of 500 black women to say, ‘How many of them had complications during pregnancy and how many of them did not?’. And this was rather good documentation that for the women who had complications during pregnancy, preeclampsia, or gestational diabetes that there was more coronary disease.

The issue of a higher rate of coronary disease in black women is really multi-factorial. What we tend to see is that there is a higher prevalence of standard complications of standard risk factors in comparably aged black and white women. They are more likely to not have good cardiovascular health in terms of hypertension, diabetes, hyperlipidemia, obesity, sedentary lifestyle, etc. And that is a contributor. And what we must not overlook are all of the social determinants of health and those are really important; those are the ones that have been highlighted by the COVID epidemic and they range from, housing to air pollution, to education to access to services, etc. So, there is a multi-factorial reason why black women are at higher cardiovascular risk than their Caucasian counterparts. And, of course, some of that relates to access to care and to insurance for healthcare and to the intensity and complexity of care they receive and here we’re talking even of preventive care. What was seen in this study is that black women who had pregnancy complications, but particularly gestational diabetes, had a higher prevalence of coronary disease on coronary CTA, on imaging. While only a history of gestational diabetes was independently associated with obstructive coronary disease. But, you know, from a preventive standpoint, we want to know not only about obstructive coronary disease but about any coronary disease.

And remember, this is a retrospective study so that the concerns are that years before, many women may not have been told much about the complications of pregnancy. A retrospective study obviously has its limitations, but certainly the data that are available define the need when you’re evaluating coronary risk in women and here in black women who are at increased risk for coronary disease to go back and get a detailed pregnancy history.

Dr. Brown:
That was Dr. Nanette Wenger, discussing her study on the relationship between pregnancy complications and subsequent coronary disease in black women. For ReachMD, I'm Dr. Alan Brown. To find other programs in our series, visit ReachMD.com/HeartMatters, where you can Be Part of the Knowledge. Thanks for listening!