Feb. 15, 2011 -- Women who have been diagnosed with preeclampsia, pregnancy-induced hypertension, or diabetes during pregnancy are now considered at risk for heart attack or stroke going forward, according to newly updated guidelines from the American Heart Association (AHA).
The 2011 update to the AHA’s cardiovascular prevention guidelines for women recategorizes a woman’s risk for heart disease. It also serves up some gender-specific prevention advice on diet and daily aspirin therapy in women at high risk of coronary heart disease in order to prevent heart attacks.
The guidelines are being published in the journal Circulation and are based on expert reviews of the medical literature.
Women are now classified in three groups: high risk for heart disease, at risk, or ideal cardiovascular health. The high-risk group changed little from previous years and includes women with established heart disease, chronic kidney disease, or diabetes, among other risk factors.
But “the at-risk group now captures women with pregnancy complications such as preeclampsia, gestational diabetes, or pregnancy-induced hypertension,” says guideline chair Lori Mosca, MD, PhD. Mosca is director of preventive cardiology at New York-Presbyterian Hospital and a professor of medicine at Columbia University Medical Center in New York City.
“These complications are the equivalent of a failed stress test,” she says. Doctors use exercise stress tests to diagnose heart disease.
“If you do develop one of these conditions during pregnancy, it is an unmasking of the risk that tells us your vascular system doesn’t function ideally,” Mosca says.
”These complications are an opportunity to detect early that there is a problem,” she says. You can then follow up with your primary care doctor to evaluate your overall cardiac risk and quickly start appropriate prevention strategies.
“If you developed gestational diabetes, follow up and say, ‘What can I do to prevent heart disease and diabetes?’” she says. Your doctor may recommend weight loss, aggressive lifestyle changes, and possibly medication, she says. “We are unmasking a problem early so that we can prevent full-blown cardiovascular disease.”
The new information about pregnancy complications and heart risk is “a big deal,” says guideline author Ileana L. Piña, MD, a professor of medicine and epidemiology and biostatistics at Case Western Reserve University in Cleveland.