Background: Endothelial dysfunction is an early manifestation of atherosclerosis .Normal aging and menopause are related to endothelial dysfunction. Pregnancy is characterized by major physiological adaptations, and is considered to be a natural "stress test" upon maternal vascular health in which endothelial dysfunction might have a central role. We hypothesized that pregnant women with complicated pregnancies will have endothelial dysfunction, that persists following child-birth.
Methods & Results: Between February to December 2014, 41 women referred to our Women`s Cardiology Clinic, underwent systematic endothelial function testing (EFT). Main indications for EFT were: menopause, multiple risk factors and a complicated pregnancy. Assessment of EFT was done using digital pulse amplitude tonometry (ENDOPAT, Itamar Medical, Caesarea, Israel). Reactive hyperemia index (RHI) of ≤1.67 was considered abnormal. Nine women (21.95%) had complicated pregnancy. Sixteen women (39.02%; mean age of 44.7±12.82 yrs) had abnormal EFT results and mean RHI was 1.42±0.22. Of them, seven women (7/16; 43.7%) with reduced EFT had complicated pregnancies: 2 had gestational DM, 1 sustained gestational HTN, 1 had preeclampsia and 3 had DM before the index pregnancy. Twenty-five women (25/41; 60.97%) at a mean age of 53.08±8.53 yrs had normal EFT with a mean RHI of 2.36±0.56. Eleven women (11/25; 44%) had at least 2 major cardiovascular risk factors. Importantly, only 2 women with complicated pregnancy (22%) had normal EFT.
Conclusions & Implications: In a preliminary cohort of women referred for EFT we observed young women with complicated pregnancies, have impaired EFT results. This finding indicates a causative relation between complicated gestation and endothelial dysfunction. Given the known relation between endothelial dysfunction and long-term cardiovascular morbidity and mortality, we propose to further explore the EFT among women with complicated pregnancies in order to identify those at high risk for cardiovascular events.
