Hypertensive disorders in pregnancy are associated with increased risk of maternal, fetal, and neonatal morbidity and mortality. It is important to distinguish between pre-existing (chronic) ...hypertension and gestational hypertension, developing after 20 weeks of gestation and usually resolving within 6 weeks postpartum. There is a consensus that systolic blood pressure ≥ 170 or diastolic blood pressure ≥ 110 mmHg is an emergency and hospitalization is indicated. The selection of the antihypertensive drug and its route of administration depend on the expected time of delivery. The current European guidelines recommend initiating drug treatment in pregnant women with persistent elevation of blood pressure ≥ 150/95 mmHg and at values > 140/90 mmHg in women with gestational hypertension (with or without proteinuria), with pre-existing hypertension with the superimposition of gestational hypertension, and with hypertension with subclinical organ damage or symptoms at any time during pregnancy. Methyldopa, labetalol, and calcium antagonists (the most data are available for nifedipine) are the drugs of choice. The results of the CHIPS and CHAP studies are likely to reduce the threshold for initiating treatment. Women with a history of hypertensive disorders in pregnancy, particularly those with pre-eclampsia, are at high risk of developing cardiovascular disease later in life. Obstetric history should become a part of the cardiovascular risk assessment in women.
Elevated serum urate levels cause gout and correlate with cardiometabolic diseases via poorly understood mechanisms. We performed a trans-ancestry genome-wide association study of serum urate in ...457,690 individuals, identifying 183 loci (147 previously unknown) that improve the prediction of gout in an independent cohort of 334,880 individuals. Serum urate showed significant genetic correlations with many cardiometabolic traits, with genetic causality analyses supporting a substantial role for pleiotropy. Enrichment analysis, fine-mapping of urate-associated loci and colocalization with gene expression in 47 tissues implicated the kidney and liver as the main target organs and prioritized potentially causal genes and variants, including the transcriptional master regulators in the liver and kidney, HNF1A and HNF4A. Experimental validation showed that HNF4A transactivated the promoter of ABCG2, encoding a major urate transporter, in kidney cells, and that HNF4A p.Thr139Ile is a functional variant. Transcriptional coregulation within and across organs may be a general mechanism underlying the observed pleiotropy between urate and cardiometabolic traits.
Cardiovascular disease (CVD) is the leading cause of death in women in developed countries. The traditional modifiable risk factors are able to explain the majority of CVD mortality. The aim of this ...review is to analyze gender-specific aspects of major conventional cardiovascular risk factors and to assess whether they have the same impact on CVD in women.
Cigarette smoking remains the single largest preventable cause of cardiovascular morbidity and premature death worldwide. Women smoke less than men; however, smoking seems to be more harmful in women, particularly in oral contraceptive users.
Obesity in the general population is more prevalent in women. Visceral adiposity is associated with insulin resistance and a higher risk of developing cardiovascular disease.
Life expectancy in female diabetic patients is shorter than in men with diabetes; women with diabetes are also at higher risk of developing cardiovascular events.
Changes of main lipid parameters in women are frequently associated with their hormonal status and/or hormonal treatment.
Hypertension is highly prevalent in post-menopausal women and carries a higher risk of developing left ventricular hypertrophy, which, together with a greater increase in vascular and myocardial stiffness, results in a higher incidence of heart failure with preserved ejection fraction and a higher risk of developing stroke. The risk of abdominal aortic rupture is substantially higher in women.
In conclusion, smoking, diabetes and hypertension seem to be more harmful in women. Therefore, the question is whether there should not be lower thresholds for initiating drug treatment in women with diabetes and hypertension.
•There are gender differences in the prevalence and awareness of major risk factors.•Smoking and diabetes seem to be more harmful in women.•Subclinical organ damage in hypertension is more prevalent in women.•Heart failure with preserved ejection fraction is more common in hypertensive women.•Women are underrepresented in large clinical trials.
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