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Pregnancy and Heart Disease – Expanding the SCOPE of our Understanding

PreeclampsiaToday marks the last day of Heart Month, an annual campaign raising awareness about cardiovascular disease, a condition including heart disease, stroke and high blood pressure that is responsible for one out of every three deaths, and is the leading cause of death in both men and women. In all its forms, the condition is responsible for over 400,000 deaths a year among women – more than all forms of cancer combined. Although we’ve all heard or read about the signs and symptoms of heart disease in women and the risk factors, there is one huge area of female heart health not found at the forefront of public education: pregnancy and heart disease, or more specifically, preeclampsia and heart disease.

During pregnancy, six to eight percent of women will develop preeclampsia, often characterized by the sudden onset of high blood pressure, swelling, and protein in the urine. Preeclampsia is a leading cause of preterm births, and can lead to maternal or fetal death, and therefore must be caught early. To make matters worse, there is no known way to prevent the condition. What is known, however, is that while preeclampsia can be treated and will eventually go away, the condition can be an early indicator of future cardiovascular problems in women. In fact, research has shown that women who develop preeclampsia during pregnancy are four times more likely to develop high blood pressure later in life, and are twice as likely to develop heart disease, stroke and blood clots in the future. And for women who have severe or repeat cases of preeclampsia, the risks are even higher.

“A diagnosis of preeclampsia does not mean you will definitely develop heart problems, but it can be a warning sign, and it’s something for patients and their doctors – both ob/gyns and primary care doctors – to be aware of,” said Lisa Levine, MD, an assistant professor of Obstetrics and Gynecology at the Perelman School of Medicine at the University of Pennsylvania. “Heart disease can take years to develop, so until we know more about how to prevent preeclampsia and its connection to heart disease, it’s crucial that health care providers be aware that their patients have these risk factors so they can monitor for signs of a potential problem.”

Though researchers do not yet know exactly how and why preeclampsia and future cardiovascular disease are linked – or even whether preeclampsia causes the risk or is merely a way to identify women at risk – Levine is currently leading a team of health care providers specializing in Maternal Fetal Medicine in a new trial that they hope will shed light on exactly how the condition affects the risk of cardiovascular events.

The trial – aptly named SCOPE (the Study of Cardiovascular Outcomes in Women with Preeclampsia using Echocardiography) – will examine the results of echocardiograms (ultrasound of the heart) and blood tests of 80 pregnant African American women both with and without preeclampsia who are receiving care at Penn Medicine. The goal of the study will be to determine how the presence of the disease affects other risk factors for heart disease, including high blood pressure, obesity, and high cholesterol. By comparing risk factors of women with and without preeclampsia, it's possible the team will be able to determine whether preeclampsia itself causes an increase in risk for heart disease, or is merely a way to identify women who are already at risk. Results of the study will also help shed light on which the women with preeclampsia are at the greatest risk for developing heart disease later in life.

“As we learn more about the link between preeclampsia and future heart disease, we will be able to identify at-risk women earlier so they can be treated preventively, so that events like heart attacks and strokes can be avoided,” Levine said. “Given the prevalence of heart disease among women, it's critically important than all women with a history of preeclampsia be regularly evaluated and treated for cardiovascular risk factors.”

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