Key result
Women with a history of gestational diabetes mellitus had a 36% increased risk for overall cardiovascular outcomes (aHR 1.36) compared to women without a history of gestational diabetes.
Why the study?
There is limited information on diverse long-term cardiovascular outcomes in older women following gestational diabetes mellitus.
Does a history of gestational diabetes mellitus increase the risk of long-term cardiovascular outcomes in women?
Cohort (n=219,330)
Yes
Does a history of gestational diabetes mellitus increase the risk of long-term cardiovascular outcomes in women?
Hazard Ratio: 1.36 (95% CI 1.18–1.55)
Absolute Event Rate: 8.62% vs 6.39%
p-value: p=<0.001
A history of gestational diabetes mellitus is associated with an increased long-term risk of diverse cardiovascular outcomes, which is partially mediated by the subsequent development of overt diabetes, hypertension, and dyslipidemia.
May warrant closer CVD surveillance in women with prior GDM; extends observational data but leaves open whether interventions alter outcomes.
BACKGROUND: Previous studies showed that gestational diabetes mellitus (GDM) can be a risk factor for subsequent atherosclerotic cardiovascular disease. However, there is a paucity of information regarding diverse cardiovascular outcomes in elderly women after GDM. In the current study, we examined whether women with a history of GDM have an increased risk for long-term overall cardiovascular outcomes. METHODS: Among the UK participants, we included 219,330 women aged 40 to 69 years who reported at least one live birth. The new incidence of diverse cardiovascular outcomes was compared according to GDM history by multivariable Cox proportional hazard models. In addition, causal mediation analysis was performed to examine the contribution of well-known risk factors to observed risk. RESULTS: After enrollment, 13,094 women (6.0%) developed new overall cardiovascular outcomes. Women with GDM history had an increased risk for overall cardiovascular outcomes [adjusted HR (aHR) 1.36 (95% CI 1.18-1.55)], including coronary artery disease [aHR 1.31 (1.08-1.59)], myocardial infarction [aHR 1.65 (1.27-2.15)], ischemic stroke [aHR 1.68 (1.18-2.39)], peripheral artery disease [aHR 1.69 (1.14-2.51)], heart failure [aHR 1.41 (1.06-1.87)], mitral regurgitation [aHR 2.25 (1.51-3.34)], and atrial fibrillation/flutter [aHR 1.47 (1.18-1.84)], after adjustment for age, race, BMI, smoking, early menopause, hysterectomy, prevalent disease, and medication. In mediation analysis, overt diabetes explained 23%, hypertension explained 11%, and dyslipidemia explained 10% of the association between GDM and overall cardiovascular outcome. CONCLUSIONS: GDM was associated with more diverse cardiovascular outcomes than previously considered, and conventional risk factors such as diabetes, hypertension, and dyslipidemia partially contributed to this relationship.
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Lee et al. (2022) conducted a cohort in Gestational diabetes mellitus (GDM) (n=219,330). History of gestational diabetes mellitus vs. No history of gestational diabetes mellitus was evaluated on Composite of new occurrence of cardiovascular outcomes (coronary artery disease, myocardial infarction, ischemic stroke, peripheral artery disease, heart failure, aortic stenosis, mitral regurgitation, atrial fibrillation/flutter, and venous thromboembolism) (aHR 1.36, 95% CI 1.18-1.55, p=<0.001). Women with a history of gestational diabetes mellitus had a 36% increased risk for overall cardiovascular outcomes (aHR 1.36) compared to women without a history of gestational diabetes.
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