Key result
A history of gestational diabetes was associated with significantly lower coronary flow velocity reserve compared to healthy controls (2.34 vs 2.80, p<0.001).
Why the study?
Does a history of previous gestational diabetes mellitus impair coronary flow velocity reserve in women?
Observational (n=188)
Does a history of previous gestational diabetes mellitus impair coronary flow velocity reserve in women?
Absolute Event Rate: 2.34% vs 2.8%
p-value: p=<0.001
A history of gestational diabetes mellitus is independently associated with impaired coronary flow velocity reserve, suggesting it may be an early manifestation of coronary microvascular dysfunction.
May signal early microvascular dysfunction post-GDM; leaves open prognostic value and needs prospective validation.
Background Gestational diabetes mellitus (GDM) is a prediabetic state that is known to increase the risk of cardiovascular diseases. We have investigated coronary flow velocity reserve (CFVR) and epicardial fat thickness (EFT), and left ventricular diastolic function in patients with a history of previous GDM (p-GDM).Methods Ninety-three women with GDM history and 95 healthy women without GDM history were recruited. We used transthoracic Doppler echocardiography to assess CFVR, EFT, and left ventricular diastolic function. Insulin resistance of each subject was assessed with homeostasis model assessment insulin resistance (HOMA-IR). Hemoglobin A1c and high-sensitivity C-reactive protein (hsCRP) were also measured in all patients.Results CFVR values were significantly lower (2.34 ± 0.39 versus 2.80 ± 0.24, p < 0.001) and EFT values were significantly higher in patients with p-GDM than the control group (5.5 ± 1.3 versus 4.3 ± 1.1, p < 0.001). E/E' ratio (7.21 ± 1.77 versus 6.53 ± 1.38, p = 0.003), hemoglobin A1c (5.2 ± 0.4 and 5.0 ± 0.3, p = 0.001), HOMA-IR (2.8 ± 1.4 versus 1.7 ± 0.9, p = 0.04), and hsCRP levels were significantly higher in the p-GDM group than the control group. Multivariate analysis revealed that gestational diabetes history is independently associated with CFVR.Conclusion Women with a GDM history may be at more risk regarding coronary microvascular dysfunction compared to the healthy ones.Key MessagesWhat is already known about this subject?Impairment of CFVR reflects coronary microvascular dysfunction and has been shown to be an early manifestation of atherosclerosis and coronary artery disease.Several studies have shown an association between p-GDM and atherosclerosis by measuring intima-media thickness.What are new findings?This preliminary study on coronary microvascular function of patients with p-GDM revealed that CFVR is significantly impaired in p-GDM patients.Although the number of patients included in this study is limited, these results suggest that impaired CFVR may be an early manifestation of coronary vascular involvement in patients with p-GDM.How might it impact on clinical practice in the foreseeable future?In patients with p-GDM, the presence of impaired CFVR should render the clinician aware of the development of coronary artery disease.
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Çalışkan et al. (2015) conducted an observational in History of gestational diabetes mellitus (n=188). History of gestational diabetes mellitus vs. Healthy women without GDM history was evaluated on Coronary flow velocity reserve (CFVR) (p=<0.001). A history of gestational diabetes was associated with significantly lower coronary flow velocity reserve compared to healthy controls (2.34 vs 2.80, p<0.001).