Women with no history of gestational diabetes may have a “graded increase” in the risk of coronary artery calcification (CAC) in midlife that is associated with worsening glucose intolerance, while women with a history of gestational diabetes may have twice as great a risk of experiencing CAC in midlife across all levels of glucose intolerance, according to a study published Feb. 1 in Circulation. Notably, midlife atherosclerotic cardiovascular disease among women with a history of gestational diabetes was not diminished by attaining normoglycemia.

Erica P. Gunderson, PhD, MS, MPH, et al., used data from the CARDIA study to look at 1,133 women without diabetes at baseline; who had given birth at least once; who had received glucose tolerance testing at baseline and up to five times between 1986 and 2011; whose gestational diabetes status was known; and who had CAC measurements from one or more follow-up examinations.

Results showed that of the 1,133 women included in the study, 139 reported gestational diabetes. CAC was present in 25% of the patients who reported gestational diabetes and 15% of women with no gestational diabetes.

“The findings show that even sustained normoglycemia after pregnancy was associated with increased risk of CAC among women with a history of [gestational diabetes],” write the authors. “In comparison with women without [gestational diabetes] and with normoglycemia, the risk of CAC was [approximately two] times higher for women with a history of [gestational diabetes] across all levels of glucose intolerance, independent of sociodemographic, clinical, and lifestyle behavioral risk factors.”

The authors conclude that these findings add to existing evidence that supports the need for enhanced cardiovascular disease risk factor screening among women with a history of gestational diabetes.

Melinda Davis, MD, FACC, explains in an ACC.org Journal Scan article, “Possible explanations for [these] important findings are: 1) gestational diabetes represents a constellation of risk factors that lead to cardiovascular disease even without hyperglycemia; 2) women with gestational diabetes may still have more insulin resistance and inflammation even if they maintain normoglycemia; and 3) gestational diabetes may be associated with dysmetabolism that leads to coronary atherogenesis and calcification.”

“A history of gestational diabetes should not only prompt screening for diabetes, but enhanced cardiovascular disease risk screening including blood pressure, dyslipidemia, hyperinsulinemia, and modifiable lifestyle behaviors,” she adds.

Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Dyslipidemia, Atherosclerotic Disease (CAD/PAD)

Keywords: Pregnancy, Female, Diabetes, Gestational, Glucose Intolerance, Cardiovascular Diseases, Insulin Resistance, Blood Pressure, Follow-Up Studies, Glucose Tolerance Test, Coronary Artery Disease, Risk Factors, Atherosclerosis, Dyslipidemias, Life Style, Inflammation, Glucose

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