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Gestational Diabetes and Future CVD
Quick Takes
- Women with gestational diabetes mellitus (GDM) are at increased risk of CVD.
- This association is mainly mediated by the development of type 2 diabetes and hypertension.
- Addressing CVD risk factors in women with prior GDM is important.
Study Questions:
What is the causality between genetic predisposition to gestational diabetes mellitus (GDM) and the risk of cardiovascular disease (CVD)?
Methods:
This study applied Mendelian randomization analyses to data from the FinnGen consortium, UK Biobank consortium, and/or genome-wide association meta-analysis studies.
Results:
In Mendelian randomization analyses, genetic predisposition to GDM was associated with increased risk of coronary artery disease (odds ratio, 1.09 [95% confidence interval, 1.01-1.17] per unit increase in the log-odds of genetic predisposition to GDM in ever-pregnant women). Type 2 diabetes and hypertension were causal mediators.
Conclusions:
Interval development of type 2 diabetes and hypertension mediated the casual relationship between GDM and future CVD.
Perspective:
Prior observational studies have indicated that patients with GDM are at higher risk for subsequent CVD. The authors sought to determine the causality by linking genetic predisposition for GDM with future CVD. Interestingly, the association was mainly mediated by the interval development of type 2 diabetes and hypertension, which are well-recognized cardiometabolic risk factors for CVD.
This study population was of European ancestry and future studies in populations with racial and ethnic diversity would be useful. Additionally, this study identified type 2 diabetes and hypertension as causal mediators, but other mediators such as socioeconomic and lifestyle factors were not studied. Granular data such as blood pressure measurements, exercise capacity, lipid profiles, and body mass index were also not available but could be useful in future studies.
Overall, the risk of CVD appears to be mediated by the interval development of type 2 diabetes and hypertension; therefore, ongoing careful management for primary prevention of CVD is important.
Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Vascular Medicine, Hypertension
Keywords: Cardiometabolic Risk Factors, Cardio-Obstetrics, Diabetes, Gestational, Hypertension, Pregnancy-Induced
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