Hypertension in pregnancy and endothelial activation: An emerging risk factor for cardiovascular disease

Natalia Lazzarin; Giovambattista Desideri; Claudio Ferri; Herbert Valensise; Giulia Gagliardi; Grazia Maria Tiralongo; Dario Manfellotto

doi:10.1016/j.preghy.2012.02.002

Hypertension in pregnancy and endothelial activation: An emerging risk factor for cardiovascular disease

Pregnancy Hypertens. 2012 Oct;2(4):393-7. doi: 10.1016/j.preghy.2012.02.002. Epub 2012 Feb 29.

Authors

Natalia Lazzarin¹, Giovambattista Desideri², Claudio Ferri², Herbert Valensise³, Giulia Gagliardi³, Grazia Maria Tiralongo³, Dario Manfellotto⁴

Affiliations

¹ AFaR (Fatebenefratelli Association for Research), Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy. Electronic address: nlazzarin@tiscali.it.
² Department of Internal Medicine and Public Health, University of L'Aquila, L'Aquila, Italy.
³ Department of Obstetrics and Gynaecology, University of Rome "Tor Vergata" and Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy.
⁴ AFaR (Fatebenefratelli Association for Research), Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy; Centre of Clinical Pathophysiology, Department of Internal Medicine, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy.

PMID: 26105609
DOI: 10.1016/j.preghy.2012.02.002

Abstract

Objective: There is emerging evidence suggesting that women who develop hypertensive disorders of pregnancy should be considered at risk for cardiovascular disease (CVD). Our objective was to determine whether persistent endothelial activation, which represents the earliest step in atherogenesis, is present after delivery in women with a history of hypertensive pregnancies compared to women with normal pregnancies.

Study design: Two matched case-control studies were conducted. In the first study, endothelial activation was assessed by the measurement of soluble intercellular adhesion molecules, namely, intercellular adhesion molecules-1 (ICAM-1), vascular cellular adhesion molecules-1 (V-CAM-1), E-selectin and P-selectin in 25 women with hypertensive pregnancies and in a matched control group with an uncomplicated pregnancy one month and three months after delivery. In the second study, adhesion molecules were measured in 20 patients with a history of HELLP syndrome several years after pregnancy and in 20 matched controls.

Results: Increased levels of soluble adhesion molecules were found in women with hypertensive complications compared to women with uncomplicated pregnancies shortly after delivery. Significant differences were still present, several years after delivery comparing levels of adhesion molecules in women with a history of HELLP syndrome with those found in control patients.

Conclusions: Patients with hypertensive pregnancies showed an abnormal activation of the endothelium which persists after pregnancy. This activation was particularly marked in patients experiencing HELLP syndrome. These observations may represent an explanation to the increased risk of CVD later in life in patients experiencing hypertensive pregnancies, especially in women with a history of HELLP syndrome.

Keywords: Adhesion molecules; Cardiovascular diseases; Endothelial activation; Pregnancy induced hypertension.