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Abstract

Click to add/remove this article to your list of 'My Favorites' Gestational Diabetes Increases the Risk of Cardiovascular Disease in Young Women

Year: 2008

Abstract Number: 27-OR

Authors: BAIJU R. SHAH, RAVI RETNAKARAN, GILLIAN L. BOOTH, Toronto, ON, Canada

Institutions: Toronto, ON, Canada

Results: Women diagnosed with gestational diabetes (GDM) are at very high risk of subsequently developing type 2 diabetes, as well as other metabolic abnormalities including obesity, hypertension, dyslipidemia and metabolic syndrome. However, despite these well-established associations with vascular risk factors, it is not known if GDM predicts an increased risk of cardiovascular disease (CVD). Given the relatively low likelihood of CVD in women of childbearing age, the demonstration of such an association would require a very large study cohort followed for many years. Thus, in this context, we used population-based administrative data to determine whether GDM increases the risk for CVD in young women, and whether any increase in risk is independent of subsequent type 2 diabetes. We identified all women who delivered in Ontario, Canada, between April 1994 and March 1997. Women with pre-existing diabetes or CVD were excluded. Each woman who had GDM was matched with up to 10 who did not, matching on age, region, socioeconomic status and year of delivery. Each cohort was followed until March 2006 for the primary outcome of hospitalization for myocardial infarction (MI), stroke, coronary artery bypass, coronary angioplasty or carotid endarterectomy. A secondary outcome of MI, bypass or angioplasty was pre-specified. Kaplan-Meier survival curves were plotted, and Cox proportional hazards regression was used to adjust for GDM status, with and without adjustment for subsequent diagnosis of type 2 diabetes as a time-dependent covariate. There were 351,685 eligible women, of whom 8,194 (2.3%) had GDM. The matched cohorts included 8,191 women with GDM and 81,262 without. The mean age was 31 years in both groups. Over median follow-up of 11.5 years, GDM was associated with both the primary and secondary outcomes (see Figure). In both cases, the association was attenuated by adjustment for the development of type 2 diabetes. This study shows that GDM substantially increases the risk for CVD, even in young women. Much of this increased risk is attributable to subsequent development of type 2 diabetes, which reinforces the need for early diabetes prevention strategies in this at-risk population.[figure1]

Category: Epidemiology

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