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Epi associations between hypertensive disorders of pregnancy (HDP, e.g., preeclampsia) and cardiometabolic risk factors are well-described, but are these relationships causal?
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.047936
Epi associations between hypertensive disorders of pregnancy (HDP, e.g., preeclampsia) and cardiometabolic risk factors are well-described, but are these relationships causal?
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.047936
We constructed genetic instruments for SBP, DBP, BMI, 
rate, LDL-C, T2D, + smoking and tested associations w/ HDP in parous women in @uk_biobank
We also created genetic proxies for beta blockers, CCBs, + nitrates (
-compatible meds)
rate, LDL-C, T2D, + smoking and tested associations w/ HDP in parous women in @uk_biobank We also created genetic proxies for beta blockers, CCBs, + nitrates (
-compatible meds)
SBP + DBP genetic risk associated w/ HDP (OR 1.22/SD, P<2e-16 for both)
Similar effects for gestational HTN only (OR 1.24) vs. preeclampsia (OR 1.19)
BMI also associated w/ HDP (OR 1.06/SD, P=0.004)
BP + BMI PRS were independent, additive
Implies BP + BMI causal for HDP
Similar effects for gestational HTN only (OR 1.24) vs. preeclampsia (OR 1.19)
BMI also associated w/ HDP (OR 1.06/SD, P=0.004)
BP + BMI PRS were independent, additive
Implies BP + BMI causal for HDP
Implications:
1. Genetic predisposition to
BP + BMI in 
w/ HDP explains + unifies HTN + obesity risks observed throughout lifespan in affected women
2. BP + BMI are viable preventive targets for
ing HDP risk – ‘primordial prevention’ against HDP-associated CVD
1. Genetic predisposition to
BP + BMI in w/ HDP explains + unifies HTN + obesity risks observed throughout lifespan in affected women 2. BP + BMI are viable preventive targets for
ing HDP risk – ‘primordial prevention’ against HDP-associated CVD
Take-
:
1. Genetic predisposition to BP + BMI are associated w/ HDP, implying causal pathways well-positioned for modulation toward HDP prevention
2. Antepartum BP-lowering and weight loss to prevent HDP in at-risk women warrant assessment in adequately powered RCTs
:1. Genetic predisposition to
BP + BMI are associated w/ HDP, implying causal pathways well-positioned for modulation toward HDP prevention 2. Antepartum BP-lowering and weight loss to prevent HDP in at-risk women warrant assessment in adequately powered RCTs
Huge thanks to @KrishnaAragam @DLBHATTMD @sarma_amy @drmalissawood @NanditaScott @pnatarajanmd @MGHHeartHealth @MGH_RI (+ co-authors not on Twitter: Mark Chaffin, Gina Peloso)
#CardioObstetrics #cvPrev #WomensHeartHealth
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.047936
#CardioObstetrics #cvPrev #WomensHeartHealth
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.047936
