Preeclampsia y riesgo cardiovascular: estudio de seguimiento en la población de GenPE en Colombia / Pre-eclampsia and cardiovascular risk: a follow-up study of the GenPE population in Colombia

RESUMEN

Introducción: las mujeres con antecedente de preeclampsia (PE) tienen mayor riesgo de desarrollar enfermedad cardiovascular. El estudio GenPE ha captado gestantes con y sin PE en Colombia durante diez años, haciendo posible hoy evaluar desenlaces cardiovasculares en este grupo. Objetivo: determinar la presencia de enfermedad cardiovascular en mujeres jóvenes expuestas o no a preeclampsia, captadas por el estudio GenPE en Bucaramanga, Colombia. Materiales y métodos: estudio de cohorte que incluyó 106 pacientes –a partir de la cohorte original, 666 pacientes (2005-2010)–, menores de 26 años, primigestantes, sin antecedentes de enfermedades crónicas. Se realizó examen físico y venopunción para glucemia, perfil lipídico, ácido úrico y apolipoproteínas A-I y B. Se evaluó la presencia de hipertensión arterial (HA), obesidad, diabetes mellitus tipo 2 y síndrome metabólico. Se establecieron diferencias entre las mujeres expuestas y no expuestas a preeclampsia y el cambio entre el ingreso a GenPE y el primer seguimiento mediante test Wilcoxon o chi cuadrado y riesgo relativo con IC 95%. Resultados: se encontró asociación entre la exposición a PE con cifras mayores de presión arterial diastólica (p = 0,003) e hipercolesterolemia (p = 0,040). En toda la población existen niveles subóptimos de colesterol HDL y Apo A-I. Al primer seguimiento no se evidencia asociación con desenlaces fuertes, tales como hipertensión arterial, obesidad, diabetes mellitus tipo 2, síndrome metabólico. Conclusión: en una muestra de mujeres colombianas jóvenes expuestas y no expuestas a PE, en un primer seguimiento, en los primeros dos años posteriores al parto, se evidencian cambios en la presión arterial diastólica (PAD), y biomarcadores asociados a riesgo cardiovascular.

ABSTRACT

Introduction: Females having a background of pre-eclampsia (PE) are at greater risk of developing cardiovascular disease. The GenPE study has captured pregnant females with and without PE in Colombia during the last 10 years, making it possible today to evaluate cardiovascular outcomes in this group. Objective: Determining the presence of cardiovascular disease in young females who were and were not exposed to preclampsia and who were recruited by the GenPE study carried out in Bucaramanga, Colombia. Materials and methods: This was a cohort study which included 106 primiparous patients aged less than 26 years old having no background of chronic disease taken from an original cohort of 666 patients (2005-2010). They were physically examined and venopuncture was made for glycemia, lipid profile, uric acid and apolypoprotein A-I and B. The presence of hypertension, obesity, type 2 diabetes mellitus and metabolic syndrome were evaluated. Differences were established by Wilcoxon or Chisquared tests (relative risk and 95% CI) between females who had been exposed to PE and those who had not been so and the change between entering the GenPE study and the first follow-up. Results: An association was found between exposure to PE and having higher diastolic pressure figures (p = 0.003) and hypercholesterolemia (p = 0.040). Sub-optimal HDL cholesterol and apo A-I levels were found in the whole population. No association with strong outcomes was found during the first follow-up, such as hypertension, obesity, type 2 diabetes mellitus or metabolic syndrome. Conclusion: Changes in peripheral arterial disease (PAD) and cardiovascular risk-associated biomarkers became evident in a sample of young colombian females who developed PE during the first followup within 2 years after delivery.