Womens risk of cardiovascular disease and innovative interventions
Access status:
Open Access
Type
ThesisThesis type
Doctor of PhilosophyAuthor/s
Marschner, Simone LouiseAbstract
Women having prior pregnancy-related cardiometabolic conditions including gestational diabetes (GDM) and hypertensive disorders of pregnancy (HDP) are at elevated risk of future CVD, but little evidence is available about the short-term risk. Utilising US Medicaid data we estimated ...
See moreWomen having prior pregnancy-related cardiometabolic conditions including gestational diabetes (GDM) and hypertensive disorders of pregnancy (HDP) are at elevated risk of future CVD, but little evidence is available about the short-term risk. Utilising US Medicaid data we estimated an age-adjusted odds ratio of 3.1 (95% CI: 2.7– 3.5) for a severe cardiovascular event within 60 days of delivery. We identified suboptimal primary care assessment of CVD risk factors among women with GDM utilising electronic health records from general practitioner sites run by Australia’s National Prescribing Service (NPS), with 29.4% (95% CI: 28.5%–30.3%) not screened for TD2M, 37.4% (95% CI: 36.5%–38.3%) having no lipids measured and 2.2% (95% CI: 1.9%–2.5%) having no blood pressure measurements. Utilising baseline data from the randomised study SMARTMUMS2 we found that only 46.9% (95% CI: 39.5%–54.2%) of women currently pregnant with GDM understood they were at high risk of T2DM. A prospective before and after study found that Women’s Heart Clinics (WHC) intervention was associated with improvements in blood pressure targets (from 69.2% to 80.5%, p=0.04) but not lipid targets (80.6% to 83.7%, p=0.18). Randomised clinical trials were designed to assess the effect of improving lifestyle using texting complemented with an activity monitor and utilising a Computed Tomography coronary artery calcium score guided cardiovascular prevention intervention. This thesis identified that women with past pregnancy-related cardiometabolic conditions have an increased risk of both short-and long-term CVD, are sub-optimally screened for CVD risk factors and, only half are aware of their high risk. WHCs are a viable intervention for improving risk factor control but may not be cost-effective. More research and novel ideas are needed to increase screening and CVD risk factor management among women with a pregnancy-related cardiometabolic conditionto reduce the burden of global CVD.
See less
See moreWomen having prior pregnancy-related cardiometabolic conditions including gestational diabetes (GDM) and hypertensive disorders of pregnancy (HDP) are at elevated risk of future CVD, but little evidence is available about the short-term risk. Utilising US Medicaid data we estimated an age-adjusted odds ratio of 3.1 (95% CI: 2.7– 3.5) for a severe cardiovascular event within 60 days of delivery. We identified suboptimal primary care assessment of CVD risk factors among women with GDM utilising electronic health records from general practitioner sites run by Australia’s National Prescribing Service (NPS), with 29.4% (95% CI: 28.5%–30.3%) not screened for TD2M, 37.4% (95% CI: 36.5%–38.3%) having no lipids measured and 2.2% (95% CI: 1.9%–2.5%) having no blood pressure measurements. Utilising baseline data from the randomised study SMARTMUMS2 we found that only 46.9% (95% CI: 39.5%–54.2%) of women currently pregnant with GDM understood they were at high risk of T2DM. A prospective before and after study found that Women’s Heart Clinics (WHC) intervention was associated with improvements in blood pressure targets (from 69.2% to 80.5%, p=0.04) but not lipid targets (80.6% to 83.7%, p=0.18). Randomised clinical trials were designed to assess the effect of improving lifestyle using texting complemented with an activity monitor and utilising a Computed Tomography coronary artery calcium score guided cardiovascular prevention intervention. This thesis identified that women with past pregnancy-related cardiometabolic conditions have an increased risk of both short-and long-term CVD, are sub-optimally screened for CVD risk factors and, only half are aware of their high risk. WHCs are a viable intervention for improving risk factor control but may not be cost-effective. More research and novel ideas are needed to increase screening and CVD risk factor management among women with a pregnancy-related cardiometabolic conditionto reduce the burden of global CVD.
See less
Date
2024Licence
Copyright All Rights ReservedRights statement
The author retains copyright of this thesis. It may only be used for the purposes of research and study. It must not be used for any other purposes and may not be transmitted or shared with others without prior permission.Faculty/School
Faculty of Medicine and Health, Westmead Clinical SchoolAwarding institution
The University of SydneyShare