Biomarkers used to predict heart failure risk in the general population may be ineffective for assessing risk after pregnancies complicated by hypertension or diabetes, according to a study published in JAMA Cardiology.
Several adverse pregnancy outcomes, including preeclampsia and gestational diabetes, have been linked to long-term heart health risks for pregnant women, said Priya Freaney, MD, ’22 GME, assistant professor of Medicine in the Division of Cardiology, who was first author of the study.
“We know that features of complicated pregnancies can impact a woman’s heart disease risk decades later,” Freaney said. “It’s important for us to have some way to track and screen the patients that have pregnancy complications to further clarify if someone’s on a high-risk path toward heart disease and help bring their risk down with aggressive screening, prevention or early implementation of therapies.”
In the study, Freaney and her collaborators tracked levels of NT-proBNP, a biomarker for heart failure, in more than 4,000 pregnancies at medical centers across the country. Investigators found that one in 17 individuals had elevated levels several years after pregnancy, indicating that their hearts were experiencing stress. However, the presence of hypertension and gestational diabetes during pregnancy did not correlate with higher levels of NT-proBNP in the years following.
“The findings of the study really surprised us because the individuals who had hypertensive disorders of pregnancy and gestational diabetes had lower rates of NT-proBNP, contrary to what we would have expected, since we know these diseases are associated with higher heart failure risk; and we also know in the general population, an elevation in this biomarker signals that patients have an accelerated risk for heart failure,” Freaney said. “This biomarker may not be the right biomarker to be used in this postpartum population for heart failure screening as it is commonly used in other populations, and we need more investigation into other biomarkers and other ways to screen for heart failure in the years after complicated pregnancies.”
Moving forward, Freaney and her collaborators will work to identify additional biomarkers that can be used to predict heart failure risk in people following pregnancies complicated by preeclampsia or gestational diabetes.
“We’re also looking at how we can add imaging, so not just using blood-based biomarkers, but how do we correlate these findings with what’s actually seen in the heart muscle a few years after delivery,” Freaney said.
This study was funded by grants U10 HD063036, U10 HD063072, U10 HD063047, U10 HD063037, U10 HD063041, U10 HD063020, U10 HD063046, U10 HD063048, and U10 HD063053 from the National Institute of Child Health and Human Development. Additional funding was provided by the Clinical and Translational Science Institutes; the National Heart, Lung, and Blood Institute; the National Center for Advancing Translational Sciences; the Barbra Streisand Women’s Cardiovascular Research and Education and the Erika J. Glazer Women’s Heart Research Initiative,
