CONCLUSIONS— Our study is the
first of its kind to show that young women
with GDM have a substantially increased
risk for CVD relative to women without
GDM. The subsequent development of
type 2 diabetes accounts for much of this
increased risk, which reinforces the vital
need for diabetes prevention strategies in
this high-risk population.
Our findings are consistent with a
cross-sectional study conducted by Carr
et al. (5), which reported that women
with a history of GDM had odds ratios for
CVD and CAD similar to those reported
here (1.85 and 1.58, respectively). However,
this study was cross-sectional and
relied on retrospective self-report to ascertain
exposures and outcomes. In contrast,
our cohort study used a more
rigorous end point assessment and followed
a much larger population of
women over many years.
Our study used administrative data
where clinical information, such as cardiovascular
risk factors, was unavailable.
Women with GDM exhibit chronic insulin
resistance (8), which is associated with
a clustering of risk factors that are in the
causal pathway to CVD. Therefore,
women with GDM likely have very different
risk factor profiles than those without
GDM, and adjusting for these differences
might obscure a clinically important association
between GDM and CVD.
In summary, women withGDMare at
increased risk for CVD events compared
with women without GDM, and much of
this risk is attributable to the subsequent
development of type 2 diabetes. As diabetes
prevention interventions in women
with a history of GDM have also been
shown to slow progression of atherosclerosis
(9), this study highlights the importance
of diabetes prevention for this highrisk
population
CONCLUSIONS— Our study is the
first of its kind to show that young women
with GDM have a substantially increased
risk for CVD relative to women without
GDM. The subsequent development of
type 2 diabetes accounts for much of this
increased risk, which reinforces the vital
need for diabetes prevention strategies in
this high-risk population.
Our findings are consistent with a
cross-sectional study conducted by Carr
et al. (5), which reported that women
with a history of GDM had odds ratios for
CVD and CAD similar to those reported
here (1.85 and 1.58, respectively). However,
this study was cross-sectional and
relied on retrospective self-report to ascertain
exposures and outcomes. In contrast,
our cohort study used a more
rigorous end point assessment and followed
a much larger population of
women over many years.
Our study used administrative data
where clinical information, such as cardiovascular
risk factors, was unavailable.
Women with GDM exhibit chronic insulin
resistance (8), which is associated with
a clustering of risk factors that are in the
causal pathway to CVD. Therefore,
women with GDM likely have very different
risk factor profiles than those without
GDM, and adjusting for these differences
might obscure a clinically important association
between GDM and CVD.
In summary, women withGDMare at
increased risk for CVD events compared
with women without GDM, and much of
this risk is attributable to the subsequent
development of type 2 diabetes. As diabetes
prevention interventions in women
with a history of GDM have also been
shown to slow progression of atherosclerosis
(9), this study highlights the importance
of diabetes prevention for this highrisk
population
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