Pré-eclâmpsia e riscos latentes após o parto (estudo PERLA-Brasil): biomarcadores do metabolismo lipídico em mulheres com histórico de pré-eclâmpsia

Abstract

Preeclampsia (PE) is a gestational complication associated with an increased long-term cardiovascular risk. However, the mechanisms underlying this association are not yet fully understood. Dyslipidemia and elevated body mass index (BMI) are among the most significant contributors to the development of cardiovascular diseases. Although dyslipidemia has been previously investigated in women with a history of PE to identify potential dysfunctions explaining the increased cardiovascular risk in this group, the results are inconsistent, and the optimal timing to initiate cardiovascular risk screening remains uncertain. PCSK9, a protein that regulates plasma LDL levels, plays a crucial role in this context. Increased PCSK9 levels can impair LDL clearance from circulation, contributing to increased plasma LDL cholesterol levels. Given the possibility of PCSK9 alterations preceding clinical symptom onset, this study aimed to investigate PCSK9 levels and their role in lipid metabolism in women with a history of PE compared to women with a history of normotensive pregnancies. This retrospective cohort study included 205 women, of whom 103 had a history of PE, and 102 had a history of normotensive pregnancies. Lipid profiles and plasma PCSK9 levels were analyzed using standardized laboratory methods. Additionally, physical characteristics (weight, BMI, fat percentage, blood pressure, and waist and hip circumferences) and the frequency of chronic conditions (diabetes, hypercholesterolemia, chronic hypertension, and metabolic syndrome) were evaluated. The results indicated that women with a history of PE had lower PCSK9 levels (p<0.001) and higher LDL cholesterol levels (p<0.001) compared to women with a history of normotensive pregnancies. Moreover, women with a history of PE exhibited higher BMI (p=0.004), fat percentage (p=0.008), systolic blood pressure (p<0.001), diastolic blood pressure (p<0.001), and waist circumference (p=0.007). A higher frequency of chronic hypertension (p<0.001) and metabolic syndrome (p=0.027) was also observed in women with a history of PE. In summary, these characteristics are predictive of CVD and highlight the need for periodic follow-up of women after PE. Lifestyle modifications aimed at reducing CVD risk should be implemented earlier in the postpartum period for women who have experienced PE.