Smoking during pregnancy could adversely affect children’s HDL levels
Ayer J. Eur Heart J. 2011;doi:10.1093/eurheartj/ehr174.
Data from a community-based longitudinal study have indicated that 8-year-old children whose mothers smoked during pregnancy had lower HDL levels while also having higher triglycerides and systolic BP.
“The prevalence of maternal smoking during pregnancy remains high, [about] 15% in many Western countries,” the researchers wrote. “The documented associations between smoking in pregnancy and childhood behavioral problems, neurocognitive deficits and sudden infant death syndrome highlight the potential for smoking to result in adverse fetal programming. The independent effect of prenatal exposure to cigarette smoke on the risk of future CVD, however, remains uncertain.”
Researchers performed a prospective analysis, culling data from questionnaires that were completed by face-to-face interviews of mothers soon after giving birth, which assessed their smoking status during the first, second and third trimesters. At the beginning of the study, 616 newborn infants were included in the analysis, and data on 405 of these children who reached 8 years of age were available.
Overall, women who smoked in pregnancy tended to have lower levels of education and shorter breast-feeding duration. At 8 years of age, children whose mothers smoked during pregnancy had lower levels of HDL (1.32 mmol/L vs. 1.50 mmol/L; P=.0005], as well as higher systolic BP (102.1 mm Hg vs. 99.9 mm Hg; P=.006) and triglycerides (1.36 mm Hg vs. 1.20 mmol/L; P=.04). However, no significant difference regarding carotid intima-media thickness was observed.
After multivariable adjustment, smoking during pregnancy remained predictive of lower HDL levels in children (P=.003), although not higher systolic BP (P=.07).
These data, the researchers concluded, “may be important for informing population-based prevention of atherosclerosis, as smoking in pregnancy remains common and HDL cholesterol has important atheroprotective functionality.”
This is a novel study of importance that extends our knowledge about long-term adverse effects on offspring of smoking during pregnancy. Lower levels of HDL that persist in childhood is clear evidence of formative pre-natal conditioning that has long-term consequences and while the mechanistic pathway(s) are not understood, the implications are clear - smoking during pregnancy sets the child up for CVD. Renewed efforts must address the smoking epidemic among younger women today.
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Intensive statin therapy may increase risk for new-onset diabetes
Preiss D. JAMA. 2011;305:2556-2564.
An analysis of data from previously published studies revealed an increased risk for new-onset diabetes with intensive-dose statin therapy as compared with moderate-dose therapy.
Pooled results from five statin trials indicated that, of 32,752 participants without diabetes, 8.4% developed diabetes during a mean follow-up of about 5 years. Diabetes developed in 1,449 of those assigned to intensive-dose statin therapy and 1,300 assigned to moderate-dose therapy.
The researchers calculated an OR of 1.12 (95% CI, 1.04-1.22) for new-onset diabetes in patients who received intensive statin therapy vs. moderate therapy. Data also showed that two more cases of incident diabetes occurred per 1,000 patient-years among those who received intensive treatment (18.9) compared with those who received moderate therapy (16.9). Consequently, the researchers found that the number needed to harm was 498 per year for intensive therapy as compared with moderate therapy.
In contrast, intensive therapy conferred cardiovascular benefits. In those who received intensive therapy, 3,134 patients experienced CV events compared with 3,550 who received moderate therapy. Compared with moderate therapy, the researchers calculated an OR of 0.84 (95% CI, 0.75-0.94) for CV events in patients who received intensive therapy. Further, 6.5 fewer first major CV events occurred per 1,000 patient-years in the intensive-dose group (44.5) vs. the moderate-dose group (51). These results suggested that the number needed to treat to prevent one CV event per year was 155.
According to other results, the risk for incident diabetes was similar among patients who received an 80-mg dose of simvastatin (Zocor, Merck) and those who received an 80-mg dose of atorvastatin (Lipitor, Pfizer), although high-dose atorvastatin was associated with greater reductions in risk for CV events.
“Our findings suggest that clinicians should be vigilant for the development of diabetes in patients receiving intensive statin therapy,” the researchers concluded.