High cholesterol during pregnancy a harbinger of serious heart attack in offspring

Having high cholesterol during pregnancy is associated with more serious acute myocardial infarction (AMI) in offspring in later life, suggests a retrospective study.  

“Cholesterol is not routinely measured during pregnancy in most countries so there are few studies on its association with the health of offspring,” said study author lead author Dr Francesco Cacciatore from the University of Naples Federico II in Naples, Italy.

Participants in the retrospective study were 310 individuals who were hospitalized between 1991 to 2019. Among these, 89 patients (mean age 47 years, 84 percent men) were admitted due to an AMI, while the remaining 221 people were admitted for other causes and served as controls. The patients were categorized based on the severity of their AMI, with severe AMI defined by the number of coronary arteries implicated (three arteries), left ventricle ejection fraction (≤35), peak levels of creatinine kinase (CK; >1,200 mg/dL) or CK-MB (>200 mg/dL).

The researchers found that maternal cholesterol during pregnancy was independently predictive of AMI severity, regardless of gender, age, BMI, serum cholesterol level after hospitalization, and number of cardiovascular risk factors (odds ratio [OR], 1.382; p=0.023). [Eur J Prev Cardiol 2021;doi: 10.1093/eurjpc/zwab152]

Among AMI cases, maternal cholesterol during pregnancy was associated with AMI severity in four aspects: number of vessels involved (β=0.382; p=0.001), CK (β=0.260; p=0.014), CK-MB (β=0.334; p=0.001), ejection fraction (β=−0.315; p=0.003), and survival time (β=−0.252; p=0.031).

“Our observations suggest that a mother’s cholesterol level during pregnancy impacts the developmental programming of offspring and heart attack severity in adulthood,” said Cacciatore.

“The present study supports the clinically relevant conclusion that MCP is an important independent risk factor not only for childhood atherogenesis, but for the severity of AMI in young adults,” he continued. “This suggests that MCP should be included among risk factors prompting more intensive screening and primary prevention in high-risk children.”

However, given the observational nature of the study, no causal relationship can be drawn, he pointed out. While the study established a link between maternal cholesterol during pregnancy and AMI severity, it did not provide estimates on the threshold of maternal cholesterol levels that might contribute to the association.

As data on maternal dietary and lifestyle confounders were unavailable, this constitutes a major limitation of the findings, according to the researchers.

“More research is needed to verify our findings,” said Cacciatore. “Prospective studies are needed to better evaluate the magnitude by which maternal cholesterol may influence the development of atherosclerosis in offspring and the combined effect of risk factors throughout the life.”

“If confirmed, this association would indicate that high cholesterol in pregnancy should be considered a warning sign and women should be encouraged to exercise and reduce their cholesterol intake. In addition, affected children could be provided dietary and lifestyle guidance aimed at preventing heart disease later in life,” he suggested.