Prevention of Vascular Dysfunction after Preeclampsia: A Potential Long-Term Outcome Measure and an Emerging Goal for Treatment

Table 1

Studies assessing the long-term impact of preeclampsia on vascular function. AIx (augmentation index) and PWV (pulse wave velocity) are robust surrogate markers of aortic stiffness. Endothelial-mediated vasodilatation was measured in conduit arteries by FMD (flow-mediated dilatation) and in the resistance arteries using VOP (venous occlusion plethysmography) to measure FBF (forearm blood flow) or peripheral arterial tonometry (PAT) to measure RHI (reactive hyperaemic index). Mircovascular endothelial responses were quantified in the microcirculation using LDF (laser Doppler flowmetry) and iontophoresis. SGA refers to small for gestational age.

Study	Subjects (Preeclampsia/control)	Interval after delivery	Vascular measures	Results in women with previous preeclampsia
Aortic stiffness
Robb et al. 2009 [13]	15/22	7 weeks	AIx, PWV	Elevated PWV and AIx.
Yinon et al. 2010 [14]	24/16	6–24 months	AIx	Increased AIx in women with early onset preeclampsia.
Evans et al. 2011 [15]	18/50	6–36 months	PWV	No significant differences in central arterial stiffness.
Páez et al. 2009 [16]	20/20	2 years	PWV, AIx	Elevated PWV and AIx.
Elvan-Taşpinar et al. 2005 [17]	44/46	4–56 months	PWV	Elevated PWV.
Lampinen et al. 2006 [18]	30/21	5-6 years	AIx	No significant differences in AIx.
Subclinical atherosclerosis
Blaauw et al. 2006 [19]	22/22	≥3 months	Femoral and carotid IMT	Increased IMT with early onset preeclampsia.
Conduit artery endothelial function
Kuscu et al. 2003 [20]	15/11	2 and 6 weeks	FMD	Reduced FMD both during pregnancy and postpartum; (no control data postpartum).
Noori et al. 2010 [21]	45/21	12 weeks	FMD	No significant differences in FMD compared to controls.
Yinon et al. 2010 [14]	24/16	6–24 months	FMD	Reduced FMD in women with early onset preeclampsia.
Hamad et al. 2007 [22]	18/17	15±3 months	FMD	Reduced FMD and endothelial independent dilatation in women with severe preeclampsia.
Germain et al. 2007 [23]	25/22	16±3.5 months	FMD	Reduced FMD.
Páez et al. 2009 [16]	20/20	2 years	FMD	Reduced FMD.
Chambers et al. 2001 [24]	113/48	3 years median	FMD	Reduced FMD particularly in women with recurrent preeclampsia and recovery of endothelial function with ascorbic acid.
Resistance artery endothelial function
Lommerse et al. 2007 [25]	32/10	0.64–1.6 years	VOP	No significant difference in FBF.
Agatisa et al. 2004 [26]	16/14	9.9±0.5 months	VOP	Reduced endothelium-mediated FBF.
Evans et al. 2011 [15]	18/50	6–36 months	VOP	Reduced FBF in response to mental stress.
Lampinen et al. 2006 [18]	30/21	5-6 yrs	VOP	Significantly reduced FBF to acetylcholine (ACh) and sodium nitroprusside (SNP).
Kvehaugen et al. 2011 [27]	26/17	5–8 years	PAT	RHI comparable between preeclamptic women and controls. Women with SGA baby had significantly lower RHI.
Cutaneous microvascular function
Khan et al. 2005 [28]	15/54	6 weeks	LDF and iontophoresis	No significant differences between women in endothelial dependent or independent microvascular dilatation.
Blaauw et al. 2005 [29]	25/23	7.0±2.8 months	LDF and iontophoresis	Greater microvascular vasodilator responses in preeclampsia.
Ramsay et al. 2003 [30]	10/10	16–25 years	LDF and iontophoresis	Reduced response to endothelial-dependent and -independent dilatation.