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Am J Transl Res. 2016 May 15;8(5):1920-34. eCollection 2016.

Precision test for precision medicine: opportunities, challenges and perspectives regarding pre-eclampsia as an intervention window for future cardiovascular disease.

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Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Logistics University of PAPF Tianjin 300162, China.
Guangdong Women and Children Hospital Guangzhou, Guangdong Province 511400, China.
Department of Radiology, Northwestern University Feinberg School of Medicine Chicago, Illinois 60611, USA.
Faculty of Medicine, Memorial University of Newfoundland Newfoundland and Labrador, 300 Prince Phillip Drive, Canada.
Department of Surgery, Stanford University Palo Alto, California, 94305, USA.


Hypertensive disorders of pregnancy (HDP) comprise a spectrum of syndromes that range in severity from gestational hypertension and pre-eclamplsia (PE) to eclampsia, as well as chronic hypertension and chronic hypertension with superimposed PE. HDP occur in 2% to 10% of pregnant women worldwide, and impose a substantial burden on maternal and fetal/infant health. Cardiovascular disease (CVD) is the leading cause of death in women. The high prevalence of non-obstructive coronary artery disease and the lack of an efficient diagnostic workup make the identification of CVD in women challenging. Accumulating evidence suggests that a previous history of PE is consistently associated with future CVD risk. Moreover, PE as a maladaptation to pregnancy-induced hemodynamic and metabolic stress may also be regarded as a "precision" testing result that predicts future cardiovascular risk. Therefore, the development of PE provides a tremendous, early opportunity that may lead to changes in maternal and infant future well-being. However, the underlying pathogenesis of PE is not precise, which warrants precision medicine-based approaches to establish a more precise definition and reclassification. In this review, we proposed a stage-specific, PE-targeted algorithm, which may provide novel hypotheses that bridge the gap between Big Data-generating approaches and clinical translational research in terms of PE prediction and prevention, clinical treatment, and long-term CVD management.


Pre-eclampsia; cardiac stress test; cardiovascular risk; hypertensive disorders in pregnancy; precision medicine


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