Ikeoluwapo Kendra Bolakale-Rufai

Lipoprotein(a) [Lp(a)] is gaining attention as a potential marker for adverse pregnancy outcomes, in addition to its well-established role in cardiovascular disease. This review explores the evolving understanding of Lp(a) in pregnancy, focusing on its links to hypertensive disorders of pregnancy, gestational diabetes mellitus, fetal growth restriction, and preterm birth, while also addressing diagnostic and management challenges. During pregnancy, Lp(a) levels rise substantially, nearly doubling between weeks 10 and 35. Although this increase is universal, its clinical implications are unclear. Lp(a) exerts pro-inflammatory, pro-thrombotic, and pro-atherogenic effects, the mechanisms of which are discussed in detail in the body of this review. However, research into Lp(a)’s specific role in increasing the risk of adverse pregnancy outcomes, such as hypertensive disorders of pregnancy, has produced mixed results, highlighting the need for further investigation. Routine screening for Lp(a) during pregnancy is not standard practice, though some experts suggest that it could be beneficial, particularly for high-risk pregnant people. Similar to managing other cardiovascular disease risk factors, managing elevated Lp(a) during pregnancy requires a comprehensive approach, from preconception counseling to lifestyle adjustments such as improving diet, increasing physical activity, and quitting smoking. Pharmacological options like statins and proprotein convertase subtilisin/kexin type 9 inhibitors have shown promise in non-pregnant populations, but their safety during pregnancy remains a concern, limiting their use. Further research is needed to clarify Lp(a)’s role in adverse pregnancy outcomes and to identify safe, effective treatments for managing elevated Lp(a) levels before and during pregnancy.

Cardiovascular disease is a leading cause of maternal morbidity and mortality. As cardio-obstetric care evolves, digital health technologies including telehealth, wearable devices and remote monitoring are playing an increasingly critical role. These innovations have the potential to enhance cardiovascular screening, risk assessment and disease management across the perinatal continuum. This article explores the role of digital health technologies in advancing cardio-obstetrics care. It focuses on the impact of telehealth, wearable sensors and emerging digital tools on improving maternal cardiovascular outcomes and reducing disparities in care delivery. A narrative review approach was used to synthesize existing literature and clinical insights related to telecardiology, wearable monitoring and digital innovations. Emphasis was placed on applications in pregnancy and post-partum care, as well as on evaluating implementation challenges and equity concerns. Digital health tools improve access to care and facilitate early diagnosis of cardiovascular conditions. Telehealth increases care continuity and patient satisfaction, especially in underserved populations. Wearable devices equipped with photoplethysmography and electrocardiogram sensors enable intermittent, non-invasive monitoring, aiding early detection of arrhythmias and hypertensive disorders. Furthermore, novel technologies such as digital twins, natural language processing and virtual reality show potential to personalize care and support medical education. Despite these advancements, key barriers persist, including data privacy concerns, unequal access to technology and algorithmic bias. Digital health technologies are transforming cardio-obstetrics care by enabling proactive management and expanding access. However, for these tools to deliver equitable benefits, targeted efforts are needed to address privacy, infrastructure and literacy challenges. Future efforts should focus on integrating digital health into routine maternal care, promoting digital literacy, ensuring equitable technology access and improving interoperability with electronic health records. Additionally, ongoing evaluation through clinical trials in high-risk pregnancies and ethical safeguards to mitigate algorithmic bias will be essential to ensure safe, scalable and inclusive implementation of these innovations in maternal cardiovascular care.

Background: Microvascular disease (MVD) describes systemic changes in small vessels (~100 µm diameter or smaller) that impair tissue oxygenation and perfusion. MVD has been demonstrated to play an independent role in the risk of limb loss. Despite this relevance, MVD is not regularly assessed clinically because tools used to evaluate and quantify the severity of MVD of the foot remain limited. We sought to evaluate if the Semmes-Weinstein 10-g Monofilament (SWM) can be used to stratify clinical MVD severity. Methods: We evaluated a racially diverse cohort of 124 patients (with 248 limbs). SWM testing was performed on the plantar aspect of the feet at 1st, 3rd^, and 5th metatarsophalangeal joints. Clinical MVD was stratified in an ascending order of severity into: no diabetes; type 2 diabetes (DM); diabetes+ neuropathy (DM+N); diabetes + neuropathy + retinopathy (DM+N+R). Logistic regression models were used to examine the association between a patient’s clinical MVD severity and an abnormal SWM test. Results: Sixty-four patients (51.6%) tested had an abnormal sensation. The odds of an abnormal SWM test were significantly higher for patients with DM+N and DM+N+R compared to those with no DM respectively. (DM vs. No DM: OR: 3.58, [0.98–13.09], p = 0.05; DM+N vs. No DM: OR: 30.46, [10.33–105.17], p < 0.001; DM+N+R vs. No DM: OR: 43.00, [9.89–309.17], p < 0.001). Furthermore, we categorized SWM based on the degree of sensation loss and found that the proportion of people with a higher degree of sensation loss increased across the clinical MVD severity spectrum. Conclusions: Abnormal SWM sensation strongly correlates with the severity of clinical MVD. This suggests that a simple, non-invasive, 1-min SWM test that can be done in the clinic is a promising tool in assessing MVD in the feet, which is particularly significant considering MVD involvement in limb loss.

BACKGROUND: It is unknown whether predelivery cardiology care is associated with future risk of major adverse cardiovascular events (MACE) in preeclampsia/eclampsia (PrE/E). We sought to determine the cumulative incidence of MACE by race and whether predelivery cardiology care was associated with the hazard of MACE up to 1 year post-delivery for Black and White patients with PrE/E. METHODS: Using Optum’s de-identified Clinformatics Data Mart Database, we identified Black and White patients with PrE/E who had a delivery between 2008 and 2019. MACE was defined as the composite of heart failure, acute myocardial infarction, stroke, and death. Cumulative incidence functions were used to compare the incidence of MACE by race. Regression models were used to assess the hazard of MACE by cardiology care for each race. Separate hazards were calculated for the first 14 days and the remainder of the year. RESULTS: Among 29 336 patients (83.4% White patients, 16.6% Black patients, 99.5% commercially insured, mean age: 30.9 years) with PrE/E, 11.2% received cardiology care (10.9% White patients, 13.0% Black patients). Black patients had higher incidence of MACE than White patients at 1 year post-delivery (2.7% versus 1.4%) with the majority within 14 days of delivery (Black patients: 58.7%; White patients: 67.8%). After adjusting for age and comorbidities, receipt of cardiology care was associated with a lower hazard of MACE for White patients within 14 days after delivery (hazard ratio, 0.31 [95% CI, 0.21–0.46]; P P =0.999). The effect of the interaction between race and cardiology care was significant in the first 14 days ( P P =0.56). CONCLUSIONS: Among a well-insured population of patients with PrE/E, Black patients had a higher cumulative incidence of MACE up to a year post-delivery. Cardiology care was associated with a lower hazard of MACE only for White patients during the first 14 days after delivery.

Aims: Racial disparities exist in clinical outcomes for valvular heart disease (VHD). It is unknown whether clinician segregation contributes to these disparities. Among an adequately insured population, we evaluated the relationship between clinician segregation in a hospital and receipt of care by a cardiologist according to patient race. We also evaluated the association between clinician segregation, race and care by a cardiologist on 30-day readmission and 1-year survival. Methods and results: Using Optum’s Clinformatics® Data Mart Database (CDM, US commercial and Medicare beneficiaries) from 2010 to 2018, we identified patients with a primary diagnosis of VHD. Hospitals were categorized into low, medium and high segregation groups (SG), according to clinician segregation index (SI). SI can range from 0–1 (0: the ratio of Black to White patients is the same for all clinicians; 1: each clinician treats only Black or only White patients). Outcomes were analysed using generalized linear mixed effect models. Among 8649 patients [median age 75 (67–82), 45.4% female, 16.1% Black, 83.9% White], odds of care from a cardiologist did not vary across race for all SGs [Low SG adjusted odds ratio (aOR): 0.79 (95% CI: 0.58–1.08), P = 0.14; Medium SG aOR: 0.86 (95% CI: 0.60–1.25), P = 0.43; High SG aOR: 1.07 (95% CI: 0.68–1.69), P = 0.76]. Among those that received care from a cardiologist, there was no difference in the 30-day readmission between Black and White patients across SGs [Low SG aOR: 1.05 (95% CI: 0.83–1.31), P = 0.70; Medium SG aOR: 1.22 (95% CI: 0.92–1.61), P = 0.17; High SG aOR: 0.81 (95% CI: 0.57–1.17), P = 0.27]. Among patients that did not receive care from a cardiologist, Black patients in low SG had higher odds of 30-day readmission compared to White patients [aOR: 2.74 (95%CI:1.38–5.43), P < 0.01]. Odds of 1-year survival were similar across race for all SG irrespective of receipt of care from a cardiologist [seen by a cardiologist: Low SG aOR: 1.13 (95% CI: 0.86–1.48), P = 0.38; Medium SG aOR: 0.83 (95% CI: 0.59–1.17), P = 0.29; High SG aOR: 1.01 (95% CI: 0.66–1.52), P = 0.98; not seen by a cardiologist: Low SG aOR: 0.56 (95% CI: 0.23–1.34), P = 0.19; Medium SG aOR: 0.81 (95% CI: 0.28–2.37), P = 0.70; High SG aOR: 0.63 (95% CI: 0.23–1.74), P = 0.37]. Conclusions: Among an insured population, race was not associated with care by a cardiologist for VHD or survival. Black patients not seen by cardiologists had higher odds of 30-day readmission in low clinician SG.

The microvasculature (with vessels <100 μm in diameter) plays a crucial role in tissue oxygenation, perfusion and wound healing in the lower limb. While this holds clinical significance, microvasculature evaluation in the limbs is not a standard practice. Surgical interventions focus on reestablishing blood flow in larger vessels affected by the peripheral artery disease (PAD). Nevertheless, the impact of revascularization on tissue oxygenation and perfusion in severe microvascular disease (MVD) is still unknown. We present the cases of two patients who underwent surgical revascularization for peripheral blood flow with different outcomes. Patient A had PAD, while B had PAD, severe MVD and a non-healing wound. Although both showed improvements in ankle-brachial index post-op, spatial frequency domain imaging metrics (which measure microvascular oxygenation and perfusion) remained unchanged in B, indicating a potential gap in assessing the surgical efficacy in MVD using ankle brachial index and emphasizing microcirculation evaluation in optimizing wound healing outcomes.