Abstract Body: Background: Gestational diabetes mellitus (GDM) increases the risk of suboptimal cardiovascular health (CVH). The association of GDM with overall CVH and predicted cardiovascular disease (CVD) risk in mid-life remains to be defined among South Asian women in the US, a subgroup at excess risk for CVD.

Methods: In female participants of the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study with a history of ≥1 live birth, we examined the association between self-reported GDM history with Life’s Essential 8 (LE8) CVH score (scale 0-100) and 10-year predicted CVD risk calculated by the base and HbA1c-enhanced PREVENT total CVD risk models. Multivariable linear regression models adjusted for age, site, parity, and post-menopausal status. Additional models adjusted for social determinants of health inclusive of income, education, years lived in the United States, and acculturation per the validated traditional cultural beliefs scale.

Results: Among 511 participants, 48 (9.4%) reported a history of GDM, mean (SD) age was 55.9 (8.7) years, and participants lived in the U.S. for a mean 26.9 (11.5) years. There were 70 participants (13.7%) with a parity of 1, 320 (62.6%) with a parity of 2, and 121 (23.7%) with a parity of ≥3. Mean (SD) LE8 CVH score was 68 (12). Median (25th, 75th percentile) PREVENT 10-year total CVD risk was 4.0% (1.8%, 7.5%) in the base model and 4.1% (2.0%, 7.7%) in the HbA1c-enhanced model. GDM history was significantly associated with lower (i.e., worse) LE8 CVH score and higher PREVENT 10-year predicted CVD risk (Table). After adjustment, GDM was associated with a 3.9-point lower LE8 CVH score (95% CI [-7.5, -0.4]), a 1.5% (0.4, 2.5) higher absolute 10-year predicted total CVD risk in the PREVENT base model, and a 1.9% (0.8, 2.9) higher absolute 10-year predicted total CVD risk in the PREVENT HbA1c-enhanced model.

Conclusions: Among U.S. South Asian women in mid-life, a history of GDM was associated with worse CVH and clinically significant higher predicted risk for CVD.