Altered Coronary Arterial Reactivity Following Pharmacological Perinatal Interventions

E xtensive epidemiological evidence indicates that indi-viduals who have a low weight at birth or who show signs of disproportionate foetal growth have an increased risk of high blood pressure, stroke and coronary artery disease in later life [1]. The association between small size at birth and cardiovascular disease is specific, since death rates from non-cardiovascular disease (with the exception of chronic ob-structive airways disease) are independent of birth weight. The association is also graded, since the standardised mortal-ity ratio for coronary artery disease falls with increasing birth weight. These data led to the hypothesis that differences in the uterine environment of the foetus could permanently change the body’s structure, physiology and metabolism to increase susceptibility to disease in later life. Two concepts are relevant to this hypothesis. Firstly, that there are “critical periods ” of development in later foetal life at which the tis