Including hypertensive disorders of pregnancy adds little to CVD risk prediction

  • J Am Coll Cardiol

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • Adding hypertensive disorders of pregnancy (HDPs) history and parity to cardiovascular disease (CVD) risk prediction in a low-risk population does not improve risk stratification.

Why this matters

  • Studies have linked HDPs and hypertension in the short and longer term.
  • Editorial says the “importance of this study cannot be overstated” and more research needs to be done.

Key results

  • As independent factors, HDPs and parity showed associations with 10-year CVD risk:
    • No HDP, 1 birth: HR, 1.42 (95% CI, 1.12-1.80) vs no HDP and 2 births.
    • HDP, 2 births: HR, 2.02 (95% CI, 1.50-2.72) vs no HDP and 2 births.
  • Adding them to the model did not affect risk reclassification or improve discrimination overall.
  • However, greater CVD risk for history of no HDP/1 birth or HDP/2 births persisted for women aged 40-49 years.

Study design

  • n=67,406 women, Nurses’ Health Study II.
  • Age ≥40 years, no CVD history.
  • Followed for fatal coronary heart disease, myocardial infarction, stroke, 1989-2013.
  • 2 models were used:
    • Total cholesterol, high-density lipoprotein cholesterol, systolic BP, antihypertensives use, current smoking, diabetes, or
    • All of the above plus HDP and parity.
  • Predicted probabilities for 10-year CVD risk vs CVD outcomes.
  • Funding: NIH.

Limitations

  • Self-reported BP values, cholesterol levels not directly measured.

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