Pre-eclampsia, hypertensive disorders of pregnancy and risk for cardiovascular disease

  • Leon LJ & al.
  • Circulation
  • 24 Sep 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Women with any hypertensive disorders of pregnancy (HDP), especially pre-term pre-eclampsia are at an increased risk for all cardiovascular (CV) disorders and chronic hypertension.
  • The effect was apparent within 1 year of the first index pregnancy.

Why this matters

  • Findings suggest that the diagnosis of HDP can be used as a natural screening tool to detect women at higher risk for CV events.

Study design

  • 1,899,150 unique pregnancies from 1,303,365 women were identified using the Clinical Practice Research Datalink (CPRD) and Hospital Episodes Statistics (HES) database.
  • Funding: The National Institute for Health Research Professorship.

Key results

  • After a median follow-up of 9.25 (interquartile range, 5.53-13.78) years, 18,624 first incident and 21,798 total any type of CV events were reported.
  • Of 18,624 first CV events, 12,129 (65.12%) occurred in women
  • Compared with women without pre-eclampsia, women who had 1 or more pregnancies affected by pre-eclampsia were at an increased risk for:
    • stroke (HR, 1.9; 95% CI, 1.53-2.35),
    • cardiac atherosclerotic events (HR, 1.67; 95% CI, 1.54-1.81),
    • peripheral events (HR, 1.82; 95% CI, 1.34-2.46),
    • heart failure (HR, 2.13; 95% CI, 1.64-2.76),
    • atrial fibrillation (HR, 1.73; 95% CI, 1.38-2.16),
    • CV deaths (HR, 2.12; 95% CI, 1.49-2.99) and for
    • chronic hypertension (HR, 4.47; 95% CI, 4.32-4.62).
  • Similar patterns of association were observed for HDP, while pre-term pre-eclampsia showed slightly further elevated risks.
  • Differences in cumulative incidence of any CV events according to pre-eclampsia status were apparent within 1 year of the first index pregnancy.

Limitations

  • Possible risk for residual confounding.

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