What explains increased CVD risk in women with hypertensive disorders of pregnancy?

  • Haug EB & al.
  • JAMA Cardiol
  • 12 Jun 2019

  • International Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • Women with hypertensive disorders of pregnancy have higher risk for cardiovascular disease (CVD), and traditional CVD risk factors are to blame.
  • BMI and BP are crucial players in explaining the excess CVD risk in these patients, who do not experience increased risk after age 70 years.

Why this matters

  • What underlies the increased CVD risk for women with hypertensive disorders of pregnancy has been unclear.

Key results

  • At ages 40-70 years, women with a history of hypertensive disorders of pregnancy had increased CVD risk vs women with normotensive pregnancies: HR, 1.57 (95% CI, 1.32-1.86).
    • However, this increased risk did not hold up at older ages. 
  • BP, BMI explained 77% of the excess risk seen in women with hypertensive disorders of pregnancy.
  • Glucose (25%), lipid levels (24%) explained less of the increase.
  • Little difference between types of pregnancy-related hypertension.
  • Specific increased risks for women ages 40-70 years (HRs; 95% CIs):
    • Myocardial infarction: 1.86 (1.40-2.48),
    • Heart failure: 1.59 (0.92-2.73), and
    • Cerebrovascular events: 1.47 (1.15-1.87).

Study design

  • Prospective Norwegian cohort registry study of 23,885 women (2119 with hypertensive disorders of pregnancy at age
  • Funding: Research Council of Norway, others. 

Limitations

  • Usual limitations of registry data.