Hypertensive Disorders of Pregnancy and Maternal CVD Risk
- Women with hypertensive disorders of pregnancy (HDP) are at increased risk for developing CVD.
- The development of CVD in women with HDP is mediated by the development of established CVD risk factors.
- Women with a history of HDP should be screened for CVD risk factors.
What proportion of the increased cardiovascular disease (CVD) risk known to be associated with hypertensive disorders of pregnancy (HDP) can be attributed to other established CVD risk factors?
The Nurses’ Health Study II was queried for parous participants without CVD (n = 60,379). To evaluate the relationship between HDP and CVD, Cox proportional hazard models were used, with adjustment for confounders such as pre-pregnancy body mass index (BMI), smoking, and family history. The difference method was used to evaluate the proportion jointly accounted for by chronic hypertension, hypercholesterolemia, type 2 diabetes, and changes in BMI.
Compared to women with normotensive pregnancies, women with HDP in their first pregnancy subsequently had a 63% higher rate of CVD (95% confidence interval, 1.37-1.94); however, 64% of this association was mediated by established CVD risk factors. Women with a history of pre-eclampsia were at higher risk for CVD than women with gestational hypertension. Among women with pre-eclampsia, 57% of the increased CVD risk was mediated by the development of established CVD risk factors (84% for those with gestational hypertension).
The development of CVD risk factors after a pregnancy complicated by hypertension or pre-eclampsia explained a large proportion of the CVD risk (84% and 57%, respectively). The authors recommend screening women with a history of HDP for development of chronic hypertension, hypercholesterolemia, type 2 diabetes, and overweight/obesity.
Several prior studies have highlighted the increased long-term risk of CVD among women with a history of HDP. The relative contribution of other established CVD risk factors that arise over time has been unclear. The current study adds to our understanding by demonstrating that a large proportion of CVD risk is related to the development of established CVD risk factors; this likely explains why prior attempts to add HDP to established risk prediction tools have not resulted in significant reclassification of risk. Clinicians should take a reproductive history when assessing CVD risk. Women with HDP should have careful screening for the development of CVD risk factors.
Keywords: Body Mass Index, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Heart Disease Risk Factors, Hypercholesterolemia, Hypertension, Pregnancy-Induced, Obesity, Overweight, Pre-Eclampsia, Pregnancy, Primary Prevention, Reproductive History, Risk Factors, Smoking, Women
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