118 Cardiovascular disease following hypertensive disorders of pregnancy

Abstract

To determine whether hypertensive disorders of pregnancy (HDP) are associated with cardiovascular (CV) morbidity and mortality within 10-20 years following delivery. Retrospective cohort study including all women who delivered ≥1 pregnancy at ≥20 weeks’ gestation within a single health system from 1996-2008. Women were excluded if they had CV risk factors prior to their first delivery or if they had no follow-up within the health system after delivery. The exposure of interest was any HDP. The primary outcome was a composite of ICD codes for coronary artery disease (CAD), peripheral vascular disease, and CV events (myocardial infarction, stroke, and death). A nested cohort of women who underwent cardiac catheterization had a primary outcome of angiographic CAD. Cox proportional hazards estimated hazard ratios for the outcomes of interest among exposed versus unexposed women, adjusting for maternal age, race, marital status, family history of CVD, smoking, substance use, spontaneous vs induced labor, preterm birth, low birthweight, abruption, and parity. Of 33,959 women included, 2,385 women had HDP (7.0%, including 1,205 pre-eclampsia, 23 eclampsia, and 1,452 gestational hypertension). 49 women with HDP had the primary composite outcome (2.1%) vs 435 women without HDP (1.4%, p=0.003). HDP was associated with the composite outcome (Table). There was a significant difference in event-free survival between groups (Figure). Parity >0 at the index pregnancy was not associated with outcomes, and no effect modification of HDP by parity was found (p-interaction= 0.81). 592 women underwent cardiac catheterization, including 90 women with HDP (15.2%) and 502 without HDP. 20 of the women with HDP had CAD (22.2%) on angiography vs 49 women without HDP (9.8%, p<0.001). HDP is associated with CV morbidity and mortality within 20 years of delivery. Because women with HDP had twice the incidence of CAD on angiography compared to parous women without HDP, obstetric history may be informative when deciding whether to proceed with cardiac catheterization.View Large Image Figure ViewerDownload Hi-res image Download (PPT)