18: Classic risk factors predictive of first cardiovascular events in women with a history of early-onset preeclampsia: Opportunities for primary prevention

Abstract

WOMEN WITH A HISTORY OF EARLY-ONSET PREECLAMPSIA: OPPORTUNITIES FOR PRIMARY PREVENTION BAS VAN RIJN, HEIN BRUINSE, MARK ROEST, HIERONYMUS VOORBIJ, MICHIEL BOTS, ARIE FRANX, University Medical Center Utrecht, Division of Perinatology & Gynecology, Utrecht, Netherlands, University Medical Center Utrecht, Department of Clinical Chemistry, , Netherlands, University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands, St. Elisabeth Ziekenhuis, Obstetrics and Gynaecology, Tilburg, Netherlands OBJECTIVE: Women with a history of early-onset preeclampsia are at increased risk of developing major cardiovascular disease (CVD) related events, that have a detrimental effect on their long-term health and life expectancy. In this follow-up study, we measured established risk factors predictive of first CVD events after early-onset preeclampsia. STUDY DESIGN: Over a 10-year interval, 243 primiparous women with a history of early-onset preeclampsia (delivery 34 weeks gestation) were included and tested for major cardiovascular risk factors at least six months after delivery, in addition to a population-based control group of 374 healthy non-pregnant women. Women with chronic hypertension were excluded. RESULTS: Mean age was 30.5 years for cases compared to 28.3 years for controls (P .001). After adjustment for age, we observed significantly increased mean values for weight (P .002), body-mass index (P .001), systolic blood pressure (P .001), diastolic blood pressure (P .001), total cholesterol (P .006), LDL cholesterol (P .001), triglycerides (P .027), fasting blood glucose (P .001), and lower HDL cholesterol (P .001) in women with previous early-onset preeclampsia. No difference was found for height, smoking, diabetes, and ethnicity. Estimated 10-year risk of first CVD events by Framingham Risk Scores remained 10% for all women (low-risk). Nonetheless, at mean (SD) 0.7 (1.0) years after early-onset preeclampsia, 15% of women met the criteria for metabolic syndrome. Additionally, 89% of women exhibited 1, 51% of women 2 and 19% of women 3 major CVD risk factors. CONCLUSION: The majority of women with a history of early-onset preeclampsia exhibit at least one modifiable risk factor for future CVD. Although most of these women are classified as low-risk according to the current AHA guidelines, this is mainly due to their young age masking other, mostly modifiable, major risk factors. Our data thus support life-style intervention programs aimed at primary prevention of CVD in women with a history of early-onset preeclampsia.