242. Preeclampsia and premature cardiovascular disease in a large UK pregnancy cohort

Abstract

Introduction Preeclampsia affects 3–5% of pregnancies, manifesting as hypertension and proteinuria in the second half of pregnancy. Recent research has highlighted an association between preeclampsia and subsequent cardiovascular disease (CVD). Aims To investigate the association between preeclampsia and other hypertensive disorders of pregnancy and subsequent CVD in a large dataset with sufficient granularity on endpoints. Methods A UK cohort of 1.9 million completed pregnancies and preeclampsia events (N = 33,344) was compiled from a larger linked dataset of primary and secondary care records, including 12 CVD endpoints. Outcomes were defined using the CALIBER resource ( https://www.caliberresearch.org/portal ). Cox models were used to quantify the association between preeclampsia and CVD and were adjusted for maternal age, ethnicity, pre-pregnancy hypertension, and socioeconomic status. Results Having one or more pregnancies affected by preeclampsia doubled a woman’s risk of any subsequent CVD event (hazard ratio (HR) for any stroke event:1.94 (1.58–2.41), total N = 1698; HR for any cardiac event:2.08 (1.99–2.18), total N = 51,008). Adjustment for diagnosis of hypertension between end of pregnancy and first CVD event attenuated associations slightly (stroke HR:1.74 (1.41–2.16); cardiac HR:1.94 (1.85–2.03)). Mean (SD) age at start of follow-up in our pregnancy cohort was 28.48 (6.15) years and at first event among women was 34.67 (8.17) years, compared to 56.46 (20.33) for the whole female linked records dataset. Conclusion Our study identified a significant association between preeclampsia and premature CVD events, many of which occur below the UK national CVD screening age of 40 years. As adjustment for post-pregnancy hypertension attenuates but does not eradicate the association, this implies that some, although not all, of the effect of preeclampsia on early life CVD is mediated via hypertension. Our data suggest that preeclampsia should be incorporated into national screening tools to identify women at risk of early life CVD events and interventions implemented to reduce CVD risk.