29. Measures of Arterial Stiffness and Subclinical Large Vessel Atherosclerosis After Preeclampsia: A Pooled Study-Level Meta-Analysis

Abstract

Background: Preeclampsia has been suggested as the risk of subsequent cardiovascular disease, specifically sustained vascular dysfunction after delivery. Several vascular imaging modalities have been studied in the post-partum period. However, it remains unclear whether some degree of vascular dysfunction in form of increasing arterial stiffness and large vessel atherosclerosis persists in women after preeclampsia. Objective: This study aims to summarize evidence of increasing arterial stiffness and subclinical large vessel atherosclerosis after preeclampsia. Methods: A search for eligible studies was conducted until April 2022 on PubMed, ScienceDirect, Cochrane Library databases. Included studies were observational, with the preeclampsia as the main exposure, assessed at least 3 months post-partum. Arterial stifness and subclinical large vessel atherosclerosis are measured by augmentation index (AIx), carotid-femoral pulse wave velocity (cfPWV) and carotid intima-media thickness (cIMT) respectively. Review Manager (RevMan) 5.4 was utilized to compute mean differences (MD) and confidence intervals (CI). Results: We identified 22 studies that involve 1,954 patients. There was evidence of increasing arterial stiffness in women after preeclampsia compared with women with normal pregnancy when measured by AIx [MD 6.52% (95% CI 2.76, 10.28; p = 0.0007; I2 = 0.81)] and cfPWV [MD 0.64 m/s (95% CI 0.17, 1.11; p = 0.007; I2 = 0.81)]. Subclinical large vessel atherosclerosis via cIMT were more frequent in women after preeclampsia [MD 0.02 mm (95% CI 0.01, 0.04; p = 0.0007; I2 = 0.48)]. Conclusion: Pooled data from studies evaluating vascular imaging suggest that some vascular dysfunction in form of increasing arterial stiffness and subclinical large vessel atherosclerosis persists after preeclampsia as compared with women with prior normal pregnancy.