Assessment of vascular function in formerly pre-eclamptic women as a novel marker of future cardiovascular risk

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Women with a history of pre-eclampsia (PE) are at increased risk of cardiovascular disease (CVD). The association between PE and CVD in later life may be explained by vascular dysfunction, either pre-existing or elicited by PE. Several small studies have shown that vascular dysfunction may persist for years in some patients, indicator of future CVD risk, while other studies could not confirm these findings. Purpose In this longitudinal prospective cohort study, we aim to comprehensively assess vascular function in previously pre-eclamptic women (early (<34 weeks) and late (>34 weeks)) and healthy controls. We hypothesize that vascular dysfunction is both more persistent and pronounced in early PE compared to late PE since different pathophysiologic mechanisms underlie both subtypes of PE. Methods For this first analysis, 63 PE patients were compared to 16 non-pregnant healthy controls. Endothelial function was determined by flow-mediated dilatation (FMD), modified FMD (mFMD) and low-flow mediated constriction (L-FMC). Arterial stiffness was assessed by carotid-femoral pulse wave velocity (cfPWV) and augmentation index using pulse wave analysis of the brachial artery, and corrected for heart-rate (Aix75). Results Average post-partum period was 11 months (1.4-111.5 months). Thirty-five presented with early PE, 28 with late PE. In the total PE group, FMD was significantly decreased compared to healthy controls (7.1 ± 2.8 vs 8.9 ± 3.8; p = 0.037), but no difference between early and late PE was observed. Likewise, Aix75 remained elevated after PE (16.5 ± 11.5 vs 5.8 ± 10.1; p < 0.001), again, without difference between early and late PE. cfPWV was not different after PE compared to healthy controls (p > 0.05) but was significantly higher in the early PE group compared to the late PE group (6.9 ± 1.0 vs 6.4 ± 1.0; p = 0.045). Conclusion Even in the postpartum, PE is characterized by overt and persisting endothelial dysfunction and arterial stiffness. Arterial stiffness is more pronounced in early PE compared to late PE. This reaffirms that PE has consequences beyond placental impairment and that the persisting vascular impairment in the postpartum could reflect the risk of CVD later in life.