Abstract
BackgroundCardiovascular disease is associated with major morbidity and mortality in women in the Western world. Prediction of an individual cardiovascular disease risk in young women is difficult. It is known that women with hypertensive pregnancy complications have an increased risk for developing cardiovascular disease in later life and pregnancy might be used as a cardiovascular stress test to identify women who are at high risk for cardiovascular disease. In this study we assess the possibility of long term cardiovascular risk prediction in women with a history of hypertensive pregnancy disorders at term.MethodsIn a longitudinal follow-up study, between June 2008 and November 2010, 300 women with a history of hypertensive pregnancy disorders at term (HTP cohort) and 94 women with a history of normotensive pregnancies at term (NTP cohort) were included. From the cardiovascular risk status that was known two years after index pregnancy we calculated individual (extrapolated) 10-and 30-year cardiovascular event risks using four different risk prediction models including the Framingham risk score, the SCORE score and the Reynolds risk score. Continuous data were analyzed using the Student’s T test and Mann–Whitney U test and categorical data by the Chi-squared test. A poisson regression analysis was performed to calculate the incidence risk ratios and corresponding 95% confidence intervals for the different cardiovascular risk estimation categories.ResultsAfter a mean follow-up of 2.5 years, HTP women had significantly higher mean (SD) extrapolated 10-year cardiovascular event risks (HTP 7.2% (3.7); NTP 4.4% (1.9) (p<.001, IRR 5.8, 95% CI 1.9 to 19)) and 30-year cardiovascular event risks (HTP 11% (7.6); NTP 7.3% (3.5) (p<.001, IRR 2.7, 95% CI 1.6 to 4.5)) as compared to NTP women calculated by the Framingham risk scores. The SCORE score and the Reynolds risk score showed similar significant results.ConclusionsWomen with a history of gestational hypertension or preeclampsia at term have higher predicted (extrapolated) 10-year and 30-year cardiovascular event risks as compared to women with a history of uncomplicated pregnancies. Further large prospective studies have to evaluate whether hypertensive pregnancy disorders have to be included as an independent variable in cardiovascular risk prediction models for women.
Highlights
Cardiovascular disease is associated with major morbidity and mortality in women in the Western world
Participants We studied 300 women who had delivered in the Netherlands between 2005 and 2008, with the diagnosis term gestational hypertension or term preeclampsia after 36 weeks' gestation and 94 healthy control women after uncomplicated term pregnancies
Of the eligible 751 women with a history of term gestational hypertension or term preeclampsia, 168 women declined participation in the follow-up study, 6 women refused blood drawing, 175 women were lost to follow-up, 101 women were pregnant or lactating and 1 woman had died in a car accident
Summary
Cardiovascular disease is associated with major morbidity and mortality in women in the Western world. Prediction of an individual cardiovascular disease risk in young women is difficult. In this study we assess the possibility of long term cardiovascular risk prediction in women with a history of hypertensive pregnancy disorders at term. Several epidemiological studies have demonstrated the association between hypertensive pregnancy disorders and cardiovascular morbidity and mortality in later life [3,4,5,6,7,8,9]. It has been suggested that pregnancy may act as an early natural “stress test” unmasking underlying defects and thereby identifying women at high risk for cardiovascular disease in later life [10]. In spite of the existence and use of several risk prediction models, it remains a great challenge to determine which specific woman is at high risk for cardiovascular disease, especially in young women
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