Evaluation of a proactive cardiovascular risk screening program after preeclampsia: the Queen of Hearts study

Abstract

Abstract Introduction: Despite the long-term risk for cardiovascular disease (CVD) after preeclampsia (PE), guidelines do not include specific recommendations on how to apply structural cardiovascular (CV) screening after complicated pregnancy. Insight in the prevalence of conventional CV risk factors at different age intervals may provide insight in the necessity of timely CV screening. Purpose Evaluate the prevalence of conventional CV risk factors in former pregnant women at different age intervals. Methods Data was used from the cross-sectional Queen of Hearts study, which includes relatively young women with a history of PE and a control group of women with a history of uncomplicated pregnancy. Based on history taking we established the prevalence of known diagnoses of hypertension, diabetes mellitus (DM) and hypercholesterolemia. Besides, a CV risk assessment was performed, including 30-minutes blood pressure (BP) measurement and venous blood sampling. De novo diagnosis of hypertension, DM and hypercholesterolemia were defined as systolic BP ≥140mmHg and/or diastolic BP ≥90mmHg, fasting glucose ≥7mmol/L, and Low Density Lipoprotein (LDL) >3.4mmol/L, respectively. Odds Ratio’s (ORs) with corresponding 95% confidence intervals (CI) were established, and survival analysis using Kaplan Meier curves and cox regression was performed. Results We included 1040 (39 ± 8 years) women who had suffered PE and 518 who experienced normotensive pregnancy (44 ± 8 years). In both groups, the prevalence of hypertension and hypercholesterolemia increased statistically significantly with advancing age (p-values trend <0.001), but this age-related increase seemed larger in former preeclamptic women. Across all age groups, former preeclamptic women suffered more often hypertension than controls whilst differences seemed most pronounced for younger individuals (<40 years: 12.4% vs. 2.1% respectively, OR 6.6 (95% CI 2.1-18.3); 40-49 years: 24.8% vs. 6.9% respectively, OR 4.5 (95% CI 2.4-8.3); ≥50 years: 38.2% vs. 15.7% respectively, OR 3.3 (95% CI 1.8-6.1)). A proportion of 33.5% former preeclamptic women and 23.9% controls suffered at least one CV risk factor (OR 1.6, 95% CI 1.3-2.0). This prevalence significantly increased with age, being 25.0% among former preeclamptic women aged <40 years and increasing up to 65.7% if aged ≥50 years. The age of CV risk diagnosis was on average 8 years younger in former preeclamptic women than controls, supported by survival analyses ((log rank p-value <0.001, Hazard Ratio 2.6 (95% CI 2.1-3.2)). Conclusions The prevalence of hypertension, DM and hypercholesterolemia is significantly higher in women with former PE compared to controls, already below the age of 40 and increasing with age. The age-related increase in risk was larger among former preeclamptic women than controls. Awareness on the high prevalence of CV risk factors at young age in former preeclamptic women should be taken into account when developing screening guidelines.Prevalence of CV risk factorsKaplan Meier curve CV risk factors