Long-term cardiovascular risk of pre-eclampsia

Abstract

Abstract Background/introduction Pre-eclampsia is a complication of the second and third trimesters of pregnancy characterized by hypertension and endothelial dysfunction causing multiorgan damage. In 2017 few studies suggested an association between pre-eclampsia and long-term cardiovascular diseases. However, since those first studies, the literature has grown exponentially. Purpose To assess the association between a history of pre-eclampsia and subsequent cardiovascular diseases, including 1) cardiovascular death, 2) coronary heart disease, 3) heart failure, and 4) stroke. Methods Following PRISMA guidelines, from inception to September 2022, we performed a systematic review of PubMed, MEDLINE, Scopus, and EMBASE. Randomized, cohort or case-control studies in English were included if fulfilling the following criteria: 1) the association between pre-eclampsia and subsequent cardiovascular disease was adjusted for at least maternal age, smoking, and obesity; 2) the presence of a control group; 3) minimum one-year follow-up. Pooled Relative Risk (RRs) and 95% confidence intervals (CIs) were used as effect estimates and calculated with a random-effects model. The primary endpoint was cardiovascular death. The secondary endpoints were coronary heart disease, heart failure, and stroke. Results Twenty-one studies met the inclusion criteria, including 478,708 women with a history of pre-eclampsia and 10,533,530 without. Pre-eclampsia was associated with a higher risk of cardiovascular disease death (RR 1.97, 95% CI 1.64-2.35, I2 60%, p<0.00001), coronary heart disease (RR 2.11, 95% CI 1.60-2.77, I2 85%, p<0.00001), heart failure (RR 2.47, 95% CI 1.70-3.59, I2 82%, p<0.00001), and stroke (RR 1.64, 95% CI 1.45-1.85, I2 43%, p<0.00001). Sensitivity analysis excluding those studies with a follow-up of less than 10 years evidenced similar results. Conclusions Compared to women who experienced a normal pregnancy, those suffering from pre-eclampsia have about double the risk of cardiovascular disease, including cardiovascular death, coronary heart disease, heart failure, and stroke. This risk becomes evident already in the first ten years after pregnancy. As such, obstetricians should counsel pre-eclamptic women on the importance of an early assessment and risk factors management in a multidisciplinary team with cardiologists.