Abstract
BackgroundWomen with history of hypertensive disorders of pregnancy (HDP) are at increased risk of early onset cardiovascular disease and type 2 diabetes (T2D). We aimed to investigate the extent to which HDP is also associated with midlife development of T2D and hypertension above and beyond established risk factors.MethodsWe included parous women who attended population-based structured clinical visits at age 50 and 60 years in Sweden 1991–2013 (N = 6587). Women with prior diabetes mellitus, stroke, or ischemic heart disease at age 50 years were excluded. Data on reproductive history were collected from registries. To study the association between history of HDP and the between-visits development of T2D, hypertension, and clinical risk factors of cardiometabolic disease (body mass index (BMI), blood pressure, and total cholesterol), we utilized multivariable adjusted regression models (logistic, log binomial, and linear regression, respectively). Models included data on outcome risk factors at age 50 years, e.g. BMI, 75 g 2 h oral glucose tolerance test result, and mean arterial pressure, respectively.ResultsBetween ages 50 and 60 years, 5.8% of initially disease-free women developed T2D and 31.6% developed hypertension. History of HDP was associated with increased risk of developing T2D between age 50 and 60 years even when adjusting for risk factors, including BMI, at age 50 years (odds ratio (OR) 1.96, 95% confidence interval (CI) 1.29–2.98). By contrast, the higher risk of developing hypertension observed in women with history of HDP (relative risk (RR) 1.47, 95% CI 1.22–1.78) was attenuated when adjusted for risk factors (RR 1.09, 95% CI 0.94–1.25). Participants with a history of HDP had higher mean BMI and blood pressure at age 50 years, with levels roughly corresponding to those observed at age 60 years in unaffected women.ConclusionsWomen with history of HDP are not only at higher risk of cardiometabolic disease during their reproductive years, but HDP is also associated with midlife T2D development above and beyond established risk factors.
Highlights
Women with history of hypertensive disorders of pregnancy (HDP) are at increased risk of early onset cardiovascular disease and type 2 diabetes (T2D)
In the analyses of continuous outcomes, we investigated the association between history of HDP and several cardiometabolic risk factors (BMI, systolic blood pressure (SBP), diastolic blood pressure (DBP), log total serum cholesterol) at ages 50 and 60 years and whether these associations changed with age
We found history of HDP to be positively associated with incident T2D in women between age 50 and 60 years even after adjustment for clinical risk factors at age 50 years, including oral glucose tolerance test (OGTT) result
Summary
Women with history of hypertensive disorders of pregnancy (HDP) are at increased risk of early onset cardiovascular disease and type 2 diabetes (T2D). In this study we were interested in the association between HDP history and the development of T2D and hypertension in a cohort of women with clinical visits at age 50 and 60 years. To further understand the clinical relevance of the association between history of HDP and cardiometabolic risk factors [including blood pressure and body mass index (BMI)] in midlife, we investigated these associations at age 50 years, the respective change in any association by age 60 years, and compared the associations with those attributable to the 10 years of older age between visits. Our primary hypothesis was that in women initially free of severe cardiovascular disease, history of HDP is positively associated with developing T2D and hypertension between age 50 and 60 years when accounting for conventional predictors of cardiometabolic deterioration measurable at age 50 years
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