Women who experience preeclampsia and gestational hypertension have a greater risk for cardiovascular disease (CVD) when compared with women with normotensive pregnancies, and this risk is linked to conventional CVD risk factors, according to study results published in JAMA Cardiology. Blood pressure and body mass index (BMI) were linked to the majority of the excess risk of CVD in this cohort of women, suggesting that preventive efforts to address these risk factors can reduce CVD risk in these women.
Researchers of this prospective, cohort study analyzed data from women with a history of hypertensive disorders during pregnancy to assess the relationship among BMI, blood pressure, glucose and lipid levels, and the risk for CVD. Data came from women participating in the Nord-Trøndelag Health Study 1, 2, and 3 and included demographics, cardiovascular (CV) risk factors, CV events, medication usage, and pregnancy history.
Of the 23,885 women included in the study, 21,766 were always normotensive and 2119 had a hypertensive disorder during pregnancy, including 728 with gestational hypertension and 1391 with preeclampsia. At follow-up (median, 18 years), 553 women had a myocardial infarction, 233 had heart failure, and 878 had a cerebrovascular event.
Women with a history of hypertensive disorders during pregnancy had an increased risk for any type of CV event (hazard ratio [HR] 1.57; 95% CI, 1.32-1.86), myocardial infarction (HR 1.86; 95% CI, 1.4-2.48), heart failure (HR 1.59; 95% CI, 0.92-2.73), and cerebrovascular events (HR 1.47; 95% CI, 1.15-1.87).
Cox proportional hazard models indicated the relationship between women with a history of hypertensive disorders during pregnancy and the risk for CVD was associated with suboptimal BMI (HR 1.19; 95% CI, 1.07-1.33), systolic blood pressure (HR 1.3; 95% CI, 1.16-1.47), and diastolic blood pressure (HR 1.38; 95% CI, 1.23-1.55).
Blood pressure and BMI were linked to a majority of the excess risk of CVD in women with history of hypertensive disorders of pregnancy.
Of note, women older than age 70 had an inverse relationship between hypertensive disorders during pregnancy and risk for CV events (HR 0.6; 95% CI, 0.34-1.04).
Limitations of this study included the potential for nonfatal events being omitted or misclassified in the database and the possibility of results not being generalizable to other populations.
The researchers concluded that “women with history of [hypertensive disorders of pregnancy] have an increased risk of CVD that is to a large extent associated with increased levels of conventional, modifiable cardiovascular risk factors.”
Haug EB, Horn J, Markovitz AR, et al. Association of conventional cardiovascular risk factors with cardiovascular disease after hypertensive disorders of pregnancy: analysis of the Nord-Trøndelag Health Study [published online June 12, 2019]. JAMA Cardiol. doi:10.1001/jamacardio.2019.1746