Rates of acute myocardial infarction (AMI) and ischemic stroke were elevated in the decades following a preeclampsia pregnancy, according to study findings published in European Journal of Preventative Cardiology.
Researchers at the University of Copenhagen collected data from population registers in Denmark to study the effects of preeclampsia in pregnancy on cardiovascular disease (CVD) risk.
Women who had a live birth or stillbirth after 20 weeks or more of pregnancy in Denmark between 1978 and 2017 were evaluated for ischemic event risk based on their diagnosis of preeclampsia during pregnancy.
Preeclampsia was defined as a notation in the National Patient Register of preeclampsia, eclampsia, or hemolysis, elevated liver enzymes, and low platelets (HELP). Early preterm preeclampsia was defined as delivery at less than 34 weeks; late preterm preeclampsia was defined as delivery at 34 to 36 weeks; and term preeclampsia was defined as delivery at more than 37 weeks.
The study population included 1,111,846 women without preeclampsia, 3270 with early preterm preeclampsia, 5405 with late preterm preeclampsia, and 37,145 with term preeclampsia. The majority of study participants (36.9%-40.4%) were aged between 25 and 29 years during pregnancy, with 0.2% to 4.0% of pregnancies resulting in a stillbirth; 0.5% to 5.4% of women developed gestational diabetes.
Compared with women without a preeclampsia, those with a first pregnancy and a preeclampsia diagnosis had a higher cumulative incidence rate of ischemic events within the first 7 to 8 years after delivery.
Among women aged less than 35 years at their first delivery, the cumulative incidence rates of all ischemic events at 20 years were 1.84% for women with preeclampsia and 0.96% for those without preeclampsia. Among women aged greater than 35 years at delivery, the rates were 4.13% and 2.13%, respectively.
Stratified by event, women with and without preeclampsia in their first pregnancy had a 20-year cumulative incidence of AMI of 0.90% and 0.34% among those who delivered aged less than 35 years and 2.03% and 0.74% among those who delivered aged more than 35 years, respectively.
The rates of ischemic stroke were 1.05% and 0.57% among those who delivered aged less than 35 years and 2.02% and 1.10% among those who delivered aged more than 35 years, respectively.
Overall, AMI was associated with recurrent preeclampsia (adjusted hazard ratio [aHR], 3.05), preeclampsia in a second (aHR, 2.10), and in a first pregnancy (aHR, 1.58).
Stratified by time, risk for AMI remained elevated among women with recurrent preeclampsia (aHR, 3.19) and preeclampsia in a second (aHR, 2.70) and first (aHR, 1.66) pregnancy at less than 20 years after delivery. Risk for AMI also remained higher among women with recurrent preeclampsia (aHR, 2.90) and preeclampsia in a second (aHR, 1.50) and first (aHR, 1.47) pregnancy at more than 20 years after delivery. Similar trends were observed for ischemic stroke.
Criteria for preeclampsia changed during the study period, which may have limited study findings.
The study authors concluded, “Our findings suggest that a history of [preeclampsia] should focus attention on a group of women at potentially high risk of CVD, with the aim of improving risk assessment and disease prevention in this vulnerable group.”
Hallum S, Basit S, Kamper-Jørgensen M, Sehested TSG, Boyd HA. Risk and trajectory of premature ischaemic cardiovascular disease in women with a history of pre-eclampsia: a nationwide register-based study. Eur J Prev Cardiol. Published online January 26, 2023. doi:10.1093/eurjpc/zwad003