10-Year cardiovascular event risks for women who experienced hypertensive disorders in late pregnancy: the HyRAS study

Hermes, Wietske; Franx, Arie; Pampus, Maria G. van; Bloemenkamp, Kitty W. M.; Post, Joris A. M. van der; Porath, Martina; Ponjee, G. A. E.; Tamsma, Jouke T.; Mol, Ben Willem J.; Groot, C.J. de

doi:10.1186/1471-2393-10-28

Cited by 48 publications

(34 citation statements)

References 15 publications

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“…Details on inclusion criteria of this cohort study have been published elsewhere. 10 In short, women who have participated in the HYPITAT trial 11 were consented for the HyRAS study, a cardiovascular follow-up 2 to 5 years after their pregnancy. The HYPITAT study evaluated if induction of labor between 36 +0 and 41 +0 weeks of gestation improved maternal outcome in women with late-onset preeclampsia and PIH.…”

Section: Hyras Cohortmentioning

confidence: 99%

Cardiovascular Disease Risk Factors After Early-Onset Preeclampsia, Late-Onset Preeclampsia, and Pregnancy-Induced Hypertension

et al. 2015

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C ardiovascular disease (CVD) has gained interest in obstetrics in recent years because large observational studies revealed a remarkable increase in the long-term risk of CVD in women who experienced different types of gestational hypertensive disorders.1-3 These include pregnancy-induced hypertension (PIH) and preeclampsia, which affect 2% to 7% of all pregnancies worldwide. 4A review by Bellamy et al 1 showed an increase of the postpartum risk of CVD events according to the severity of the hypertensive pregnancy disorder, with the highest risk in women who experienced early-onset preeclampsia. Women with a normal pregnancy have an advantage according to these results, but still develop CVD later in life. Currently, it is not possible to identify individual women who have the highest risk in developing CVD. In recent years, other studies did reveal that common modifiable risk factors such as fasting blood glucose and lipid levels are significantly elevated 6 months after a pregnancy complicated by early-onset preeclampsia .5-8 The dose-response relationship with the severity of a hypertensive pregnancy disorder and future CVD suggest that the differences in long-term CVD risk between women with a history of a hypertensive pregnancy may be dependent on variation in the underlying maternal CVD risk profiles. However, studies that compare cardiovascular risk factors between women with a previous pregnancy complicated by early-onset preeclampsia, late-onset preeclampsia, or PIH within the same population are lacking.In this study, we compare CVD risk profiles ≥3 months postpartum between women with previous early-onset preeclampsia, term preeclampsia and term gestational hypertension. We hypothesize that there is a difference in the prevalence of modifiable CVD risk factors postpartum between women with a history of a hypertensive disorder of pregnancy. Identification of women at high risk of CVD at a relatively young age may provide an opportunity for early personalized follow-up and prevention.Abstract-Observational studies have shown an increased lifetime risk of cardiovascular disease (CVD) in women who experienced a hypertensive disorder in pregnancy. This risk is related to the severity of the pregnancy-related hypertensive disease and gestational age at onset. However, it has not been investigated whether these differences in CVD risk factors are already present at postpartum cardiovascular screening. We evaluated postpartum differences in CVD risk factors in 3 subgroups of patients with a history of hypertensive pregnancy. We compared the prevalence of common CVD risk factors postpartum among 448 women with previous early-onset preeclampsia, 76 women with previous late-onset preeclampsia, and 224 women with previous pregnancy-induced hypertension. Women with previous early-onset preeclampsia were compared with women with late-onset preeclampsia and pregnancy-induced hypertension and had significantly higher fasting blood glucose (5.29 versus 4.80 and 4.83 mmol/L), insulin (9.12 versus 6.31 and 6.7 uIU/L), ...

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Section: Hyras Cohortmentioning

confidence: 99%

Cardiovascular Disease Risk Factors After Early-Onset Preeclampsia, Late-Onset Preeclampsia, and Pregnancy-Induced Hypertension

et al. 2015

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“…Recently, Hermes et al [23], published a protocol stuyding modifiable cardiovascular risk factors in the course of 2.5 years after delivery by women with preeclampsia or hypertension during pregnancy. This might help in the determination during a longer period whether preeclampsia or hypertension during pregnancy is a long-standing risk factor or a stress test for later life-events.…”

Section: Discussionmentioning

confidence: 99%

“…A coronary angiography was graded normal when no stenosis, wall irregularity without stenosis, or minimal calcification was present. Indication for angiography was acute coronary syndrome (3), chest pain with and without abnormal EKG (182), Left ventrikel dysfunction (23) and valve abnormality (3).…”

Section: Open Accessmentioning

confidence: 99%

Abnormal coronary artery angiography is not associated with adverse pregnancies outcomes

Heemskerk¹,

Ramanna²,

Bloemenkamp³

et al. 2012

OJOG

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Background: Recently, epidemiologic studies have suggested an association between pregnancy complications and the development of coronary artery disease later in life. The current study investigate the relation between obstructive coronary versus normal coronary angiographies and the prevalence of complications during pregnancy including preeclampsia, pregnancy induced-hypertension, low birth weight, and preterm birth. Methods: All consecutive women aged <55 year, who had coronary angiography were included. Based on angiography outcome, patients were classified as normal (controls: no stenosis, wall irregularity without stenosis, or minimal calcification present) or abnormal (subjects). A standard questionnaire was sent to all participating women. The questionnaires inquired into risk factors for coronary vascular disease, in particular history of hypertensive diseases, and specific obstetric history. The results were analyzed using the unpaired t-test, the Chi-squared test, and Pearson's correlation coefficients as appropriate. A significance level of P < 0.05 was used. Results: Of the 211 consecutive women aged <55 years, 62% (n = 131) had normal coronary angiography and 38% (n = 80) abnormal coronary angiography. We found no differences of reported pregnancy complications including preeclampsia, hypertension, low birth weight, and preterm birth (combined RR = 0.70, 95% C.I. = 0.38 -1.3) in case of abnormal coronary angiography compared to women with normal coronary angiography. The traditional risk factors hypercholesterolemia, tobacco use, and diabetes were identified as the major risk factors for developing cardiovascular disease, with a relative risk ranging from 4.2 -1.8. Conclusion: These data suggest that pregnancy complications are not an important denominator for cardiovascular disease.

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“…9,10 It has been hypothesized that placental abruption results from poor vessel quality of placental spiral arteries in women who are already predisposed to CVD. [1][2][3][4] Defective spiral artery remodeling is assumed to cause underperfusion of the placental bed with subsequent infarction and increased resistance of the placental vessels. 11,24,25 Specific decidual vasculopathy like muscular thickening, thrombosis, and acute atherosis lesions possibly arise as response to increased sheer stress and are indeed seen more often in cases of placental abruption and other MPS.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] MPS may be considered as a cluster of pregnancyrelated disorders that appear when the cardiovascular system fails to adapt to the increased metabolic, inflammatory, and hemodynamic demands during pregnancy and represent the first manifestation of compromised cardiovascular health of the mother. 5,6 Placental abruption, the separation of the placenta before delivery, is a serious complication of pregnancy, associated with a high morbidity and mortality for both mother and child.…”

mentioning

confidence: 99%

Maternal Cardiovascular Risk Profile After Placental Abruption

Veerbeek

Smit²,

Koster³

et al. 2013

Hypertension

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All women with a pregnancy complicated by placental abruption who delivered at the University Medical Center Utrecht, The Netherlands, between November 1994 and December 2009 were considered to Abstract-The prevalence of premature cardiovascular diseases (CVD) is increased in women with a history of maternal placental syndromes, including pregnancy-associated hypertensive disorders (eg, preeclampsia), fetal growth restriction, and placental abruption. Whereas previous studies have shown a high prevalence of CVD risk factors after pregnancies complicated by preeclampsia, this has not been studied for women with a history of placental abruption. To explore the association of placental abruption with CVD risk factors after delivery, we compared 75 women with a history of placental abruption with a control group of 79 women with uneventful pregnancies at 6 to 9 months postpartum for the presence of common CVD risk factors. In a subanalysis, data were stratified according to the presence or absence of concomitant hypertensive disease and further adjusted for potential confounders. Women with previous placental abruption had significantly higher mean systolic blood pressure, body-mass index, fasting blood glucose, C-reactive protein, total cholesterol, high-density lipoprotein-cholesterol, and low-density lipoprotein-cholesterol as compared with controls with only uneventful pregnancies. In the subanalysis, all differences remained significant for women with a history of placental abruption only (ie, without concomitant gestational hypertension), except for the associations with low-density lipoprotein-cholesterol and diastolic and systolic blood pressure. Most likely, the identified CVD risk factors predispose to placental abruption and development of premature CVD later in life. (Hypertension. 2013;61:1297-1301.)

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10-Year cardiovascular event risks for women who experienced hypertensive disorders in late pregnancy: the HyRAS study

Cited by 48 publications

References 15 publications

Cardiovascular Disease Risk Factors After Early-Onset Preeclampsia, Late-Onset Preeclampsia, and Pregnancy-Induced Hypertension

Cardiovascular Disease Risk Factors After Early-Onset Preeclampsia, Late-Onset Preeclampsia, and Pregnancy-Induced Hypertension

Abnormal coronary artery angiography is not associated with adverse pregnancies outcomes

Maternal Cardiovascular Risk Profile After Placental Abruption

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