Association Between Hypertensive Disorders of Pregnancy and Dementia: a Systematic Review and Meta-Analysis

Schliep, Karen C.; McLean, Hailey; Yan, Binbin; Qeadan, Fares; Theilen, Lauren; Havenon, Adam de; Majersik, Jennifer J.; Østbye, Truls; Sharma, Surendra; Varner, Michael W.

doi:10.1161/hypertensionaha.122.19399

Cited by 31 publications

(19 citation statements)

References 55 publications

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“…A meta-analysis included 5 cohort studies with a total of 183 874 females with and 2 309 705 females without hypertensive disorders in pregnancy to study the risk of subsequent dementia. 93 Any type of hypertensive disorder in pregnancy was associated with a higher risk of subsequent dementia (HR, 1.38 [95% CI, 1.18–1.61]). For dementia subtypes, any hypertensive disorder in pregnancy was associated with higher risk of vascular dementia (HR, 3.14 [95% CI, 2.32–4.24]).…”

Section: High Blood Pressurementioning

confidence: 99%

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

Martin,

Aday,

Almarzooq

et al. 2024

Circulation

434

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BACKGROUND: The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS: The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year’s worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year’s edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS: Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS: The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

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Section: High Blood Pressurementioning

confidence: 99%

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

Martin,

Aday,

Almarzooq

et al. 2024

Circulation

434

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“…By contrast, gestational hypertension is associated with a 3.6-fold increase in risk of end stage kidney disease and a 1.5-fold increase in risk of chronic kidney disease 138. Overall, HDP are associated with a 1.4-fold increase in risk of dementia,140 with pre-eclampsia being associated with a 2.6-fold increase in risk of vascular dementia 141. Pre-eclampsia has been associated with a 1.5-fold and 1.8-fold increase in risk of venous thromboembolism and premature mortality, respectively 122.…”

Section: Postnatal Follow-upmentioning

confidence: 98%

Hypertensive disorders of pregnancy

Green

Myers

2023

BMJ

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Hypertensive disorders of pregnancy (HDP) are one of the most commonly occurring complications of pregnancy and include chronic hypertension, gestational hypertension, and pre-eclampsia. New developments in early pregnancy screening to identify women at high risk for pre-eclampsia combined with targeted aspirin prophylaxis could greatly reduce the number of affected pregnancies. Furthermore, recent advances in the diagnosis of pre-eclampsia, such as placental growth factor based testing, have been shown to improve the identification of those pregnancies at highest risk of severe complications. Evidence from trials has refined the target blood pressure and timing of delivery to manage chronic hypertension and pre-eclampsia with non-severe features, respectively. Importantly, a wealth of epidemiological data now links HDP to future cardiovascular disease and diabetes decades after an affected pregnancy. This review discusses the current guidelines and research data on the prevention, diagnosis, management, and postnatal follow-up of HDP. It also discusses the gap in knowledge regarding the long term risks for cardiovascular disease following HDP and illustrates the importance of improving adherence to postnatal guidelines to monitor hypertension and the need for more research focused on primary prevention of future cardiovascular disease in women identified as being at high risk because of HDP.

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“…191 Furthermore, there appears to be a dose effect, with women who experience recurrent preeclampsia facing an even greater risk. 194,213,214 Epidemiological studies have also shown an increased risk of end-stage renal disease, 208,212,215,216 metabolic syndrome, 212 diabetes, 217,218 cognitive dysfunction, [219][220][221] stroke and other neurological complications. 208,221,222 Although sFlt-1 levels fall after delivery, when examined at two years post-partum, we demonstrated that women with a history of preeclampsia had altered angiogenic profiles and insulin resistance compared to women without a history of preeclampsia.…”

Section: Diseasesmentioning

confidence: 99%

Translation of mechanistic advances in preeclampsia to the clinic: Long and winding road

Thadhani,

Cerdeira,

Karumanchi

2024

The FASEB Journal

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As one of the leading causes of premature birth and maternal and infant mortality worldwide, preeclampsia remains a major unmet public health challenge. Preeclampsia and related hypertensive disorders of pregnancy are estimated to cause >75 000 maternal and 500 000 infant deaths globally each year. Because of rising rates of risk factors such as obesity, in vitro fertilization and advanced maternal age, the incidence of preeclampsia is going up with rates ranging from 5% to 10% of all pregnancies worldwide. A major discovery in the field was the realization that the clinical phenotypes related to preeclampsia, such as hypertension, proteinuria, and other adverse maternal/fetal events, are due to excess circulating soluble fms‐like tyrosine kinase‐1 (sFlt‐1, also referred to as sVEGFR‐1). sFlt‐1 is an endogenous anti‐angiogenic protein that is made by the placenta and acts by neutralizing the pro‐angiogenic proteins vascular endothelial growth factor (VEGF) and placental growth factor (PlGF). During the last decade, this work has spawned a new era of molecular diagnostics for early detection of this condition. Antagonizing sFlt‐1 either by reducing production or blocking its actions has shown salutary effects in animal models. Further, in early‐stage human studies, the therapeutic removal of sFlt‐1 from maternal circulation has shown promise in delaying disease progression and improving outcomes. Recently, the FDA approved the first molecular test for preterm preeclampsia (sFlt‐1/PlGF ratio) for clinical use in the United States. Measuring serum sFlt‐1/PlGF ratio in the acute hospital setting may aid short‐term management, particularly regarding step‐up or step‐down of care, decision to transfer to settings better equipped to manage both the mother and the preterm neonate, appropriate timing of administration of steroids and magnesium sulfate, and in expectant management decisions. The test itself has the potential to save lives. Furthermore, the availability of a molecular test that correlates with adverse outcomes has set the stage for interventional clinical trials testing treatments for this disorder. In this review, we will discuss the role of circulating sFlt‐1 and related factors in the pathogenesis of preeclampsia and specifically how this discovery is leading to concrete advances in the care of women with preeclampsia.

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Association Between Hypertensive Disorders of Pregnancy and Dementia: a Systematic Review and Meta-Analysis

Cited by 31 publications

References 55 publications

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

Hypertensive disorders of pregnancy

Translation of mechanistic advances in preeclampsia to the clinic: Long and winding road

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