Cardiovascular risk estimation in women with a history of hypertensive pregnancy disorders at term: a longitudinal follow-up study

Abstract

BackgroundCardiovascular disease is associated with major morbidity and mortality in women in the Western world. Prediction of an individual cardiovascular disease risk in young women is difficult. It is known that women with hypertensive pregnancy complications have an increased risk for developing cardiovascular disease in later life and pregnancy might be used as a cardiovascular stress test to identify women who are at high risk for cardiovascular disease. In this study we assess the possibility of long term cardiovascular risk prediction in women with a history of hypertensive pregnancy disorders at term.MethodsIn a longitudinal follow-up study, between June 2008 and November 2010, 300 women with a history of hypertensive pregnancy disorders at term (HTP cohort) and 94 women with a history of normotensive pregnancies at term (NTP cohort) were included. From the cardiovascular risk status that was known two years after index pregnancy we calculated individual (extrapolated) 10-and 30-year cardiovascular event risks using four different risk prediction models including the Framingham risk score, the SCORE score and the Reynolds risk score. Continuous data were analyzed using the Student’s T test and Mann–Whitney U test and categorical data by the Chi-squared test. A poisson regression analysis was performed to calculate the incidence risk ratios and corresponding 95% confidence intervals for the different cardiovascular risk estimation categories.ResultsAfter a mean follow-up of 2.5 years, HTP women had significantly higher mean (SD) extrapolated 10-year cardiovascular event risks (HTP 7.2% (3.7); NTP 4.4% (1.9) (p<.001, IRR 5.8, 95% CI 1.9 to 19)) and 30-year cardiovascular event risks (HTP 11% (7.6); NTP 7.3% (3.5) (p<.001, IRR 2.7, 95% CI 1.6 to 4.5)) as compared to NTP women calculated by the Framingham risk scores. The SCORE score and the Reynolds risk score showed similar significant results.ConclusionsWomen with a history of gestational hypertension or preeclampsia at term have higher predicted (extrapolated) 10-year and 30-year cardiovascular event risks as compared to women with a history of uncomplicated pregnancies. Further large prospective studies have to evaluate whether hypertensive pregnancy disorders have to be included as an independent variable in cardiovascular risk prediction models for women.

Determinants of future cardiovascular health in women with a history of preeclampsia

“…[38] In a short-term follow-up study that included mostly term and mild cases of hypertensive disease in pregnancy tested 2.5 years postpartum, the Reynolds Risk Score and the more traditional risk algorithms (SCORE and Framingham Risk Scores), we more or less equivalent in estimating predicted 10-year CVD risk. [39] It will be interesting the see whether or not these risk algorithms perform differently in cohorts with longer-term (>10 years) postpartum follow-up, and whether or not novel risk markers (in particular inflammatory markers) may prove to be beneficial in improving CVD risk prediction in models specifically designed to predict CVD in women with previous preeclampsia.…”

Synergistic Effect of Gestational Hypertension and Postpartum Incident Hypertension on Cardiovascular Health: A Nationwide Population Study

“…Hermes et al showed that women with a history of GH or preeclampsia at term had higher predicted 10‐ and 30‐year cardiovascular risk than did women with a history of uncomplicated pregnancies. 15 In a Japanese cohort study, GH was identified as a risk factor for hypertension, hypercholesterolemia, and diabetes in later life. 16 However, these studies failed to provide information about the cardiovascular risk of women with GH who later also developed hypertension.…”

Cardiovascular Implications of Preeclampsia

“…Risk factors unique to women, such as preeclampsia and gestational diabetes that have been shown to increase a woman's future risk of CVD are not included in the women's equation (Hermes et al, 2013). Sibley, Blumenthal, Merz, and Mosca (2006) found based on the variables currently in the equation, unless a women is older than 70, she will usually not score high enough on the Framingham assessment to qualify for pharmacologic preventive interventions.…”