Impact of a History of Hypertension in Pregnancy on Later Diagnosis of Atrial Fibrillation

Abstract

BackgroundAtrial fibrillation/flutter (AF) produces significant morbidity in women and is typically attributed to cardiac remodeling from multiple causes, particularly hypertension. Hypertensive pregnancy disorders (HPDs) are associated with future hypertension and adverse cardiac remodeling. We evaluated whether women with AF were more likely to have experienced a HPD compared with those without.Methods and ResultsA nested case–control study was conducted within a cohort of 7566 women who had a live or stillbirth delivery in Olmsted County, Minnesota between 1976 and 1982. AF cases were matched (1:1) to controls based on date of birth, age at first pregnancy, and parity. AF and pregnancy history were confirmed by chart review. We identified 105 AF cases: mean age 57±8 (mean±SD) years, (controls 56±8 years), 32±8 years (controls 31±8 years) after the first pregnancy. Cases were more likely to have obesity during childbearing years, and hypertension, diabetes mellitus, dyslipidemia, coronary disease, valvular disease, and heart failure at the time of AF diagnosis. Cases were more likely to have a history of HPDs, compared with controls: 28/105 (26.7%) cases versus 12/105 (11.4%) controls, odds ratio: 2.60 (95% confidence interval, 1.21–6.04). After adjustment for hypertension and obesity, the association was attenuated and no longer statistically significant; odds ratio (95% confidence interval, 2.12 (0.92–5.23).ConclusionsWomen with AF are more likely to have had a HPD, a relationship at least partially mediated by associated obesity and hypertension. Given the high morbidity of AF, studies evaluating the benefit of screening for and management of cardiovascular risk factors in women with a history of HPD should be performed.

Differences in Epidemiology and Risk Factors for Atrial Fibrillation Between Women and Men

“…A recent nested case-control study from Olmsted County, Minnesota, reported women with AF to be more likely to have experienced a hypertensive pregnancy disorder. This relationship was at least partially mediated by associated obesity and hypertension (54).…”

Hypertensive Disorders of Pregnancy and Future Maternal Cardiovascular Risk

“…An aspect of CVD risk that has not been previously examined is the relationship between HDP and atrial fibrillation, which is explored by Scantlebury et al in a recent issue of the Journal of the American Heart Association (JAHA) 53. In a nested case–control study conducted within a cohort of >7000 women, 105 cases of atrial fibrillation were compared with 105 controls.…”

Gender Differences in Atrial Fibrillation: A Review of Epidemiology, Management, and Outcomes

“…While gestational hypertension, gestational diabetes, and preeclampsia are independently associated with the long-term development of cardiovascular disease [ 14 , 15 ], the association between these pregnancy complications and incident risk of atrial fibrillation has not been well-studied. Olmstead county data showed that hypertensive disease in pregnancy predicts the development of atrial fibrillation later in life with an odds ratio of 2.6, but this association was attenuated and not statistically significant (OR 2.12, confidence interval 0.92-5.23), when adjusted for hypertension and obesity [ 16 ].…”