Linking preeclampsia and cardiovascular disease later in life

Abstract

Preeclampsia (PE), which is defined as new onset hypertension after 20 weeks of pregnancy accompanied by proteinuria, is characterized by inadequate placentation, oxidative stress, inflammation and widespread endothelial dysfunction. A link between PE and long-term risk of cardiovascular disease (CVD) was suggested by retrospective studies, which found that PE was associated with a 2–3-fold risk of CVD later in life, with a 5–7-fold risk in the case of severe and/or early-onset PE. Recently, meta-analyses and prospective studies have confirmed the association between PE and the emergence of an unfavorable CVD risk profile, in particular a 3–5-fold increased prevalence of the metabolic syndrome only 8 years after the index pregnancy. PE and CVD share many risk factors, including obesity, hypertension, dyslipidemia, hypercoagulability, insulin resistance and both entities are characterized by endothelial dysfunction. PE and CVD are complex traits sharing common risk factors and pathophysiological processes, but the genetic link between both remains to be elucidated. However, recent evidence suggests that genetic determinants associated with the metabolic syndrome, inflammation and subsequent endothelial dysfunction are involved. As the evidence now supports that PE represents a risk factor for the emergence of the metabolic syndrome and CVD later in life, the importance of long-term follow-up assessment of CVD risk beginning early in women with a history of PE must be considered and translated into new preventive measures.

Preeclampsia as a Form of Type 5 Cardiorenal Syndrome: An Underrecognized Entity in Women’s Cardiovascular Health

“…This increased risk is based on genetic determinants shared with metabolic syndrome and inflammation [29]. Preeclamptic women have lower insulin sensitivity and a higher prevalence of postpartum metabolic syndrome than women without preeclampsia [30].…”

Homocysteinemia After Hypertensive Pregnancy Disorders at Term

“…Currently the pathophysiology of both hypertensive pregnancy disorders and cardiovascular disease and the link between these two disorders is investigated. 7 The most common hypothesis is that in both disorders there is an underlying endothelial dysfunction, manifesting in pregnancy by changes in spiral arteries and later in life in cardiovascular disease as atherosclerosis. 8,9 Studies on cardiovascular risk factors after hypertensive pregnancy disorders mainly focused on classic biomarkers, like lipid profiles, blood pressure, and glucose metabolism.…”

Vitamin D and maternal and child health: Overview and implications for dietary requirements

“…These studies are observational in nature; longitudinal clinical trials are needed to assess whether vitamin D has an active role in the development or progression of preeclampsia. In addition, preeclampsia has recently been reported to be a risk factor for the development of CVD and metabolic syndrome later in life with a five-to sevenfold risk of CVD associated with severe and/or early-onset preeclampsia (Giguere et al, 2012); thus, it will be important to identify genetic, environmental, and dietary factors that can contribute to the development of preeclampsia in order to prevent or treat this disorder.…”