Review: Preeclampsia and future cardiovascular risk: formal risk factor or failed stress test?

Abstract

It is estimated that 10% of pregnancies are affected by hypertension worldwide. Approximately one-half of all hypertensive pregnancy disorders are due to preeclampsia, a pregnancy-specific disorder, its distinctive feature being either sudden onset, or worsening of pre-existing proteinuria. It has become increasingly recognized that women with a history of preeclampsia are at increased risk for future cardiovascular disease (CVD), but the mechanisms of this increase in risk are unclear. One possible explanation is that these two conditions share several common metabolic abnormalities as risk factors, including obesity, insulin resistance, and lipid abnormalities that may lead to preeclampsia and CVD at different times of a woman's life. Recent studies have revealed that, similar to CVD, several mediators of endothelial cell dysfunction are up-regulated in preeclampsia. Free radical derived oxidative stress, various inflammatory markers, including neutrophil response, C-reactive protein, and leukocyte adhesion, may contribute to endothelial dysfunction in both preeclampsia and coronary atherosclerosis. Alternatively, preeclampsia itself may induce metabolic and vascular changes that may increase the overall future risk for CVD in affected women. Therefore, at present, it remains unclear whether preeclampsia is a formal risk factor for CVD, or identifies women at increased risk for CVD later in life. Pending large-scale studies aiming to examine the causality of this association, women with a history of preeclampsia should be counseled regarding their increased risks for hypertension and other cardiovascular sequelae later in life, followed closely and treated aggressively for modifiable CVD risk factors.

Hypertension in Pregnancy and Offspring Cardiovascular Risk in Young Adulthood

“…40 However, it is not known whether similar patterns may be replicated in the offspring. 41,42 Unfortunately, low statistical power in our study precludes any definite answer to these questions. Another interesting aspect of preterm preeclampsia is the time-related improvement in prognosis for children born after these pregnancies.…”

Identification of ACOX2 as a shared genetic risk factor for preeclampsia and cardiovascular disease

“…It might include endothelial dysfunction and inflammation, similar to that associated with cardiovascular disease (CVD). 3 Both PE and CVD also share several metabolic abnormalities, 4 including increase in small, dense low-density lipoprotein and triglycerides. 5 Still, years after PE, many women have increased blood pressure, insulin resistance, triglycerides, and uric acid compared to women with normal pregnancies.…”

Preeclampsia and cardiovascular disease share genetic risk factors on chromosome 2q22

“…hypertension and obesity) [9], pathological features (e.g. endothelial dysfunction and inflammation) [10,11], and tend to occur in the same families [12]. These common antecedents have drawn attention to the likelihood of shared genetic susceptibility [13,14].…”