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Hypertensive disorders of pregnancy increase later risk for cardiomyopathy
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Women with a history of hypertensive disorders of pregnancy have a small but significantly higher risk for cardiomyopathy after the peripartum period compared with women who remain normotensive throughout pregnancy.
Ida Behrens, MD, of the department of epidemiology research at Statens Serum Institut in Copenhagen, Denmark, and colleagues followed 1,075,763 women enrolled in Denmark’s National Patient Register and Medical Birth Register between 1978 and 2012. Their goal was to determine whether a history of hypertensive disorders of pregnancy places women more at greater risk for cardiomyopathy years after delivery. Women were excluded from the trial if they had pre-existing CVD or diabetes.
The primary endpoint was cardiomyopathy diagnosed 5 months after delivery to end of follow-up period, nearly 35 years later.
In total, 2,067,633 pregnancies both live and stillborn were recorded. Preeclampsia or gestational hypertension developed in 76,108 of the pregnancies (12,974 severe preeclampsia, 44,711 moderate preeclampsia and 18,423 gestational hypertension). By the end of the follow-up, 1,577 women had been diagnosed with cardiomyopathy. Of these, 10.7% (n = 169) had a history of hypertensive disorders of pregnancy.
The link between hypertensive disorders of pregnancy and cardiomyopathy was independent of potential confounders such as ischemic heart disease, diabetes, obesity, age, birth year and smoking status, according to a press release.
The HRs for women with history of hypertensive disorders of pregnancy were:
- 2.2 (95% CI, 1.5-3.23) for severe preeclampsia;
- 1.89 (95% CI, 1.55-2.32) for moderate preeclampsia; and
- 2.06 (95% CI, 1.5-2.82) for gestational hypertension.
This increased risk remained significant even more than 5 years after last pregnancy.
The researchers noted that although a small increased risk was observed, because cardiomyopathy is rare, “the absolute risk was small.”
“Although the American Heart Association recommends monitoring for ischemic heart disease following preeclampsia, a similar recommendation would not be justified for a more rare condition such as cardiomyopathy, regardless of the strength of the observed association with [hypertensive disorders for pregnancy],” Behrens and colleagues wrote.
“Further research is necessary to understand whether there is a causal mechanism behind this association,” according to the researchers. – by Tracey Romero
Disclosure: The study was funded by the Danish Heart Association and the Danish Council for Independent Research. Behrens reports no relevant financial disclosures.
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