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Hypertensive disorders during pregnancy increase CVD risk
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Women with a history of hypertensive disorders during pregnancy had an increased risk for CVD, according to a study published in JAMA Cardiology.
The increased risk was associated with increased levels of modifiable, conventional CV risk factors, according to the study.
Eirin B. Haug, PhD, postdoctoral researcher in the department of public health and nursing at Norwegian University of Science and Technology in Trondheim, and colleagues analyzed data from 23,885 women who were parous. Women were assessed for history of hypertensive disorders of pregnancy, defined as either preeclampsia or gestational hypertension at age 40 years or younger.
Questionnaires, interviews and examinations were conducted to collect information on smoking status, work titles, highest obtained educational level, current antihypertensive use, family history of CHD and CV risk factors. Medical records were also assessed for CV events.
Of the women in the study, 9% had a history of hypertensive disorders of pregnancy at age 40 years or younger. Compared with women aged 40 to 70 years with normotensive pregnancies, those in the same age range with a history of hypertensive disorders of pregnancy had an increased risk for CVD (HR = 1.57; 95% CI, 1.32-1.87). This was not seen in women older than 70 years (beta = 0.98; 95% CI, 0.96-1; P for interaction by age = .01).
Up to 77% of the excess risk for CVD in women with a history of hypertensive disorders of pregnancy was linked to BP and BMI. Smaller proportions of this risk were associated with lipid and glucose levels.
“Blood pressure plays a substantial role in driving the excess cardiovascular risk in women who experiences preeclampsia and an even larger role in women who experienced gestational hypertension,” Haug and colleagues wrote. “The association of conventional risk factors, in particular blood pressure and BMI, with the development of CVD in women with history [of hypertensive disorders of pregnancy] indicate that preventive efforts aimed at decreasing the levels of these risk factors could reduce cardiovascular risk in women with history of [hypertensive disorders of pregnancy].” – by Darlene Dobkowski
Disclosures: Haug reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Margo B. Minissian, PhD, ACNP, CLS, AACC, FAHA
Pregnancy serves as a window into our CV future. Women who experience hypertensive disorder during pregnancy have a twofold risk for CVD. Although the mechanisms between hypertensive disorder during pregnancy and CVD are not clearly understood, there is a lot we do know about how to reduce CVD risk.
The study by Haug and colleagues validated prior data that confirms women with hypertensive disorder during pregnancy are at risk for any CVD event at an earlier age (40 to 70 years) than normotensive women. The risk further increased for women who experienced preeclampsia. The study also suggests that hypertension and adiposity play an important role in accumulating excess risk.
Clinicians should always record pregnancy history and ensure that women who had a history of hypertensive disorder during pregnancy have regular BP and blood glucose checks. It is also important for clinicians to have open discussions with their patients about a heart-healthy lifestyle to help manage a healthy weight. Incorporating Mediterranean-style nutrition, walking 10,000 steps daily and not smoking are important steps towards a healthy lifestyle.
Despite identifying modifiable risk factors which are responsible for an excess of 77% risk, there is still a lot we do not understand about underlying mechanisms in women who experience an adverse pregnancy outcome such as hypertensive disorder during pregnancy, preterm delivery, gestational diabetes and intrauterine growth restriction. Phenotyping differences between adverse pregnancy outcomes is critical if interventional studies are going to be successful.
These data help to improve awareness around the risk of CVD in young women who have a prior hypertensive disorder during pregnancy. Bias remains among these young women who appear healthy, however develop hypertension early (which is often unrecognized or dismissed) and subsequently develop MI at higher rates at relatively younger ages (40 to 70 years)
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