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Prior preeclampsia confers increased CVD risk for older women
PHILADELPHIA — Older women with prior preeclampsia are at elevated risk for future CV diagnoses and incidence of arterial stiffness and hypertension, according to findings presented at the American Heart Association Scientific Sessions.
Women who reported at least one live birth and had a history of preeclampsia were found to be at greater risk for CAD (HR = 1.8; 95% CI, 1.3-2.6), HF (HR = 1.7; 95% CI, 1-2.6), aortic stenosis (HR = 2.9; 95% CI, 1.5-5.4) and mitral regurgitation (HR = 5; 95% CI, 1.5-17.1) compared with women with no prior preeclampsia.
Moreover, researchers observed that women with a history of preeclampsia also experienced a greater incidence of arterial stiffness and more prevalence of hypertension (age-adjusted OR = 11.6; P < .001) compared with women with no such history.
“When we looked at the prevalence of chronic hypertension by age at study enrollment, we saw fairly dramatic differences between women without hypertensive disorders of pregnancy (HDP) and with HDP,” Michael C. Honigberg, MD, MPP, cardiology fellow at Massachusetts General Hospital, said during his presentation. “Differences in baseline prevalence of hypertension ranged from two- to fivefold, and we saw that four out of five women with a history of HDP who were enrolled at or after age 60 had very high rates of chronic hypertension. We know that arterial stiffness increases with age in everybody, but adjusting for age and menopausal status, women with prior HDP have significantly higher arterial stiffness. This difference persisted further after we adjusted for diabetes status, smoking and body mass index.”
Causal mediation analysis
Researchers also found that hypertension explained approximately 64% of preeclampsia’s association with incident CAD and 43% of its association with incident aortic stenosis.
“We wondered whether these associations that we observed were mediated by conventional cardiovascular disease risk factors like hypertension, so we employed a causal mediation analysis,” Honigberg said. “This is a statistical approach that aims to explain how much of the relationship between an exposure (HDP) and an outcome (CVD) is explained by the presence of a mediator. We looked specifically at the mediation effects of hypertension, hyperlipidemia and diabetes and we found that in our mediation analysis, 64% of the association between HDP and coronary disease is explained by chronic hypertension and 49% of the association with heart failure was hypertension. There was no mediation effect of hyperlipidemia or diabetes.”
Methods and future research
Assessing the data of 220,024 women (mean age, 57 years; mean years from first birth, 31.4; 1.3% with preeclampsia) obtained from the UK Biobank, researchers analyzed qualifying ICD codes with the aim of determining the association of preeclampsia with incident CAD, HF, aortic stenosis, mitral regurgitation, atrial fibrillation, ischemic stroke, peripheral artery disease and venous thromboembolism.
“These findings suggest that hypertensive disorders of pregnancy are associated with a syndrome of accelerated cardiovascular aging, spanning vascular and nonvascular outcomes and as evidenced by accelerated arterial stiffness in this population,” Honigberg said. “We feel further researchers needed to elucidate underlying mechanisms and define optimal strategies for screening, prevention and treatment. Our findings suggest a focus on high blood pressure management and other strategies to slow vascular aging may be of particularly high importance.” – by Scott Buzby
References:
Honigberg MC, et al. Abstract RF227. Presented at: American Heart Association Scientific Sessions; Nov. 16-18, 2019; Philadelphia.
Honigberg MC, et al. J Am Coll Cardiol. 2019;doi:10.1016/j.jacc.2019.09.052.
Disclosures: Honigberg reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.