Preeclampsia strongly linked to incident HF
Preeclampsia was associated with a twofold increased risk for HF, but gestational hypertension was not, according to a study of Norwegian women published in Hypertension.
Among women with hypertensive disorders of pregnancy, the risk for HF was not affected by concurrent small for gestational age or preterm delivery, researchers reported.
“Although hypertensive disorders of pregnancy is associated with incident CAD and CAD is in turn associated with HF, HF risks associated with hypertensive disorders of pregnancy in our cohort appeared largely independent of CAD,” Michael C. Honigberg, MD, MPP, cardiologist and researcher at Massachusetts General Hospital and an instructor in medicine at Harvard Medical School, and colleagues wrote.
For this study, investigators included 508,422 Norwegian women (565 with incident HF; median follow-up, 11.8 years) with a first birth from 1980 to 2004 and used Cox models to assess gestational hypertension and preeclampsia during the first pregnancy as predictors of the composite outcome of HF-related hospitalization or HF-related death. They also evaluated potential effect modification by concurrent small for gestational age or preterm delivery.
Researchers observed that women with a hypertensive disorder of pregnancy — preeclampsia or gestational hypertension — experienced a significantly greater risk for HF (HR = 1.83; 95% CI, 1.41-2.36) compared with those without one. Preeclampsia increased the risk for HF twofold (HR = 2; 95% CI, 1.5-2.68), whereas there was no association between gestational hypertension and subsequent HF (HR = 1.41; 95% CI, 0.84-2.35).
Moreover, among women with hypertensive disorders of pregnancy in a second or later birth, incident HF was elevated, even when the first birth was normotensive (HR for women with gestational hypertension in a second or later birth = 3.15; 95% CI, 1.77-5.61; HR for women with preeclampsia in a second or later birth = 2.92; 95% CI, 1.89-4.5).
Additionally, small for gestational age delivery was independently associated with incident HF (HR = 1.35; 95% CI, 1.09-1.67), but preterm delivery was not (HR = 1.26; 95% CI, 0.93-1.7), and HF risk after hypertensive disorder of pregnancy during the first birth was not affected by concurrent small for gestational age or preterm delivery (P for interaction = .42).
After researchers excluded women with incident CAD, the risk for incident HF was similar to the primary analysis (HR for women with gestational hypertension = 1.32; 95% CI, 0.7-2.48; HR for women with preeclampsia = 1.89; 95% CI, 1.33-2.7).
Investigators also observed no significant interaction between gestational hypertension (P for interaction = .81) or preeclampsia (P for interaction = .8) with small for gestational age or preterm delivery for incident HF.
“I was surprised that the associations between hypertensive disorders of pregnancy and HF were not modified by concurrent small-for-gestational-age or preterm delivery,” Honigberg said in an interview. “These concurrent pregnancy complications represent other indicators of placental vascular health, have been independently associated with future risk of atherosclerotic CVD and have been shown to modify ASCVD risk when they accompany hypertensive disorders of pregnancy. The lack of modifying effect for HF risk may indicate that mechanisms underlying development of ASCVD and development of HF in women with hypertensive disorders of pregnancy are different.
“We need additional research to identify molecular mechanisms linking pregnancy complications to CVD,” Honigberg told Healio. “Greater mechanistic understanding may enable both improvement in CVD risk prediction and development of effective preventive strategies.”
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