Preeclampsia elevates long-term risk for arrhythmia among primiparous women
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Key takeaways:
- Women with preeclampsia had a higher 20-year cumulative incidence of arrhythmia than women without preeclampsia.
- Among women with arrhythmias, those with preeclampsia had an increased risk for mortality.
Preeclampsia appeared to increase primiparous women’s risk for developing arrhythmia, according to results of a real-world study published in European Journal of Preventative Cardiology.
Although preeclampsia has been linked to hypertension and heart disease, “the association between preeclampsia and arrhythmias remains sparsely investigated,” Eva Havers-Borgersen, MD, PhD fellow in the department of cardiology at Rigshospitalet at Copenhagen University Hospital in Denmark, and colleagues wrote.
“This nationwide study sets out to examine the yet unknown, adjusted long-term risk of arrhythmias following preeclampsia in primiparous pregnancies with no history of arrhythmias,” they wrote. “This is crucial in order to assess the future cardiovascular risk and identify a potential need for prophylactic measures and interventions in women with preeclampsia.”
The observational cohort study included data from 523,271 primiparous women (median age, 28 years; interquartile range [IQR], 25-31) without a history of arrhythmias or cardiac implantable devices who gave birth from 1997 to 2016 in Denmark.
The researchers used national records to identify cases of arrhythmia among participants during a median follow-up of 10.1 years (IQR, 5.2-15.3).
During their first pregnancy, 23,367 (4.5%) women were diagnosed with preeclampsia.
A median of 7.1 years (IQR 3.2-11.6) after pregnancy, 5,440 (1.04%) women developed arrhythmias, including 1.4% of the women with preeclampsia and 1% of those without.
Overall, women with preeclampsia had a higher 20-year cumulative incidence of arrhythmias compared with women without preeclampsia (2.8%; 95% CI, 2.4-3.3 vs. 2.2%; 95% CI, 2.1-2.3; P < .0001).
Women with preeclampsia had an increased risk for developing a composite of cardiac arrest, ventricular tachycardia/fibrillation or implantable cardioverter defibrillator insertion (adjusted HR = 1.6; 95% CI, 1.14-2.24), as well as supraventricular tachyarrhythmias and extrasystoles (aHR = 1.34; 95% CI, 1.19-1.51). The risk for advanced second- or third-degree atrioventricular block, sinoatrial dysfunction and pacemaker implantation appeared higher among women with preeclampsia in an unadjusted analysis (HR = 1.53; 95% CI, 1.1-2.31), but it lost significance in the adjusted analysis (aHR = 1.48; 95% CI, 0.97-2.23).
Overall, preeclampsia was associated with a higher risk for developing any arrhythmia (aHR = 1.37; 95% CI, 1.23-1.54), although researchers noted this was primarily driven by the risk for supraventricular tachyarrhythmias and extrasystoles.
Women with preeclampsia also had an elevated risk for death compared with women without preeclampsia (20-year cumulative incidence, 1.4% vs. 1.2%; aHR = 1.33; 95% CI, 1.1-1.6).
Among women who developed arrhythmias, those who had preeclampsia had a higher risk for mortality compared with women without preeclampsia, but the difference did not reach statistical significance in the unadjusted (HR = 1.65; 95% CI, 0.93-2.91) and adjusted (aHR = 1.56; 95% CI, 0.88-2.76) analyses.
“Women with a history of preeclampsia were associated with a significantly increased long-term risk of arrhythmias persisting even after thorough adjustment for known arrhythmogenic risk factors,” the researchers wrote. “Our results support the current clinical recommendations that women with preeclampsia should be offered evaluations of cardiovascular risk factors and educational interventions in terms of lifestyle changes to prevent future cardiovascular disease.”
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