Cardiovascular risk estimation in women with a history of hypertensive pregnancy disorders at term: a longitudinal follow-up study

BMC Pregnancy and Childbirth

Christianne JM de Groot⁵  Ben W Mol⁸  Martina Porath⁴  Kitty WM Bloemenkamp⁶  Maria G van Pampus¹  Joris van der Post⁸  Arie Franx⁷  Diana C Grootendorst²  Jouke T Tamsma³  Wietske Hermes⁵ 

[1] Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands;Department of Clinical Epidemiology, Landsteiner Institute, Medical Center Haaglanden, The Hague, the Netherlands;Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands;Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven, the Netherlands;Department of Obstetrics, VU University Medical Center, Amsterdam, the Netherlands;Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands;Division of Woman and Baby, University Medical Center, Utrecht, the Netherlands;Department of Obstetrics and Gynecology, Amsterdam Medical Center, Amsterdam, the Netherlands

关键词: Preeclampsia;    Gestational hypertension;    Follow-up study;    Cardiovascular risk prediction;    Cardiovascular risk;   

Others  :  1137995
DOI  :  10.1186/1471-2393-13-126

 received in 2013-02-21, accepted in 2013-05-23,  发布年份 2013

【 摘 要 】

Background

Cardiovascular disease is associated with major morbidity and mortality in women in the Western world. Prediction of an individual cardiovascular disease risk in young women is difficult. It is known that women with hypertensive pregnancy complications have an increased risk for developing cardiovascular disease in later life and pregnancy might be used as a cardiovascular stress test to identify women who are at high risk for cardiovascular disease. In this study we assess the possibility of long term cardiovascular risk prediction in women with a history of hypertensive pregnancy disorders at term.

Methods

In a longitudinal follow-up study, between June 2008 and November 2010, 300 women with a history of hypertensive pregnancy disorders at term (HTP cohort) and 94 women with a history of normotensive pregnancies at term (NTP cohort) were included. From the cardiovascular risk status that was known two years after index pregnancy we calculated individual (extrapolated) 10-and 30-year cardiovascular event risks using four different risk prediction models including the Framingham risk score, the SCORE score and the Reynolds risk score. Continuous data were analyzed using the Student’s T test and Mann–Whitney U test and categorical data by the Chi-squared test. A poisson regression analysis was performed to calculate the incidence risk ratios and corresponding 95% confidence intervals for the different cardiovascular risk estimation categories.

Results

After a mean follow-up of 2.5 years, HTP women had significantly higher mean (SD) extrapolated 10-year cardiovascular event risks (HTP 7.2% (3.7); NTP 4.4% (1.9) (p<.001, IRR 5.8, 95% CI 1.9 to 19)) and 30-year cardiovascular event risks (HTP 11% (7.6); NTP 7.3% (3.5) (p<.001, IRR 2.7, 95% CI 1.6 to 4.5)) as compared to NTP women calculated by the Framingham risk scores. The SCORE score and the Reynolds risk score showed similar significant results.

Conclusions

Women with a history of gestational hypertension or preeclampsia at term have higher predicted (extrapolated) 10-year and 30-year cardiovascular event risks as compared to women with a history of uncomplicated pregnancies. Further large prospective studies have to evaluate whether hypertensive pregnancy disorders have to be included as an independent variable in cardiovascular risk prediction models for women.

【 授权许可】

   
2013 Hermes et al.; licensee BioMed Central Ltd.

【 图 表 】

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