Hypertensive Disorders of Pregnancy and 10-Year Cardiovascular Risk Prediction

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:72

Article

Stuart, Jennifer J.^1,2,3  Tanz, Lauren J.^1,2,3  Cook, Nancy R.^1,3,4  Spiegelman, Donna^1,3,5,6  Missmer, Stacey A.^1,3,7,8  Rimm, Eric B.^1,3,6,9  Rexrode, Kathryn M.^2,3,4  Mukamal, Kenneth J.^9,10  Rich-Edwards, Janet W.^1,2,3 

[1] Harvard TH Chan Sch Publ Hlth, Dept Epidemiol, Boston, MA USA

[2] Brigham & Womens Hosp, Div Womens Hlth, 75 Francis St, Boston, MA 02115 USA

[3] Harvard Med Sch, Boston, MA USA

[4] Brigham & Womens Hosp, Dept Med, Div Prevent Med, 75 Francis St, Boston, MA 02115 USA

[5] Harvard TH Chan Sch Publ Hlth, Dept Biostat, Boston, MA USA

[6] Brigham & Womens Hosp, Dept Med, Channing Div Network Med, 75 Francis St, Boston, MA 02115 USA

[7] Boston Childrens Hosp, Dept Pediat, Div Adolescent & Young Adult Med, Boston, MA USA

[8] Michigan State Univ, Coll Human Med, Dept Obstet Gynecol & Reprod Biol, Grand Rapids, MI USA

[9] Harvard TH Chan Sch Publ Hlth, Dept Nutr, Boston, MA USA

[10] Beth Israel Deaconess Med Ctr, Div Gen Med & Primary Care, Boston, MA 02215 USA

关键词: cardiovascular disease;    cardiovascular disease risk factors;    pre-eclampsia;    pregnancy;   

DOI  :  10.1016/j.jacc.2018.05.077

来源: Elsevier

【 摘 要 】

BACKGROUND Hypertensive disorders of pregnancy (HDP) affect 10% to 15% of women and are associated with a 2-fold increased risk of cardiovascular disease (CVD). OBJECTIVES This study sought to determine whether inclusion of HDP in an established CVD risk score improves prediction of CVD events in women. METHODS The analysis comprised 106,230 <= 10-year observations contributed by 67,406 women, age >= 40 years, free of prior CVD, with data available on model covariates in the Nurses' Health Study II. Participants were followed up for confirmed myocardial infarction, fatal coronary heart disease, or stroke from 1989 to 2013. We fit an established CVD risk prediction model (Model A: age, total cholesterol and high-density lipoprotein cholesterol, systolic blood pressure, antihypertensive medication use, current smoking, diabetes mellitus) and compared it to the same model plus HDP and parity (Model B); Cox proportional hazards models were used to obtain predicted probabilities for 10-year CVD risk. RESULTS HDP and parity were associated with 10-year CVD risk independent of established CVD risk factors, overall and at ages 40 to 49 years. However, inclusion of HDP and parity in the risk prediction model did not improve discrimination (Model A: C-index = 0.691; Model B: C-index = 0.693; p value for difference = 0.31) or risk reclassification (net reclassification improvement = 0.4%; 95% confidence interval: -0.2 to 1.0%; p = 0.26). CONCLUSIONS In this first test of the clinical utility of HDP and parity in CVD risk prediction, additional inclusion of HDP and parity in an established risk score did not improve discrimination or reclassification in this low-risk population; this might be because of the known associations between HDP and established CVD risk factors in the reference model. (C) 2018 by the American College of Cardiology Foundation.

【 授权许可】

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