Long-Term Cardiovascular Risk in Women With Hypertension During Pregnancy

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:74

Article

Honigberg, Michael C.^1,2,3,4,5  Zekavat, Seyedeh Maryam^4,5,6  Aragam, Krishna^1,2,3,4,5  Klarin, Derek^3,7  Bhatt, Deepak L.⁸  Scott, Nandita S.^1,2  Peloso, Gina M.⁹  Natarajan, Pradeep^1,2,3,4,5 

[1] Harvard Med Sch, Massachusetts Gen Hosp, Cardiol Div, Boston, MA 02115 USA

[2] Harvard Med Sch, Massachusetts Gen Hosp, Dept Med, Boston, MA 02115 USA

[3] Harvard & MIT, Program Med & Populat Genet, Broad Inst, Cambridge, MA USA

[4] Massachusetts Gen Hosp, Cardiovasc Res Ctr, Boston, MA 02114 USA

[5] Massachusetts Gen Hosp, Ctr Genom Med, Boston, MA 02114 USA

[6] Yale Univ, Sch Med, New Haven, CT USA

[7] Massachusetts Gen Hosp, Dept Surg, Boston, MA 02114 USA

[8] Harvard Med Sch, Brigham & Womens Hosp, Cardiovasc Div, Boston, MA 02115 USA

[9] Boston Univ Sch Publ Hlth, Dept Biostat, Boston, MA USA

关键词: cardio-obstetrics;    cardiovascular epidemiology;    hypertension in pregnancy;    preeclampsia;    pregnancy;    women's health;   

DOI  :  10.1016/j.jacc.2019.09.052

来源: Elsevier

【 摘 要 】

BACKGROUND History of a hypertensive disorder of pregnancy (HDP) among women may be useful to refine atherosclerotic cardiovascular disease risk assessments. However, future risk of diverse cardiovascular conditions in asymptomatic middle-aged women with prior HDP remains unknown. OBJECTIVES The purpose of this study was to examine the long-term incidence of diverse cardiovascular conditions among middle-aged women with and without prior HDP. METHODS Women in the prospective, observational UK Biobank age 40 to 69 years who reported >= 1 live birth were included. Noninvasive arterial stiffness measurement was performed in a subset of women. Cox models were fitted to associate HDP with incident cardiovascular diseases. Causal mediation analyses estimated the contribution of conventional risk factors to observed associations. RESULTS Of 220,024 women included, 2,808 (1.3%) had prior HDP. The mean age at baseline was 57.4 +/- 7.8 years, and women were followed for median 7 years (interquartile range: 6.3 to 7.7 years). Women with HDP had elevated arterial stiffness indexes and greater prevalence of chronic hypertension compared with women without HDP. Overall, 7.0 versus 5.3 age-adjusted incident cardiovascular conditions occurred per 1,000 women-years for women with versus without prior HDP, respectively (p = 0.001). In analysis of time-to-first incident cardiovascular diagnosis, prior HDP was associated with a hazard ratio (HR) of 1.3 (95% CI: 1.04 to 1.60; p = 0.02). HDP was associated with greater incidence of CAD (HR: 1.8; 95% CI: 1.3 to 2.6; p < 0.001), heart failure (HR: 1.7; 95% CI: 1.04 to 2.60; p = 0.03), aortic stenosis (HR: 2.9; 95% CI: 1.5 to 5.4; p < 0.001), and mitral regurgitation (HR: 5.0; 95% CI: 1.5 to 17.1; p = 0.01). In causal mediation analyses, chronic hypertension explained 64% of HDP's association with CAD and 49% of HDP's association with heart failure. CONCLUSIONS Hypertensive disorders of pregnancy are associated with accelerated cardiovascular aging and more diverse cardiovascular conditions than previously appreciated, including valvular heart disease. Cardiovascular risk after HDP is largely but incompletely mediated by development of chronic hypertension. (C) 2019 by the American College of Cardiology Foundation.

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