Association of remote hypertension in pregnancy with coronary artery disease: a case-control study

Because hypertensive pregnancies have been associated with increased cardiovascular disease, we aimed to identify whether angiographically characterized coronary artery disease differed in women with previous normotensive pregnancies or hypertensive pregnancies (HPs). The study group included 217 parous women, aged 60.9+/-9.2 (SD) years, who required coronary angiography between January 2006 and December 2007, 36.8+/-9.9 and 28.8+/-10.5 years after their first and last pregnancy, respectively; 146 had normotensive pregnancies and 71 had >/=1 HP, according to a questionnaire including reproductive history and cardiovascular risks. Body mass index, smoking, and frequency of diabetes were similar in both groups. Chronic hypertension (93% versus 78%; P=0.007), hyperlipidemia (82% versus 69%; P=0.049), and premature familial cardiovascular disease (42% versus 20%; P=0.001) prevailed in HPs. Participants with HPs were younger (58.9+/-8.3 versus 61.9+/-9.6 years; P=0.025) than participants with normotensive pregnancies. Although 49% of all participants had hemodynamically significant coronary artery disease (>/=70% stenosis), no differences were observed between groups in the number of stenotic arteries; however, their number increased by 28% and 22% over a 10-year period in HPs and normotensive pregnancies, respectively (P=0.034). Multivariate analysis showed that HPs had a nonsignificant risk of having coronary artery disease (odds ratio: 1.21; 95% CI: 0.64 to 2.28), and being a current smoker (odds ratio: 4.13; 95% CI: 1.85 to 9.25), a diabetic (odds ratio: 2.29; 95% CI: 1.85 to 9.25), or having a family history of premature cardiovascular disease (odds ratio: 2.34; 95% CI: 1.17 to 2.39) significantly increased the risk of coronary artery disease. This study demonstrates that women with HPs have earlier coronary disease, probably related to intermediate cardiovascular risks that have a gestational expression.