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Trajectory of Cardiovascular Risk Factors After Hypertensive Disorders of Pregnancy
T Katrien J Groenhof1, Gerbrand A Zoet2, Arie Franx2
1From the Julius Centre for Health Sciences and Primary Care (T.K.J.G., M.L.B.), University Medical Centre Utrecht, the Netherlands.
Insights
Women with a history of hypertensive disorder of pregnancy (HDP) face higher risks of cardiovascular disease. Early cardiovascular risk assessment, starting in their 30s, is crucial for timely intervention and prevention.
Area of Science:
- Cardiovascular Medicine
- Obstetrics & Gynecology
- Preventive Cardiology
Background:
- Women with a history of hypertensive disorder of pregnancy (HDP) have an elevated risk of premature cardiovascular disease.
- Current cardiovascular risk management guidelines lack uniform recommendations for initiating risk assessment in these women.
- Identifying an optimal time for cardiovascular risk factor assessment is essential for effective prevention strategies.
Purpose of the Study:
- To determine the ideal window for initiating cardiovascular risk factor assessment in women with a history of HDP.
- To investigate longitudinal changes in blood pressure, lipids, and glucose levels in women with and without a history of HDP.
- To identify the optimal age for screening for hypertension, dyslipidemia, and diabetes mellitus in this high-risk group.
Main Methods:
- A population-based cohort study included women with a history of normotensive pregnancy (n=1811) and HDP (n=1005).
- Longitudinal assessment of blood pressure, lipids, glucose, 10-year cardiovascular risk, and incidence of hypertension, dyslipidemia, and diabetes mellitus.
- Data were collected through 5 measurements at 3-year intervals, analyzed using generalized estimating equations with age as the time variable.
Main Results:
- Women with a history of HDP exhibited significantly higher overall prevalence of hypertension, dyslipidemia, and diabetes mellitus.
- Hypertension and diabetes mellitus developed earlier in women with a history of HDP compared to those with normotensive pregnancies.
- Screening for hypertension at age 35 identified one woman with a treatment indication for every 9 women with HDP history, versus 38 for normotensive pregnancy history.
Conclusions:
- Cardiovascular follow-up for women with a history of HDP should commence within their fourth decade of life.
- Early identification and management of cardiovascular risk factors are critical for this high-risk population.
- This study provides evidence-based recommendations for timely cardiovascular risk assessment in women post-HDP.
Abstract:
Women with a history of a hypertensive disorder of pregnancy (HDP) are at increased risk of premature cardiovascular disease. Cardiovascular risk management guidelines emphasize the need for prevention of cardiovascular disease in these women but fail to provide uniform recommendations on when and how to start cardiovascular risk assessment. The aim of this study was to identify a window of opportunity in which to start cardiovascular risk factor assessment by investigating changes in blood pressure, lipids, and fasting glucose levels over time in women with a history of an HDP. We identified women with a history of a normotensive pregnancy (n=1811) or an HDP (n=1005) within a high-risk population-based cohort study. We assessed changes in blood pressure, lipids, glucose, 10-year cardiovascular risk and the occurrence of hypertension, dyslipidemia, and diabetes mellitus longitudinally using 5 measurements at 3-year intervals. Generalized estimating equations were used for statistical analysis, with age as the time variable, adjusting for multiple comparisons using the least significant differences method. In women with an HDP, the overall prevalence of hypertension ( P<0.0001), dyslipidemia ( P=0.003), and diabetes mellitus ( P<0.0001) was significantly higher. They also developed hypertension and diabetes mellitus earlier. At age 35, few women with HDP need to be screened to detect clinically relevant hypertension: 9 need to be screened to detect 1 woman with a treatment indication as opposed to 38 women with history of a normotensive pregnancy. Our data supports cardiovascular follow-up of women with a history of an HDP starting within the fourth decade of life.
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