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Cardiovascular health and vascular age after severe preeclampsia: A cohort study
Laura Benschop1, Sara Jc Schelling1, Johannes J Duvekot1
1Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
Insights
Severe preeclampsia elevates cardiovascular disease risk. Maintaining good cardiovascular health (CVH) after pregnancy is linked to reduced subclinical atherosclerosis and younger vascular age, suggesting early intervention opportunities.
Area of Science:
- Cardiology
- Obstetrics
- Preventive Medicine
Background:
- Severe preeclampsia is a known risk factor for long-term cardiovascular disease (CVD).
- The timing of CVD risk development and its relation to postpartum cardiovascular health (CVH) remain unclear.
- Subclinical atherosclerosis, assessed via carotid intima-media thickness (CIMT), is a key indicator of early CVD.
Purpose of the Study:
- To evaluate the cardiovascular health (CVH) status one year after severe preeclampsia.
- To investigate the association between postpartum CVH and subclinical atherosclerosis (CIMT).
- To determine the relationship between CVH and both chronological and vascular age.
Main Methods:
- A prospective cohort study involving women with a history of severe preeclampsia.
- Assessment of CVH using the American Heart Association's 7-metric score (blood pressure, cholesterol, glucose, smoking, diet, physical activity, BMI).
- Measurement of carotid intima-media thickness (CIMT) to determine vascular age and assess subclinical atherosclerosis.
Main Results:
- In 244 women, median CVH score was 10; low CVH (<10) correlated with higher CIMT (626.3 μm) compared to high CVH (≥12, 567.0 μm).
- Higher CVH was associated with a younger vascular age (-2.0 years).
- Women with low CVH exhibited a greater age difference between chronological and vascular age (22.5 years) versus those with high CVH (16.5 years).
Conclusions:
- Postpartum cardiovascular health (CVH) is inversely associated with subclinical atherosclerosis and vascular age one year after severe preeclampsia.
- Low CVH is particularly linked to a significant discrepancy between chronological and vascular age.
- Targeted CVH counseling post-preeclampsia may facilitate timely cardiovascular disease prevention.
Background And Aims:
Severe preeclampsia increases lifetime-risk for cardiovascular disease (CVD). It remains unclear when this risk translates to subclinical atherosclerosis and whether this is related to cardiovascular health (CVH) after pregnancy. Our aims were (1) to determine CVH after severe preeclampsia, (2) to relate CVH to carotid intima-media thickness (CIMT), as a marker of subclinical atherosclerosis and (3) to relate CVH to chronological and vascular age.
Methods:
A prospective cohort study was performed in women with previous severe pre-eclampsia. CVH, proposed by the American Heart Association, was assessed one year after pregnancy. The CVH score (range 0-14) includes seven metrics (blood pressure, total-cholesterol, glucose, smoking, physical activity, diet and body mass index [BMI]), each weighted as poor (0), intermediate (1) or ideal (2). Vascular age was determined by CIMT. We related CVH to delta age (chronological age - vascular age).
Results:
In 244 women, the median CVH score was 10 (90% range 7.0, 13.0). Low CVH (<10) was associated with a larger CIMT than high CVH (≥12) (median 626.3 μm vs. 567.0 μm, respectively). Higher CVH was also associated with a lower vascular age (-2.0 years, 95%CI -3.3, -0.60). Women with low CVH had a larger delta age (22.5 years [90% range -3.9, 49.6) than women with high CVH (16.5 years [90% range -11.9, 43.3).
Conclusions:
CVH is inversely related to subclinical atherosclerosis and to vascular age one year after severe preeclampsia. Especially low CVH is associated with a large difference between chronological age and vascular age. CVH counseling might provide the opportunity for timely cardiovascular prevention.
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