The Role of Adverse Pregnancy Outcomes in Conventional Cardiovascular Risk Prediction

Area of Science:

• Cardiovascular Disease Research
• Women's Health
• Reproductive Health

Background:

• Adverse pregnancy outcomes (APOs) affect one-third of U.S. women and are potential cardiovascular disease (CVD) risk factors.
• Traditional CVD risk factors are well-established, but the independent contribution of APOs requires further investigation.

Purpose of the Study:

• To determine if APOs confer additional CVD risk beyond traditional risk factors.
• To assess if including APOs in CVD risk prediction models improves accuracy.

Main Methods:

• Survival models (Cox proportional hazard regression) analyzed CVD event risk in 2306 women (age 40-79) with a pregnancy history.
• APOs included any APO, hypertensive disease of pregnancy (HDP), and gestational diabetes (GDM).
• CVD risk prediction models were evaluated for discrimination, calibration, and net reclassification with and without APOs.

Main Results:

• No significant association was found between any APO, HDP, or GDM and time to CVD outcome.
• Inclusion of APOs did not significantly improve CVD risk prediction model discrimination or reclassification.
• Black race emerged as the strongest predictor of CVD events (HR 1.59-1.62).

Conclusions:

• APOs do not confer additional CVD risk when traditional risk factors are controlled.
• APOs did not enhance the predictive accuracy of existing CVD risk models.
• Black race is a significant predictor of CVD, underscoring health disparities.