Long-Term Biochemical and Cardiovascular Profiles 3-6 Years After Preeclampsia: Impact of Angiogenic Imbalance During...

Background/Objectives: Preeclampsia is associated with long-term cardiovascular and metabolic risks. This study aimed to evaluate metabolic and cardiovascular biochemical profiles in women with a history of preeclampsia and angiogenic imbalance during pregnancy. Methods: We conducted a cross-sectional study at Hospital de la Santa Creu i Sant Pau between August 2023 and July 2025. Participants had been prospectively enrolled during pregnancy (2018-2022) and were re-evaluated 3 to 6 years later. Blood and urine samples were collected after a 12-h fast to assess hematological, metabolic, and cardiovascular markers. Angiogenic profiles were determined using sFlt-1/PlGF ratios obtained during pregnancy. Multivariable linear regression models were used to assess associations with a history of PE and angiogenic imbalance, adjusting for relevant confounders. Results: 363 participants were included. 113 (31.1%) had a history of preeclampsia. Women with previous preeclampsia showed slightly higher high-sensitivity troponin T concentrations [4.0 (3.0-6.0) ng/L vs. 3.2 (3.0-5.0) ng/L, p = 0.03]. Women with sFlt-1/PlGF ≥38 exhibited significantly higher urinary protein [0.09 (0.07-0.18) g/L vs. 0.08 (0.07-0.13) g/L, p = 0.01], potassium [4.25 (4.07-4.40) mmol/L vs. 4.19 (4.02-4.37) mmol/L, p = 0.048], and LDH concentrations [168 (150-189) U/L vs. 163 (149-177) U/L, p = 0.046], and lower leukocyte counts [6150 (5348-7055) vs. 6250 (5430-7450) U/mL, p = 0.03]. Conclusions: Women with angiogenic imbalance during pregnancy display subtle alterations in renal and endothelial function markers years after delivery, whereas those with preeclampsia show slightly higher troponin concentrations. These findings, though clinically irrelevant, suggest that pregnancy-related vascular dysfunction may have different long-term manifestations depending on whether the maternal cardiovascular system was sufficiently compromised to develop overt preeclampsia.