For women with a history of pre-eclampsia related to their first pregnancy, the risk of acute myocardial infarction (MI) and ischemic stroke remains elevated for up to 20 years, Danish researchers find , European Journal of Preventive Cardiology.
A registry-based study of more than 1.5 million women found that during the first 10 years postpartum, women who experienced preeclampsia had up to four times the incidence of AMI compared with women who did not. , found that the incidence of ischemic stroke was up to 3-fold higher. The risk of both ischemic cardiovascular events persisted for her 20 years, with her AMI and ischemic stroke rates 1.5 to 2 times higher compared to women with no history of pre-eclampsia. was observed, the study authors report.
The relative risk was highest among young women aged 30 to 39 years within 10 years of pre-eclampsia, but remained substantial after more than 20 years.
Principal investigator Sara Hallum, M.D., an epidemiologist and PhD student at the University of Copenhagen, Denmark, said: in a statement“This indicates that interventions to prevent heart attacks and strokes in affected women cannot wait until middle age when they are eligible for conventional cardiovascular screening programs.”
“The increased risk of cardiovascular disease after pre-eclampsia manifests itself at a young age and early in the postpartum period. It shows that you can’t wait until you’re middle-aged to be eligible for the program.
clear and present danger
Preeclampsia affects 2% to 8% of all pregnancies. A well-established body of evidence on her lifetime risk of CVD in a woman with a history of complications has led both the American Heart Association and the European College of Cardiology to recognize pre-eclampsia as a risk factor for her CVD in women. have begun to do so, write the study authors. Among these are: How early and how much does the risk of cardiovascular disease increase after delivery with pre-eclampsia, and does that risk change over time? Current data included only composite endpoints, and participants were mostly ‘eligible for conventional CVD screening’.
Hallum and colleagues designed the current study to answer similar questions, examining the ‘timing and trajectory’ of AMI and ischemic stroke in women with and without a history of pre-eclampsia.
Investigators used data from three Danish national registries and linked them to the national medical birth register to find out that at least one pregnancy ended alive or stillborn between 1978 and 2017. We created a cohort of all Danish women. After excluding the first prenatally enrolled woman with circulatory problems, the final cohort counted her 1,157,666 women. Median follow-up for this cohort was 20.5 (IQR, 10-30.5) years.
findings
Incidence of pre-eclampsia. Of the final group of participants, 4.0% (n=45,820) had a first pregnancy complicated by pre-eclampsia. Within this group, 7.1% (n=3270) had early preterm preeclampsia, 11.8% (n=5405) had late preterm preeclampsia, and 81.1% (n=37,145) had full term preeclampsia. During the study period, findings showed that 58,120 women had their 64,357 pregnancies complicated by pre-eclampsia.
Ischemic eventDuring the 23,503,887 person-years of follow-up, 2.5% (n=8702) of women experienced AMI as their first ischemic event and 3.8% (n=13,999) experienced ischemic stroke as their first event. . During her first 20 years from her first pregnancy, 1.2% of her (n = 3089) and 1.8% of her (n = 5119) of women experienced her AMI and ischemic stroke, respectively.
timingThe researchers found that up to 2% (95% CI, 1.46-2.82) of women with pre-eclampsia during their first pregnancy experienced an AMI or stroke within the first 20 years after giving birth, whereas up to 1.2% (95% CI, 1.08–1.30) of nonpregnant women with preeclampsia. They further found that differences in cumulative incidence between groups became apparent at 7 years postpartum.
Persistent risk. Further analysis suggested that pre-eclampsia was associated with more than four times the risk of AMI (HR, 4.16 [95% CI, 3.16-5.49]) and almost three times the risk of ischemic stroke (HR, 2.59 [95% CI, 2.04-3.28]) during the first decade of pregnancy. Of note, the relative risk of ischemic events remained twice as high as her over 20 years, making women over the age of 50 more susceptible to ischemic CVD.
Hallum et al. were also interested in how age at delivery influenced the timing of CVD onset, and in an age-stratified subgroup analysis, preeclamptic women aged 30–39 years and We found that the women who did not were almost 5 years old in the same age group. Double risk of AMI (HR, 4.88 [95% CI, 3.55-6.71]) and more than double the risk of ischemic stroke (HR, 2.56 [95% CI, 1.95-3.36]).
Women aged 30-39 years with pre-eclampsia and women without pre-eclampsia in the same age group had a nearly five-fold higher risk of AMI and a more than two-fold higher risk of ischemic stroke.
The researchers emphasized that data on the timing and trajectory of CVD events would be of great help in screening, prevention, and intervention in women affected by pre-eclampsia, and that contact with the postpartum health care system It points to “providing a window of opportunity” to identify them. high risk.
“Our study suggests that the women most likely to benefit from screening were those who had pre-eclampsia after age 35 and those who had two or more pregnancies,” they said. concluded. “Prevention should begin within 10 years of childbirth. For example, treating high blood pressure and educating women about heart disease risk factors such as smoking and inactivity.”
References: Hallum S, Basit S, Kamper-Jorgensen M, Sehested TSG, Boyd HA. Risk and trajectory of early ischemic cardiovascular disease in women with a history of preeclampsia: a national registry-based study. Eur J Preventive Cardiol. Published online 26 January 2023. doi:10.1093/eurjpc/zwad003
