97 Association between hypertensive disorders of pregnancy and later risk of cardiovascular outcomes

Introduction

Hypertensive disorders of pregnancy, especially pre-eclampsia, are associated with greater cardiovascular disease risk. However, the risk of specific cardiovascular outcomes associated with pre-eclampsia or gestational hypertension is unclear.

Methods

Cox regression analysis compared rates of 19 cardiovascular outcomes in women with and without a history of pre-eclampsia and gestational hypertension, using electronic health records from women with one or more live births in England, 1997–2015.

Results

The cohort comprised 6,333,053 women, 276,389 and 223,715 pregnancies were complicated by gestational hypertension and pre-eclampsia, respectively. During 61.7 million person-years of follow-up, the incidence of any cardiovascular events for normotensive women, women with prior gestational hypertension and women with prior pre-eclampsia were: 39.95/100 000 person-years [95% CI, 39.05–40.87] (no. of CVD events=7,474), 62.24/100 000 person-years [95% CI, 56.67–68.20] (no. of CVD events= 469), and 73.72/100 000 person-years [95% CI, 67.20–80.71] (no. of CVD events=469), respectively. Compared with women with normotensive pregnancies, there was a greater risk of any cardiovascular event for women with previous gestational hypertension, adjusted HR (aHR) = 1.45 (1.31, 1.61), and pre-eclampsia, aHR = 1.69 (1.53–1.87). A history of gestational hypertension was most strongly associated with cardiomyopathy, aHR = 2.10 (1.52–2.89), and ischemic stroke, aHR = 1.79 (1.36–2.35). Women with two or more pregnancies with gestational hypertension were at greatest risk of stroke, aHR = 2.61 (1.91, 3.57), specifically ischemic stroke, aHR = 3.47 (2.38, 5.06). Women with a history of pre-eclampsia were at greatest risk of acute myocardial infarction, aHR = 3.08 (2.27, 4.16), and cardiomyopathy, aHR = 2.43 (1.78–3.31). Two or more pregnancies with pre-eclampsia was most strongly associated with ischemic stroke, aHR = 3.80 (2.53, 5.73) and acute myocardial infarction, aHR = 3.18 (1.91, 5.28).

Conclusions

This is the first study to compare the risk of a spectrum of CVD events for women with pre-eclampsia or gestational hypertension. Women with either previous gestational hypertension or pre-eclampsia are at increased risk of a range of cardiovascular outcomes compared to women with normotensive pregnancies. Associations were stronger with pre-eclampsia than gestational hypertension, and increased with a greater number of affected pregnancies. Gestational hypertension was most strongly associated with strokes, in particular ischemic stroke, and pre-eclampsia was most strongly associated with acute myocardial infarction and cardiomyopathy.

Conflict of Interest

None