Pre-eclampsia doubles CVD risk for next 20 years

Older mothers are more at risk, and are at a five-fold increased risk of heart attack if they have pre-eclampsia.

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Women who develop pre-eclampsia during pregnancy have a significantly higher risk of cardiovascular disease for up to two decades, according to Danish research.

The increased risk of acute myocardial infarction and stroke was highest within 10 years after delivery, according to the register-based study of more than one million women. 

A history of pre-eclampsia would help identify women at increased risk of cardiovascular disease, said Dr Sara Hallum, lead author and epidemiologist at the University of Copenhagen.

Dr Hallum told TMR it was important that targeted interventions not be delayed until women with pre-eclampsia became eligible for screening programs in middle-age. 

The analysis found that in the decade after childbirth, women with a history of pre-eclampsia had four times the risk of heart attack and three times the risk of stroke compared to women without pre-eclampsia.

Rates of cardiovascular events in general remained twice as high more than 20 years later, the authors wrote in the European Journal of Preventive Cardiology. 

“I was a bit surprised by our finding that women aged 30-40 years with a history of pre-eclampsia had up to a five-fold higher risk of heart attack than women the same age without such a history,” Dr Hallum told TMR.

Women in this age group were also at three time the risk of stroke.

“This is a very important finding considering the very young age of these women when they get severe cardiovascular disease. It really highlights the need for early interventions,” Dr Hallum said.

Overall, 2% of women with a history of pre-eclampsia developed a heart attack or stroke within two decades of delivery. 

“Although this risk may be considered low, a 2% risk should not be accepted as the cost of a pregnancy complicated by pre-eclampsia,” Dr Hallum said. 

“And we included only severe cardiovascular outcomes. Imagine how many of these women may also suffer from other clinically important cardiovascular-related conditions such as increased blood pressure.”  

Dr Hallum said preventive strategies should begin soon after delivery, when women were still in close contact with the health system.

“The early post-partum period represents a window of opportunity for targeted interventions,” she said.

“But because routine follow-up could take decades and the number of women with pre-eclampsia is large, we need to identify those most likely to benefit from screening, which our study suggests are women 35 years or older or women with recurrent pre-eclampsia.

“One step in terms of prevention could be to increase the awareness among practitioners about these women’s increased risk of cardiovascular disease, so that they can inform and routinely monitor them for modifiable cardiovascular disease risk factors, such as increased blood pressure, high cholesterol and other lifestyle factors.” 

Pre-eclampsia could unmask an existing predisposition to ischaemic cardiovascular disease or could instigate a cascade of events that progressed into atherosclerosis and later ischaemic cardiovascular disease, the authors suggested.

European Journal of Preventive Cardiology 2023, online 26 January