Abstract MP20: Hypertensive Disorders In Pregnancy and the Risk of Incident Cardiovascular Disease
Background: Despite the different pathophysiological mechanisms of gestational hypertension and preeclampsia, hypertensive disorders (HTD) in pregnancy are hypothesized to increase the risk of incident cardiovascular disease (CVD). However, previous studies investigating the association between HTD in pregnancy and incident CVD have not accounted for time-varying confounding.
Methods: A retrospective cohort of 156,967 women with a first recorded pregnancy between the ages of 15-45 years and no prior history of chronic hypertension or CVD. Exposure was defined as a composite of: 1) a diagnosis of HTD in pregnancy or new hypertension; 2) high systolic or diastolic blood pressure readings; or 3) a prescription for anti-hypertensive agents between 20 weeks gestation and 6 weeks postpartum. Our primary outcome was incident CVD, defined as a composite endpoint of coronary artery disease and related procedures, cerebrovascular disease, and peripheral vascular disease. Our secondary outcome was chronic hypertension. Marginal structural Cox models were used to account for important time-varying confounders. In secondary analyses, exposure was sub-classified as 1) pre-eclampia or eclampsia; and 2) other HTD of pregnancy. In sensitivity analyses, an approach analogous to an intention-to-treat analysis was used.
Results: The mean age at cohort entry was 29 years (SD 6). HTDs in pregnancy were associated with an approximately 3 times higher rate of CVD and 7 times higher rate of hypertension (Table). Similar results were obtained when using an intention-to-treat approach. The increased rate of incident CVD was greater with other HTDs in pregnancy than with preeclampsia/eclampsia, while both groups had a similarly increased rate of hypertension.
Conclusions: Women who are exposed to HTD in pregnancy are at increased risk of developing future CVD. These results suggest that a more aggressive approach to management for CVD risk factors should be taken in women with a history of HTD in pregnancy.
Author Disclosures: S.M. Grandi: None. K. Vallée-Pouliot: None. M. Eberg: None. R.W. Platt: None. R. Arel: None. K.B. Filion: None.
- © 2015 by American Heart Association, Inc.