Abstract 14574: Peripartum Cardiomyopathy and Hypertensive Pregnancy Subtypes Among 1.6 Million Pregnancies in California Independently Predict Subsequent Incident Myocardial Infarction, Heart Failure, and Stroke
Introduction: Cardiovascular complications from the hemodynamic challenge of pregnancy and childbirth present an opportunity to assess risk for later cardiovascular disease (CVD) in many women. Peripartum cardiomyopathy (PPCM) and hypertensive pregnancy (HP) are interrelated and are each individually associated with CVD. However, prior studies have not assessed PPCM and specific subtypes of HP as predictors of subsequent myocardial infarction (MI), heart failure (HF), and stroke (ischemic, hemorrhagic and embolic).
Methods: The Healthcare Cost and Utilization Project was used to identify unique admissions for PPCM and HP in California hospitals between 1/1/2002 and 12/31/2005 with ICD9 codes. We employed multivariable Cox proportional hazards models to determine the association of PPCM and HP (with subtypes defined as chronic HTN + gestational HTN, chronic HTN + preeclampsia, de novo gestational HTN, and de novo preeclampsia) with subsequent admissions for MI, HF and stroke through 12/31/2011.
Results: Among 1.6 million pregnancies in California from 2005-2009 (mean age = 28 years; 35% White, 6% African-American, 35% Hispanic; median follow-up time to event = 2.7 years), 562 and 111,202 cases of PPCM and HP were observed, respectively. PPCM was independently associated with a 15-to 29- fold increase in MI, stroke, and HF up to 6 years later. HP was associated with a 1.6- to 2.4-fold higher risk of these CVD outcomes. There was no effect modification between PPCM and HP subtypes. De novo gestational HTN was the only HP subtype that did not show higher CVD risk. See Table.
Conclusions: Our findings support close monitoring of women with the above pregnancy complications for potential primary prevention of CVD events and beg further study of potential pathologic mechanisms underlying the development of CVD events in these women less than a decade postpartum.
Author Disclosures: R. Arnaout: None. G. Nah: None. G.M. Marcus: None. Z.H. Tseng: None. E. Foster: None. I. Harris: None. P. Divanji: None. J. Olgin: None. L. Klein: None. J. Gonzalez: None. N.I. Parikh: None.
- © 2016 by American Heart Association, Inc.