A history of preeclampsia doubles the risk of heart attack or stroke for as long as two decades compared to women who did not have preeclampsia, suggests a new study of more than more than one million pregnant women from Denmark published in the European Journal of Preventive Cardiology.¹

In this study, evaluated data of 1,157,666 women who became pregnant more than once and had a live birth or stillbirth between 1978 and 2017 obtained from various Danish registers including the Civil Registration System and the Medical Birth Register. None of the participants had a heart disease before pregnancy. Through this, the researchers aimed to examine the temporal association between preeclampsia and the risk of cardiovascular disease (CVD) including acute myocardial infarction (AMI) and stroke. Nearly 3% of women had developed preeclampsia during pregnancy at the end of follow-up period of more than two decades (20.5 years, median).

The incidence of an acute MI or stroke among women with preeclampsia in their first pregnancy was up to 2% compared to 1.2% among women who did not have preeclampsia. The difference in the cumulative incidence of acute cardiovascular events were seen 7 years after childbirth, especially among pregnant women younger than 35 years.

The risk of acute MI was increased 4-folds in the first decade post-delivery among women with a history of preeclampsia with hazard ratio (HR) of 4.16. These women were also 3 times more likely to develop a stroke with HR of 2.59. The risk of AMI and ischemic stroke was found to persist and doubled after more than two decades compared to women without a history of preeclampsia. Among women with pre-eclampsia aged 30-39 years, the probability of acute MI was increased nearly five times (HR 4.88) and that for stroke, it was 3-folds higher (HR 2.56) compared to their counterparts without preeclampsia. The HR for acute MI was greater among women who developed pre-eclampsia in their second pregnancy (2.70) compared to those who had preeclampsia in the first pregnancy (1.66).

This study demonstrates the high association of acute cardiovascular events among women with a history of pre-eclampsia, particularly those younger than 35 years, the age when they are not expected to have heart disease. The risk was evident within a decade after childbirth but persisted even after two decades. Women with history of pre-eclampsia therefore constitute a high-risk group for CVD and should be closely monitored after delivery for timely initiation of preventive interventions. Women who had preeclampsia after 35 years of age, history of pre-eclampsia in the second pregnancy but not the first pregnancy and recurrent pre-eclampsia are particularly at high risk.

Women with history of preeclampsia should be counselled about their CV risk, as also recommended by the International Society for the Study of Hypertension in Pregnancy (ISSHP) guidelines.² Clinicians managing such patients should encourage them to lead a healthy lifestyle and also refer them to a physician for regular CV risk monitoring especially blood pressure and other modifiable risk factors. “The ‘early’ post-partum period represents a window of opportunity for early preventive measures”, note the authors.

References

1. Hallum S, et al. Risk and trajectory of premature ischaemic cardiovascular disease in women with a history of pre-eclampsia: a nationwide register-based study. Eur J Prev Cardiol. 2023 Jan 26;zwad003. doi: 10.1093/eurjpc/zwad003.
2. Mark A Brown, et al; International Society for the Study of Hypertension in Pregnancy (ISSHP). The hypertensive disorders of pregnancy: ISSHP classification, diagnosis & management recommendations for international practice. Pregnancy Hypertens. 2018 Jul;13:291-310. doi: 10.1016/j.preghy.2018.05.004.