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Open Access Research article

Cardiovascular risk estimation in women with a history of hypertensive pregnancy disorders at term: a longitudinal follow-up study

Wietske Hermes12*, Jouke T Tamsma3, Diana C Grootendorst4, Arie Franx5, Joris van der Post6, Maria G van Pampus7, Kitty WM Bloemenkamp8, Martina Porath9, Ben W Mol6 and Christianne JM de Groot2

Author Affiliations

1 Department of Obstetrics and Gynecology, Medical Center Haaglanden, The Hague, the Netherlands

2 Department of Obstetrics, VU University Medical Center, Amsterdam, the Netherlands

3 Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands

4 Department of Clinical Epidemiology, Landsteiner Institute, Medical Center Haaglanden, The Hague, the Netherlands

5 Division of Woman and Baby, University Medical Center, Utrecht, the Netherlands

6 Department of Obstetrics and Gynecology, Amsterdam Medical Center, Amsterdam, the Netherlands

7 Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands

8 Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands

9 Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven, the Netherlands

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BMC Pregnancy and Childbirth 2013, 13:126  doi:10.1186/1471-2393-13-126

Published: 4 June 2013

Abstract

Background

Cardiovascular disease is associated with major morbidity and mortality in women in the Western world. Prediction of an individual cardiovascular disease risk in young women is difficult. It is known that women with hypertensive pregnancy complications have an increased risk for developing cardiovascular disease in later life and pregnancy might be used as a cardiovascular stress test to identify women who are at high risk for cardiovascular disease. In this study we assess the possibility of long term cardiovascular risk prediction in women with a history of hypertensive pregnancy disorders at term.

Methods

In a longitudinal follow-up study, between June 2008 and November 2010, 300 women with a history of hypertensive pregnancy disorders at term (HTP cohort) and 94 women with a history of normotensive pregnancies at term (NTP cohort) were included. From the cardiovascular risk status that was known two years after index pregnancy we calculated individual (extrapolated) 10-and 30-year cardiovascular event risks using four different risk prediction models including the Framingham risk score, the SCORE score and the Reynolds risk score. Continuous data were analyzed using the Student’s T test and Mann–Whitney U test and categorical data by the Chi-squared test. A poisson regression analysis was performed to calculate the incidence risk ratios and corresponding 95% confidence intervals for the different cardiovascular risk estimation categories.

Results

After a mean follow-up of 2.5 years, HTP women had significantly higher mean (SD) extrapolated 10-year cardiovascular event risks (HTP 7.2% (3.7); NTP 4.4% (1.9) (p<.001, IRR 5.8, 95% CI 1.9 to 19)) and 30-year cardiovascular event risks (HTP 11% (7.6); NTP 7.3% (3.5) (p<.001, IRR 2.7, 95% CI 1.6 to 4.5)) as compared to NTP women calculated by the Framingham risk scores. The SCORE score and the Reynolds risk score showed similar significant results.

Conclusions

Women with a history of gestational hypertension or preeclampsia at term have higher predicted (extrapolated) 10-year and 30-year cardiovascular event risks as compared to women with a history of uncomplicated pregnancies. Further large prospective studies have to evaluate whether hypertensive pregnancy disorders have to be included as an independent variable in cardiovascular risk prediction models for women.

Keywords:
Cardiovascular risk; Cardiovascular risk prediction; Follow-up study; Gestational hypertension; Preeclampsia