Women who have pre-eclampsia have an increased risk of cardiovascular diseases compared to those who do not suffer the condition in pregnancy, a Danish study out today has shown.
The study in more than one million pregnant women found a four-fold risk within seven years of delivery. The likelihood remained heightened more than 20 years later.
Study author Dr Sara Hallum of the University of Copenhagen said: “The high risk of cardiovascular disease after pre-eclampsia manifests at young ages and early after delivery.
“This indicates that interventions to prevent heart attacks and strokes in affected women cannot wait until middle age when they become eligible for conventional cardiovascular screening programmes.”
This is the first study to examine how soon after pregnancy heart attacks and strokes manifest, and the magnitude of risk in different age groups. Findings are published in the latest edition of the European Journal of Preventative Cardiology.
Researchers used national registers to identify all pregnant women in Denmark between 1978 and 2017.
They were grouped into those with one or more pregnancies complicated by pre-eclampsia and those with no pre-eclampsia.
None had cardiovascular disease before pregnancy and they were followed for a maximum of 39 years for heart attack and stroke.
The study included 1,157,666 women and up to 2% of those with pre-eclampsia in their first pregnancy had a heart attack or stroke within two decades of delivery, compared with up to 1.2% of unaffected women.
They found differences in risk became apparent seven years after delivery.
The authors write: “A 2% incidence of acute myocardial infarction and ischaemic stroke should not be accepted as the cost of a pregnancy complicated by pre-eclampsia, particularly considering the young age of these women when they fall ill (below 50 years of age).”
Women with pre-eclampsia were four times more likely to have a heart attack and three times more likely to have a stroke within 10 years of delivery than those without pre-eclampsia.
The risk of heart attack or stroke remained twice as high in the pre-eclampsia group more than 20 years after giving birth compared to unaffected women.
When the researchers examined the risk of cardiovascular disease according to age, they found that women aged 30 to 39 years with a history of pre-eclampsia had five- and three-fold higher rates of heart attack and stroke, respectively, than those of similar age with no history of pre-eclampsia.
In women over 50, the risk remained doubled compared to those who did not have the condition.
Dr Hallum said: “Women are often in contact with the healthcare system during and immediately after pregnancy, providing a window of opportunity to identify those at increased risk of cardiovascular disease.
“The number of women with previous pre-eclampsia is large, and routine follow-up could last years or even decades. Our study suggests that the women most likely to benefit from screening are those who had pre-eclampsia after age 35 and those who had it more than once.
“Prevention should start within a decade of delivery, for example by treating high blood pressure and informing women about risk factors for heart disease such as smoking and inactivity.”
Hallum S, Basit S, Kamper-Jørgensen M, 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.. 26 January 2023; doi:10.1093/eurjpc/zwad003.
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