MSGID: 1:317/3 6279ea73   
   PID: hpt/lnx 1.9.0-cur 2019-01-08   
   TID: hpt/lnx 1.9.0-cur 2019-01-08   
    Hypertensive pregnancy disorders linked to future cardiac events    
      
     Date:   
         May 9, 2022   
     Source:   
         NIH/National Heart, Lung and Blood Institute   
     Summary:   
         Women who experienced complications related to developing high   
         blood pressure, or hypertension, during pregnancy had a 63%   
         increased risk for developing cardiovascular disease later in life,   
         according to new research.   
      
      
      
   FULL STORY   
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   Women who experienced complications related to developing high blood   
   pressure, or hypertension, during pregnancy had a 63% increased risk for   
   developing cardiovascular disease later in life, according to research   
   funded by the National Heart, Lung, and Blood Institute (NHLBI), part   
   of the National Institutes of Health.   
      
      
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   While hypertensive pregnancy complications previously have been linked   
   to increased cardiovascular risks, the current study controlled for   
   pre-pregnancy shared risk factors for these types of complications and   
   cardiovascular disease. Researchers also found that high blood pressure,   
   high cholesterol, type 2 diabetes, or being overweight or obese after   
   pregnancy accounted for most of the increased risk between pregnancy   
   complications and future cardiovascular events.   
      
   The findings, published in theJournal of the American College of   
   Cardiology, could support healthcare providers in developing personalized   
   heart disease prevention and monitoring strategies for women who had   
   hypertension during pregnancy. The information could also help bridge   
   the gap that often occurs after a woman ends obstetric care and resumes   
   or starts care with another provider.   
      
   Using health data shared by more than 60,000 participants in the Nurses'   
   Health Study II, the research represents one of the most comprehensive   
   reviews evaluating links between future cardiovascular events in women   
   who have had preeclampsia or gestational hypertension. Gestational   
   hypertension is characterized by an increase in blood pressure during   
   pregnancy. Preeclampsia is a more severe complication marked by a sudden   
   rise in blood pressure that can affect the organs and be dangerous for   
   both mother and baby. Both conditions are often diagnosed after 20 weeks   
   of pregnancy.   
      
   "Women with a history of gestational hypertension or preeclampsia   
   should be informed that they have an increased risk for cardiovascular   
   disease," said Jennifer J. Stuart, Sc.D., a study author and associate   
   epidemiologist in the Division of Women's Health at Brigham and Women's   
   Hospital and Harvard Medical School, Boston. "While the American Heart   
   Association and American College of Cardiology recognize these conditions   
   as cardiovascular risk factors, women and their providers have lacked   
   clear direction on what to do in the intervening years between delivery   
   of a hypertensive pregnancy and the onset of cardiovascular disease."   
   The researchers' analysis showed that early screening and monitoring in   
   four targeted areas -- blood pressure, cholesterol and glucose levels, and   
   body mass index -- could provide even more personalized targets to help   
   delay or possibly prevent future cardiovascular events among these women.   
      
      
      
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   In this study, almost 10% of women developed hypertension during their   
   first pregnancy. Among these women, 3,834 (6.4%) developed preeclampsia   
   and 1,789 (3%) developed gestational hypertension. Women who were   
   obese before pregnancy were three times more likely to experience a   
   hypertensive pregnancy disorder, and those with a family history of   
   heart disease or stroke also shared increased risks. In their analysis,   
   the researchers controlled for these and other important pre-pregnancy   
   factors that could increase the risk of developing hypertension during   
   pregnancy and having a heart attack or stroke later in life.   
      
   After about 30 years, when the average age of women in the study was 61   
   years, approximately 1,074 (1.8%) of study participants had experienced   
   a cardiovascular event, such as a heart attack or stroke. The type of   
   event women had -- and when they had it -- often overlapped with specific   
   pregnancy complications.   
      
   For example, compared to women with normal blood pressure in pregnancy,   
   women with gestational hypertension, which was associated with a   
   41% increased risk for cardiovascular disease, were more likely to   
   have a stroke about 30 years after their first pregnancy. Women with   
   preeclampsia, which was associated with a 72% increased cardiovascular   
   risk, were more likely to have a coronary artery event, such as a heart   
   attack, as early as 10 years after their first pregnancy.   
      
   Post-pregnancy cardiometabolic risk factors, such as obesity, type 2   
   diabetes, and chronic hypertension, explained most of the increased   
   cardiovascular risk observed among women with gestational hypertension   
   or preeclampsia. Chronic hypertension was the largest contributor of all,   
   accounting for 81% of increased cardiovascular disease risks among women   
   who had gestational hypertension and for 48% of increased risks among   
   women who had preeclampsia.   
      
   Most women who experienced a hypertensive pregnancy disorder developed   
   chronic hypertension in the years or decades after they gave birth.   
      
   "This study reinforces how important it is for women and their healthcare   
   providers to address known cardiovascular disease risk factors, such as   
   obesity or having high blood pressure, while thinking about starting   
   a family and then during and after during pregnancy," said Victoria   
   Pemberton, R.N.C., a program officer at NHLBI.   
      
   For future research, Stuart said diversity is key. Most women in the   
   Nurses' Health Study II were white, which means the percentage of women   
   affected by different risk factors may vary. The study also provides a   
   foundation to expand on emerging associations, such as studying links   
   between gestational hypertension and stroke and between preeclampsia   
   and coronary artery disease.   
      
   Additionally, while over 80% of the increased risk for cardiovascular   
   disease among women with a history of gestational hypertension appears   
   to be jointly accounted for by established cardiovascular risk factors,   
   nearly 40% of the risk for cardiovascular disease following preeclampsia   
   remains unexplained.   
      
   Investigating these pathways may help clarify why some women who   
   experienced preeclampsia are more likely to develop heart disease. By   
   better understanding these connections, researchers may be able to   
   contribute insight to help healthcare providers provide even more   
   personalized recommendations and strategies for women at greatest risk.   
      
   The research was also supported by grants from the National Cancer   
   Institute and the Eunice Kennedy Shriver National Institute of Child   
   Health and Human Development.   
      
      
   ==========================================================================   
   Story Source: Materials provided by   
   NIH/National_Heart,_Lung_and_Blood_Institute. Note: Content may be edited   
   for style and length.   
      
      
   ==========================================================================   
   Journal Reference:   
      1. Jennifer J. Stuart, Lauren J. Tanz, Eric B. Rimm, Donna Spiegelman,   
         Stacey A. Missmer, Kenneth J. Mukamal, Kathryn M. Rexrode,   
         Janet W. Rich- Edwards. Cardiovascular Risk Factors Mediate the   
         Long-Term Maternal Risk Associated With Hypertensive Disorders of   
         Pregnancy. Journal of the American College of Cardiology, 2022;   
         79 (19): 1901 DOI: 10.1016/ j.jacc.2022.03.335   
   ==========================================================================   
      
   Link to news story:   
   https://www.sciencedaily.com/releases/2022/05/220509150748.htm   
      
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