Hilde Kristin Refvik Riise1, Gerhard Sulo2, Grethe S Tell3, Jannicke Igland4, Grace Egeland5, Ottar Nygard6, Randi Selmer7, Ann-Charlotte Iversen8, Anne Kjersti Daltveit9. 1. Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. Electronic address: hilde.riise@uib.no. 2. Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Centre for Disease Burden, Norwegian Institute of Public Health, Bergen, Norway. 3. Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway. 4. Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. 5. Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Divisions of Health Data and Digitalization and Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway. 6. Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway. 7. Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Bergen, Norway. 8. Centre of Molecular Inflammation Research, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. 9. Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway.
Abstract
BACKGROUND AND AIM: Hypertensive pregnancy disorders are associated with subsequent cardiovascular disease (CVD), but the extent to which this association is explained by shared risk factors is unknown. We aimed to evaluate whether hypertensive pregnancy disorder in first pregnancy is associated with increased subsequent risk of maternal CVD after adjustment for established CVD risk factors measured after pregnancy. METHODS AND RESULTS: A total of 20,075 women with a first delivery registered in the Medical Birth Registry of Norway (1980-2003) participated in Cohort of Norway (CONOR) health surveys a mean (standard deviation) of 10.7 (5.5) years after delivery. They were then followed (median 11.4 years) for an incident fatal or non-fatal CVD event through linkage to the Cardiovascular Disease in Norway (CVDNOR) database and the Norwegian Cause of Death Registry. Hypertensive pregnancy disorders were associated with an increased risk of CVD [Hazard ratio (HR) 2.3; 95% confidence interval (CI) 1.9-2.8], which remained significant after adjustment for established CVD risk factors including body mass index, smoking, hypertension, diabetes, serum glucose and lipid levels (HR 1.5; 95% CI 1.2-1.8). The population attributable fraction of CVD due to hypertensive pregnancy disorder was 4.3% (95% CI 1.9-6.6) after multivariable adjustment. CONCLUSION: The association between hypertensive pregnancy disorders and CVD risk was mediated in part by related CVD risk factors measured 10 years following delivery. These results underline the importance of post-pregnancy follow-up of women with hypertensive pregnancy disorders focusing on modifiable, lifestyle related risk factors to prevent future CVD.
BACKGROUND AND AIM: Hypertensive pregnancy disorders are associated with subsequent cardiovascular disease (CVD), but the extent to which this association is explained by shared risk factors is unknown. We aimed to evaluate whether hypertensive pregnancy disorder in first pregnancy is associated with increased subsequent risk of maternal CVD after adjustment for established CVD risk factors measured after pregnancy. METHODS AND RESULTS: A total of 20,075 women with a first delivery registered in the Medical Birth Registry of Norway (1980-2003) participated in Cohort of Norway (CONOR) health surveys a mean (standard deviation) of 10.7 (5.5) years after delivery. They were then followed (median 11.4 years) for an incident fatal or non-fatal CVD event through linkage to the Cardiovascular Disease in Norway (CVDNOR) database and the Norwegian Cause of Death Registry. Hypertensive pregnancy disorders were associated with an increased risk of CVD [Hazard ratio (HR) 2.3; 95% confidence interval (CI) 1.9-2.8], which remained significant after adjustment for established CVD risk factors including body mass index, smoking, hypertension, diabetes, serum glucose and lipid levels (HR 1.5; 95% CI 1.2-1.8). The population attributable fraction of CVD due to hypertensive pregnancy disorder was 4.3% (95% CI 1.9-6.6) after multivariable adjustment. CONCLUSION: The association between hypertensive pregnancy disorders and CVD risk was mediated in part by related CVD risk factors measured 10 years following delivery. These results underline the importance of post-pregnancy follow-up of women with hypertensive pregnancy disorders focusing on modifiable, lifestyle related risk factors to prevent future CVD.
Authors: Angela H E M Maas; Giuseppe Rosano; Renata Cifkova; Alaide Chieffo; Dorenda van Dijken; Haitham Hamoda; Vijay Kunadian; Ellen Laan; Irene Lambrinoudaki; Kate Maclaran; Nick Panay; John C Stevenson; Mick van Trotsenburg; Peter Collins Journal: Eur Heart J Date: 2021-03-07 Impact factor: 29.983
Authors: Angela M Malek; Dulaney A Wilson; Tanya N Turan; Julio Mateus; Daniel T Lackland; Kelly J Hunt Journal: J Am Heart Assoc Date: 2021-02-23 Impact factor: 5.501