title: Risk of cardiovascular disease after pre-eclampsia and the effect of lifestyle interventions: a literature-based study.
abstract: OBJECTIVE
  This study addresses the following questions. Do cardiovascular risk factors fully explain the odds ratio of cardiovascular risk after pre-eclampsia? What is the effect of lifestyle interventions (exercise, diet, and smoking cessation) after pre-eclampsia on the risk of cardiovascular disease?
  
  
  METHODS
  Literature-based study.
  
  
  METHODS
  N/A.
  
  
  METHODS
  N/A.
  
  
  METHODS
  Data for the calculations were taken from studies identified by PubMed searches. First, the differences in cardiovascular risk factors after pre-eclampsia compared with an uncomplicated pregnancy were estimated. Second, the effects of lifestyle interventions on cardiovascular risk were estimated. Validated risk prediction models were used to translate these results into cardiovascular risk.
  
  
  RESULTS
  After correction for known cardiovascular risk factors, the odds ratios of pre-eclampsia for ischaemic heart disease and for stroke are 1.89 (IQR 1.76-1.98) and 1.55 (IQR 1.40-1.71), respectively. After pre-eclampsia, lifestyle interventions on exercise, dietary habits, and smoking cessation decrease cardiovascular risk, with an odds ratio of 0.91 (IQR 0.87-0.96).
  
  
  CONCLUSIONS
  Cardiovascular risk factors do not fully explain the risk of cardiovascular disease after pre-eclampsia. The gap between estimated and observed odds ratios may be explained by an additive risk of cardiovascular disease by pre-eclampsia. Furthermore, lifestyle interventions after pre-eclampsia seem to be effective in decreasing cardiovascular risk. Future research is needed to overcome the numerous assumptions we had to make in our calculations.
authors.affiliation: Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, the Netherlands. d.berks@erasmusmc.nl
authors.forename: D
authors.initials: D
authors.lastname: Berks
authors.forename: M
authors.initials: M
authors.lastname: Hoedjes
authors.forename: H
authors.initials: H
authors.lastname: Raat
authors.forename: J J
authors.initials: JJ
authors.lastname: Duvekot
authors.forename: E A P
authors.initials: EA
authors.lastname: Steegers
authors.forename: J D F
authors.initials: JD
authors.lastname: Habbema
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008019:Life Style; D016017:Odds Ratio; D011225:Pre-Eclampsia / Q000453:epidemiology*; D011247:Pregnancy; D012307:Risk Factors