title: Cardiovascular risk estimation in women with a history of hypertensive pregnancy disorders at term: a longitudinal follow-up study.
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.
authors.forename: Wietske
authors.initials: W
authors.lastname: Hermes
authors.forename: Jouke T
authors.initials: JT
authors.lastname: Tamsma
authors.forename: Diana C
authors.initials: DC
authors.lastname: Grootendorst
authors.forename: Arie
authors.initials: A
authors.lastname: Franx
authors.forename: Joris
authors.initials: J
authors.lastname: van der Post
authors.forename: Maria G
authors.initials: MG
authors.lastname: van Pampus
authors.forename: Kitty Wm
authors.initials: KW
authors.lastname: Bloemenkamp
authors.forename: Martina
authors.initials: M
authors.lastname: Porath
authors.forename: Ben W
authors.initials: BW
authors.lastname: Mol
authors.forename: Christianne J M
authors.initials: CJ
authors.lastname: de Groot
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology*; D016022:Case-Control Studies; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology*; D008137:Longitudinal Studies; D009426:Netherlands / Q000453:epidemiology; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D012044:Regression Analysis; D018570:Risk Assessment / Q000379:methods*; D014280:Triglycerides / Q000097:blood
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D008076:Cholesterol, HDL; D014280:Triglycerides; D002097:C-Reactive Protein; D002784:Cholesterol