title: A history of preeclampsia is associated with a risk for coronary artery calcification 3 decades later.
abstract: BACKGROUND
  A history of preeclampsia is an independent risk factor for cardiac events and stroke. Changes in vasculature structure that contribute to these associations are not well understood.
  
  
  OBJECTIVE
  The aim of this study was to quantify coronary artery calcification (CAC), a known risk factor for cardiac events, in a prospective cohort of women with and without histories of preeclampsia.
  
  
  METHODS
  Women without prior cardiovascular events (40 with and 40 without histories of preeclampsia, matched for parity and age at index birth) were recruited from a large population-based cohort of women who were residents of Olmsted County, Minnesota, and who delivered from 1976 through 1982. Computed tomography was performed to measure CAC in Agatston units. All pregnancy histories and covariates were confirmed by review of the medical records. Current clinical variables were assessed at the time of imaging. Differences between women with and without histories of preeclampsia were examined using χ(2) tests and tests; CAC, in particular, was compared as a categorical and ordinal variable, with a χ(2) test and with Wilcoxon 2-sample tests and ordinal logistic regression, as appropriate.
  
  
  RESULTS
  Mean age (SD) at imaging was 59.5 (±4.6) years. Systolic and diastolic blood pressures, hyperlipidemia, and current diabetes status did not differ between women with and without histories of preeclampsia. However, the frequencies of having a current clinical diagnosis of hypertension (60% vs 20%, P < .001) and higher body mass index in kg/m(2) (expressed as median [25th-75th percentile], 29.8 [25.9-33.7] vs 25.3 [23.1-32.0], P = .023) were both greater in the women with histories of preeclampsia compared to those without. The frequency of a CAC score >50 Agatston units was also greater in the preeclampsia group (23% vs 0%, P = .001). Compared to women without preeclampsia, the odds of having a higher CAC score was 3.54 (confidence interval [CI], 1.39-9.02) times greater in women with prior preeclampsia without adjustment, and 2.61 (CI, 0.95-7.14) times greater after adjustment for current hypertension. After adjustment for body mass index alone, the odds of having a higher CAC based on a history of preeclampsia remained significant at 3.20 (CI, 1.21-8.49).
  
  
  CONCLUSIONS
  In this first prospective cohort study with confirmation of preeclampsia by medical record review, a history of preeclampsia is associated with an increased risk of CAC >30 years after affected pregnancies, even after controlling individually for traditional risk factors. A history of preeclampsia should be considered in risk assessment when initiating primary prevention strategies to reduce cardiovascular disease in women. Among women with histories of preeclampsia, the presence of CAC may be able to identify those at a particularly high cardiovascular risk, and should be the subject of future studies.
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN.
authors.forename: Wendy M
authors.initials: WM
authors.lastname: White
authors.affiliation: Department of Health Science Research and Neurology, Mayo Clinic, Rochester, MN.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Mielke
authors.affiliation: Division of Radiology, Mayo Clinic, Rochester, MN.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Araoz
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Lahr
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
authors.forename: Kent R
authors.initials: KR
authors.lastname: Bailey
authors.affiliation: Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN.
authors.forename: Muthuvel
authors.initials: M
authors.lastname: Jayachandran
authors.affiliation: Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN; Department of Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Virginia M
authors.initials: VM
authors.lastname: Miller
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN. Electronic address: Garovic.vesna@mayo.edu.
authors.forename: Vesna D
authors.initials: VD
authors.lastname: Garovic
mesh_terms: D015992:Body Mass Index; D015331:Cohort Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D016555:Matched-Pair Analysis; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D011225:Pre-Eclampsia / Q000453:epidemiology*; D011247:Pregnancy; D012307:Risk Factors; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000453:epidemiology*
keywords: cardiovascular disease; hypertension; preeclampsia; pregnancy