title: Premature cardiovascular disease following a history of hypertensive disorder of pregnancy.
abstract: BACKGROUND
  Following an episode of hypertensive disorder of pregnancy (HDP) women have an increased risk of cardiovascular disease over their lifetime. At the time of acute coronary syndrome we compared clinical information between women with and without a history of hypertension in pregnancy to gain further insight into the pathophysiology of cardiovascular disease in this population.
  
  
  METHODS
  GENESIS-PRAXY (GENdEr and Sex determInantS of cardiovascular disease: from bench to beyond-PRemature Acute Coronary SYdrome) is a prospective multicenter study, with recruitment between January 2009 and April 2013, including 242 parous women with premature acute coronary syndrome.
  
  
  RESULTS
  The median age was 50years (IQR 6) and HDP was common; 43 (17.8%) women had prior gestational hypertension, 33 (13.6%) preeclampsia and 166 (68.6%) a prior normotensive pregnancy. Women with a history of HDP commonly had chronic hypertension and diabetes and those presenting with ST-elevation myocardial infarction were more likely to have a history of preeclampsia (aOR 3.12, 95% CI 1.22-8.01) than were women with prior normotensive pregnancies. Neither gestational hypertension (aOR 1.40, 95% CI 0.60-3.26) nor preeclampsia (aOR 0.63, 95% CI 0.23-1.74) was associated with a higher composite risk of three-vessel, left main or proximal left anterior descending coronary disease.
  
  
  CONCLUSIONS
  In this study of women with premature cardiovascular disease, ST-elevation myocardial infarction was associated with a history of preeclampsia possibly because of persistent endothelial dysfunction. High-risk coronary lesions on angiography did not appear to have an association with preeclampsia or gestational hypertension despite a high burden of traditional risk factors.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Canada. Electronic address: emily.mcdonald@mcgill.ca.
authors.forename: Emily G
authors.initials: EG
authors.lastname: McDonald
authors.affiliation: Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Canada.
authors.forename: Natalie
authors.initials: N
authors.lastname: Dayan
authors.affiliation: Division of Clinical Epidemiology, McGill University Health Centre, Montréal, Québec.
authors.forename: Roxanne
authors.initials: R
authors.lastname: Pelletier
authors.affiliation: Division of Cardiology, Department of Medicine, McGill University, Canada.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Eisenberg
authors.affiliation: Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Canada.
authors.forename: Louise
authors.initials: L
authors.lastname: Pilote
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000175:diagnosis / Q000453:epidemiology; D008875:Middle Aged; D011225:Pre-Eclampsia / Q000175:diagnosis* / Q000453:epidemiology*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis* / Q000453:epidemiology*; D011446:Prospective Studies; D057566:Self Report
keywords: Cardiovascular disease; Endothelial dysfunction; Gestational hypertension; Hypertensive disorders of pregnancy; Preeclampsia