title: Effect of early-onset preeclampsia on cardiovascular risk in the fifth decade of life.
abstract: Women with hypertensive disorders in pregnancy, in particular early-onset preeclampsia, are at increased risk of developing cardiovascular disease later in life. These women have a more than 2-fold increased risk of dying from cardiovascular diseases. Most studies have focused on identification of risk factors shortly after pregnancy. Less is known on the prevalence of risk factors or actual signs of cardiovascular disease 5-20 years later. The presence of hypertension or metabolic syndrome can be seen as an opportunity for preventive interventions to reduce the development of severe cardiovascular diseases like myocardial infarction and stroke.
  
  
  
  To assess cardiovascular risk factors and established cardiovascular disease in women after early-onset preeclampsia, in the fifth decade of life. As a consequence, we can assess whether there is still a window of opportunity for preventive measures and to establish in what proportion of women cardiovascular disease already has developed.
  
  
  
  In a prospective observational study, cardiovascular risk assessment was performed in women with early-onset preeclampsia (<34 weeks' gestation) and normotensive controls (≥37 weeks' gestation) 9-16 years after their index pregnancy. Medical records of 2 tertiary hospitals in Amsterdam, The Netherlands, were screened consecutively, and all eligible women were invited. Cardiovascular risk assessment consisted of a questionnaire, blood pressure measurement, anthropometrics, and blood and urine for fasting lipids, lipoproteins, glucose levels, glycated hemoglobin, renal function, N-terminal brain natriuretic peptide, and albuminuria. History of cardiovascular diseases (ie, myocardial infarction and stroke) was determined. Prevalence of women presenting in an optimal window of opportunity for preventive measures was defined by the presence of cardiovascular risk factors (ie, hypertension and metabolic syndrome) but in the absence of established cardiovascular diseases (ie, myocardial infarction and stroke).
  
  
  
  Women with a history of early-onset preeclampsia (n = 131) had significantly greater systolic and diastolic blood pressure, greater body mass index, more often had an abnormal lipid profile (lower high-density lipoprotein levels, higher triglycerides), greater glycated hemoglobin, and greater levels of albuminuria compared to controls (n = 56). None of the women with a history of early-onset preeclampsia was diagnosed with cardiovascular disease; 38.2% were diagnosed with hypertension; and 18.2% were diagnosed with metabolic syndrome. A total of 42% met the criteria for the window of opportunity for preventive measures. In women with a history of an uncomplicated pregnancy, no women were diagnosed with cardiovascular disease; 14.3% were diagnosed with hypertension; 1.8% with metabolic syndrome. In this cohort, 14.3% met the criteria for the window of opportunity for preventive measures.
  
  
  
  A large proportion of women who experienced early-onset preeclampsia had major cardiovascular risk factors in the fifth decade of life, compared with healthy controls. These women are currently outside the scope of most preventive programs due to their relatively young age, but have important modifiable risk factors for cardiovascular diseases.
authors.affiliation: Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: a.bokslag@vumc.nl.
authors.forename: Anouk
authors.initials: A
authors.lastname: Bokslag
authors.affiliation: Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands; Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
authors.forename: Pim W
authors.initials: PW
authors.lastname: Teunissen
authors.affiliation: Department of Physiology, VU University Medical Center, Amsterdam, The Netherlands; Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium.
authors.forename: Constantijn
authors.initials: C
authors.lastname: Franssen
authors.affiliation: Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands; Heart Center, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Floortje
authors.initials: F
authors.lastname: van Kesteren
authors.affiliation: Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Otto
authors.initials: O
authors.lastname: Kamp
authors.affiliation: Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Wessel
authors.initials: W
authors.lastname: Ganzevoort
authors.affiliation: Department of Physiology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Paulus
authors.affiliation: Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Christianne J M
authors.initials: CJM
authors.lastname: de Groot
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000453:epidemiology; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008055:Lipids / Q000097:blood; D024821:Metabolic Syndrome / Q000453:epidemiology; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011225:Pre-Eclampsia / Q000453:epidemiology*; D011247:Pregnancy; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016387:Women's Health
chemical_list: D006442:Glycated Hemoglobin; D008055:Lipids
keywords: cardiovascular disease; cardiovascular risk factors; early-onset preeclampsia; metabolic syndrome; preeclampsia; prevention; women’s health