CV Risk Rises With Early-Preeclampsia History


DALLAS — Early cardiovascular risk-factor screening is warranted in women with a history of early-onset preeclampsia, according to results of a study in 617 women.

Significantly more women with a history of early-onset preeclampsia exhibited at least one major cardiovascular risk factor, as defined by the American Heart Association, when screened 6 months after delivery, and compared with healthy controls (89% vs. 71%).

The percentages of women exhibiting at least two and at least three cardiovascular risk factors were also significantly higher in the preeclampsia group, Dr. Bas Van Rijn said at the annual meeting of the Society for Maternal-Fetal Medicine.

Among women in the preeclampsia group 51% had two or more cardiovascular risk factors vs. 26% in the control group, and 19% had three or more risk factors vs. 6% in the control group.

“We advise using global risk estimations, such as the Framingham chart, to identify women that require lifestyle intervention programs aimed at primary prevention of cardiovascular disease,” said Dr. Van Rijn of the division of perinatology and gynecology, University Medical Center Utrecht (the Netherlands).

The study included 243 women (mean age 30.5 years) admitted from 1995 to 2005 for early-onset preeclampsia and delivery before 34 weeks and a population-based control group of 374 healthy, nonpregnant women (mean 28.3 years). Women with chronic hypertension (greater than 140/90 mm Hg) were excluded. Outcomes were adjusted for age.

When compared with matched controls, women in the preeclampsia group had significantly higher rates of obesity (body mass index 26.1 vs. 24.3 kg/m

HDL-cholesterol levels were significantly lower among cases versus controls (55 vs. 61 mg/dL).

No significant differences were found for rates of diabetes mellitus and smoking.

In all, 15.2% of women with a history of preeclampsia met the criteria for metabolic syndrome, as formulated by the AHA and World Health Organization versus only 4.3% of controls (odds ratio 3.6).

The estimated 10-year risk of first cardiovascular disease events, as calculated by the Framingham CHD risk prediction scores, remained less than 10% for all of the women. This places the women in the AHA low-risk range, which is a 1%–3% absolute risk of developing a major cardiovascular event in the coming years, he said.

However, this is a bit deceptive, mainly because of the young age of the women, Dr. Van Rijn added.

For example, if one adds 10 years to the Framingham risk score (mean age 40 years), the risk category for the preeclampsia group would be 5%–10%, which is comparable to a woman who has experienced a myocardial infarction.

“Women with a history of early-onset preeclampsia exhibit many risk factors, but their relatively young age is masking their absolute cardiovascular risk,” said Dr. Van Rijn, who disclosed no financial conflicts of interest.

The study was sponsored by the Netherlands Organization for Scientific Research.

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