Original ResearchObstetricsA history of preeclampsia is associated with a risk for coronary artery calcification 3 decades later
Introduction
Cardiovascular disease (CVD) is the leading cause of death in women. A history of preeclampsia is a sex-specific independent risk factor for cardiac events and stroke.1, 2, 3, 4 The importance of documenting a history of adverse events in pregnancy, such as preeclampsia, is now highlighted in guidelines for the prevention of stroke and coronary artery disease.5, 6
It is important to understand the pathophysiologic processes linking preeclampsia to subsequent CVD risk, given the strong association between preeclampsia and future adverse cardiovascular outcomes. Conventional risk factors, including obesity and chronic hypertension, are shared by both conditions.7 Other nontraditional risk factors that are shared by preeclampsia and adverse CVD outcomes include increased levels of C-reactive protein and homocysteine.8, 9
Coronary artery calcification (CAC), as measured in Agatston units (AU) by computed tomography, is an important biomarker of CVD. The extent of CAC strongly correlates with a higher risk for an adverse cardiac event even in asymptomatic individuals10: for a CAC >100, the relative risk for a cardiac event in the next 4 years is >9.11 The American College of Cardiology/American Heart Association guidelines from both 2010 and 2013 stated that measurement of CAC may help to define risk in those persons at low to intermediate risk based on Framingham scoring.12 CAC measurement may be beneficial in assessing risk of CVD for women in particular as the Framingham risk score typically underestimates female CVD risk.
A systematic study of the relationship between a history of preeclampsia, as defined by accepted clinical criteria, and CAC quantification in asymptomatic women has not been undertaken. The aim of this study was to quantify and compare CAC in age- and parity-matched women with and without histories of preeclampsia, and to establish whether this association was independent of traditional CVD risk factors. We postulated that CAC would be higher in women with histories of preeclampsia and could better stratify cardiovascular risk in these women.
Section snippets
Materials and Methods
The Rochester Epidemiology Project (REP) medical records linkage system was used to identify, from a larger population-based cohort, 40 age- and parity-matched women with and without histories of preeclampsia who then were recruited to undergo imaging, examination, and laboratory assessment.
The REP medical records linkage system was established in 1966 to capture all health care information for the entire population of Olmsted County, Minnesota.13, 14, 15 The REP now encompasses the medical
Results
The mean age of the study participants at the time of delivery was 24 years. Prior to their index pregnancies, women with preeclampsia, compared to those with normotensive pregnancies, had higher BMI, expressed as median (23.9; IQR, 21.3-26.1 vs 21.0; IQR, 20.0-24.3, P = .012). The rates of gestational diabetes were similar between the groups, affecting 2 of 40 women in each group (P = 1.00). The mean age of the study participants at the time of imaging was 59.5 (±4.6) years. There were no
Comment
This is the first prospective cohort study that utilized review of the medical record to confirm the diagnosis of preeclampsia by accepted clinical criteria that demonstrated a history of preeclampsia is associated with an increased risk of CAC >3 decades after pregnancy in asymptomatic women without prior CVD events. The association between preeclampsia and CAC, in part, could be due to conventional CVD risk factors common to both processes. Indeed, women with preeclampsia had higher BMI and
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This research was funded, in part, by grants from the National Institutes of Health (NIH) P50 AG044170; NIH R01 AG034676; UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS), a component of the NIH; the Department of Surgery; and the Mayo Foundation. The contents is solely the responsibility of the authors and do not necessarily represent the official view of NIH.
The authors report no conflict of interest.
Cite this article as: White WM, Mielke MM, Araoz PA, et al. A history of preeclampsia is associated with a risk for coronary artery calcification 3 decades later. Am J Obstet Gynecol 2016;214:519.e1-8.