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Original Investigation
June 12, 2019

Association of Conventional Cardiovascular Risk Factors With Cardiovascular Disease After Hypertensive Disorders of Pregnancy: Analysis of the Nord-Trøndelag Health Study

Author Affiliations
  • 1K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
  • 2Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
  • 3Department of Obstetrics and Gynecology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
  • 4Department of Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
  • 5Division of Women’s Health, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
  • 6Mathematica Policy Research, Cambridge, Massachusetts
  • 7Department of Population Health Sciences, Bristol Medical School and Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, England
  • 8Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
  • 9Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
  • 10Cardiac Clinic, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
  • 11Department of Endocrinology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
JAMA Cardiol. 2019;4(7):628-635. doi:10.1001/jamacardio.2019.1746
Key Points

Question  Women with history of hypertensive pregnancy disorders have a higher risk of cardiovascular disease, but how much of their excess cardiovascular risk is associated with conventional cardiovascular risk factors?

Findings  In this cohort study, blood pressure and body mass index were associated with up to 77% of the excess risk of cardiovascular disease in women with history of hypertensive pregnancy disorders, while glucose and lipids were associated with smaller proportions.

Meaning  The association of conventional risk factors, in particular blood pressure and body mass index, with the development of cardiovascular in women with history of hypertensive pregnancy disorders indicate that preventive efforts aimed at decreasing the levels of these risk factors could reduce cardiovascular risk in women with history of hypertensive pregnancy disorders.

Abstract

Importance  Women with a history of hypertensive disorders of pregnancy (HDP) have higher risk of cardiovascular disease (CVD). It is not known how much of the excess CVD risk in women with a history of HDP is associated with conventional cardiovascular risk factors.

Objective  To quantify the excess risk of CVD in women with a history of HDP and estimate the proportion associated with conventional cardiovascular risk factors.

Design, Setting, and Participants  Prospective cohort study with a median follow-up of 18 years. Population-based cohort of women participating in the Nord-Trøndelag Health Study in Norway. We linked data for 31 364 women from the Nord-Trøndelag Health Study (1984-2008) to validated hospital records (1987-2015), the Cause of Death Registry (1984-2015), and the Medical Birth Registry of Norway (1967-2012). A total of 7399 women were excluded based on selected pregnancy characteristics, incomplete data, or because of emigrating or experiencing the end point before start of follow-up, leaving 23 885 women for study. Data were analyzed between January 1, 2018, and June 6, 2018.

Exposures  Experiencing 1 or more pregnancies complicated by HDP before age 40 years vs only experiencing normotensive pregnancies.

Main Outcomes and Measures  We used Cox proportional hazards models to estimate the hazard ratios (HRs) for the association between HDP and CVD. The proportion of excess risk associated with conventional cardiovascular risk factors was estimated using an inverse odds ratio weighting approach.

Results  Our study population consisted of 23 885 parous women from Nord-Trøndelag County, Norway. A total of 21 766 women had only normotensive pregnancies, while 2199 women experienced ever having an HDP. From age 40 to 70 years, women with history of HDP had an increased risk of CVD compared with women with only normotensive pregnancies (HR, 1.57; 95% CI, 1.32-1.87) but not at older age (β = 0.98; 95% CI, 0.96-1.00; P for interaction by age = .01). Blood pressure and body mass index were associated with up to 77% of the excess risk of CVD in women with history of HDP, while glucose and lipid levels were associated with smaller proportions.

Conclusion and Relevance  In this study, the risk of excess CVD in women with history of HDP was associated with conventional cardiovascular risk factors, indicating that these risk factors are important targets for cardiovascular prevention in these women.

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