Preeclampsia and cardiovascular disease death: prospective evidence from the child health and development studies cohort

Abstract

This study prospectively investigates the contribution of pregnancy complications and other reproductive age risk factors on the risk of subsequent cardiovascular disease death. Participants were 14 403 women in the Child Health and Development Studies pregnancy cohort drawn from the Kaiser Permanente Health Plan in California. Only women with nonmissing parity and no previously diagnosed heart conditions were included. A total of 481 had observed preeclampsia, and 266 died from cardiovascular disease. The median age at enrollment was 26 years, and the median follow-up time was 37 years. Cardiovascular disease death was determined by linkage with the California Department of Vital Statistics. Observed preeclampsia was independently associated with cardiovascular disease death (mutually adjusted hazard ratio: 2.14 [95% CI: 1.29 to 3.57]). The risk of subsequent cardiovascular disease death was notably higher among women with onset of preeclampsia by 34 weeks of gestation (hazard ratio: 9.54 [95% CI: 4.50 to 20.26]). At 30 years of follow-up and a median age of 56 years, the cumulative cardiovascular disease death survival for women with early preeclampsia was 85.9% compared with 98.3% for women with late preeclampsia and 99.3% for women without preeclampsia. Women with preeclampsia had an increased risk of cardiovascular disease death later in life, independent of other measured risk factors. These findings reinforce previously reported recommendations that a history of preeclampsia should be used to target women at risk for cardiovascular disease. Additionally, women with preeclampsia earlier in pregnancy may be particularly at risk for cardiovascular disease death and could be targeted for early and intensive screening and intervention.

Figure 1

Cardiovascular disease death Kaplan-Meier survival according to gestational timing of preeclampsia * Survival analysis is based on 14,403 women and 266 events of cardiovascular disease death. † All groups are statistically significantly different.