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. 2025 Jan 31:zwaf021.
doi: 10.1093/eurjpc/zwaf021. Online ahead of print.

Life's Essential 8 and cardiovascular disease in women with a history of adverse pregnancy outcomes

Haozhang Chen  1 , Ruyi Li  1 , Sen Liu  1 , Shiyu Zhao  1 , Tianyu Guo  1 , Shufan Tian  1 , Jiale Zhong  1 , Zijun Tang  1 , Zhenghao Ge  1 , Jiawei Xia  1 , Tingting Geng  1 , Xiongfei Pan  2 , An Pan  3 , Frank Qian  4 , Gang Liu  1
Affiliations

Life's Essential 8 and cardiovascular disease in women with a history of adverse pregnancy outcomes

Haozhang Chen et al. Eur J Prev Cardiol. .

Abstract

Aims: To assess whether better cardiovascular health is associated with a lower long-term risk of CVD in women with a history of adverse pregnancy outcomes (APOs).

Methods: Using data from the UK Biobank prospective cohort, we included 2,263 participants with prior APOs and 107,260 participants without prior APOs. Life's Essential 8 (LE8) score was assessed at baseline. Multivariable-adjusted Cox models were used to estimate the associations between LE8 score and CVD events.

Results: Over a median 13.5 years of follow-up, 11,134 incident CVD events were documented. Among women with prior APOs, the incidence of total CVD was significantly lower in the top tertile compared to the bottom tertile, with a HR (95% CI) of 0.43 (0.29, 0.65). A similar trend was observed in women without APOs, with an HR (95% CI) of 0.55 (0.53, 0.58). With respect to the individual CVD outcomes, among women with APOs, only the associations with coronary heart disease, HR (95% CI) for T3 vs T1: 0.30 (0.17, 0.55) and atrial fibrillation, 0.47 (0.24, 0.91), achieved statistical significance. Women with high LE8 score and prior APOs had a similar long-term cardiovascular risk compared to women with high LE8 score and no prior APOs, 0.95 (0.63, 1.44).

Conclusions: Among women with a history of APOs, better cardiovascular health as assessed using LE8 was associated with a significantly lower incidence of CVD, particularly coronary heart disease and atrial fibrillation. The excess risk associated with APOs appears to be attenuated among those with a high LE8 score.

Keywords: Adverse pregnancy outcomes; Cardiovascular diseases; Life’s Essential 8.

Plain language summary

In this prospective cohort study of 109,523 women from the UK Biobank, women with a history of APOs may benefit more from maintaining better cardiovascular health than women without a history of APOs, suggesting the clinical and public health utility of targeting this population specifically for primary prevention of CVD. Better cardiovascular health as assessed using LE8 was associated with a significantly lower incidence of CVD, particularly coronary heart disease and atrial fibrillation.Significant additive interaction was found between history of APOs and LE8 score on CVD risk, and excess risk associated with APOs appears to be attenuated among those with a high LE8 score.

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