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Cardiovascular Risk Assessment and Follow-Up of Women After Hypertensive Disorders of Pregnancy:A Prospective Cohort Study

Published:January 14, 2019DOI:https://doi.org/10.1016/j.jogc.2018.10.024

      Abstract

      Objective

      Hypertensive disorders of pregnancy (HDP) comprise an independent, sex-specific risk factor for cardiovascular disease (CVD) in women. This study examined the utility of CVD risk models proposed in the 2016 Canadian Cardiovascular Society (CCS) lipid guidelines to identify women requiring further screening or lipid treatment following HDP.

      Methods

      Using data collected from the postpartum Maternal Health Clinic (MHC) at Kingston General Hospital in Kingston, Ontario and the Preeclampsia New Emerging Team (PE-NET) cohort study, the study investigators used the models recommended by the CCS guidelines and the cardiometabolic model of life expectancy in each cohort to estimate CVD risk in women after HDP. (Canadian Task Force Classification II-2).

      Results

      Using the 10-Year Modified Framingham Risk Score, all women were classified by the 2016 CCS Guidelines as low risk, requiring no follow-up. The 30-Year and Lifetime Risk Scores resulted in significant reclassification of women at risk in the PE-NET control and HDP groups (P < 0.001 and P < 0.0001, respectively); 49.2% of women with HDP were classified as high risk, requiring follow-up, compared with 14.3% of control subjects. Using the cardiometabolic model, median life expectancy was significantly lower and expected onset of CVD was earlier in the HDP group compared with the control group (P < 0.0001).

      Conclusion

      The 2016 CCS lipid guidelines’ risk classification recommendations significantly underestimated lifelong CVD risk in the HDP group compared with the control group. Women with HDP also had a significant decrease in cardiometabolic life expectancy and an earlier predicted age at onset of CVD. Early primary prevention in this at-risk population may improve CVD outcomes and reduce the future burden on the health care system.

      Résumé

      Objectif

      Les troubles hypertensifs de la grossesse (THG) constituent un facteur de risque de maladie cardiovasculaire indépendant exclusif aux femmes. Cette étude a examiné l'efficacité des modèles de risque de maladie cardiovasculaire proposés dans les lignes directrices sur la dyslipidémie de 2016 de la Société canadienne de cardiologie (SCC) à cibler les femmes ayant besoin d'un dépistage poussé ou d'un traitement lipidique après des THG.

      Méthodologie

      À l'aide de données recueillies à la clinique de santé maternelle postpartum de l'Hôpital général de Kingston (Ontario) et dans le cadre de l'étude de cohorte Preeclampsia New Emerging Team (PE-NET), les chercheurs ont utilisé les modèles recommandés dans les lignes directrices de la SCC et le modèle cardiométabolique de l'espérance de vie pour estimer le risque de maladie cardiovasculaire des femmes ayant présenté des THG de chaque cohorte. (Classification II-2 du Groupe d'étude canadien).

      Résultats

      Avec le score de risque de Framingham modifié sur 10 ans, toutes les femmes présentaient un risque faible et ne nécessitaient aucun suivi selon les lignes directrices de 2016 de la SCC. Le score de risque sur 30 ans et le score de risque à vie ont significativement modifié la classification des femmes à risque dans le groupe témoin et dans le groupe ayant connu des THG de la PE-NET (P < 0,001 et P < 0,0001, respectivement): 14,3 % des femmes du premier groupe et 49,2 % des femmes du deuxième groupe étaient alors considérées comme présentant un risque élevé et nécessitant un suivi. Selon le modèle cardiométabolique, l'espérance de vie médiane était significativement réduite et l'âge prévu d'apparition de maladie cardiovasculaire était inférieur chez les femmes ayant souffert de THG, par rapport au groupe témoin (P < 0,0001).

      Conclusion

      Les recommandations en matière de classification du risque contenues dans les lignes directrices de 2016 de la SCC ont significativement sous-estimé, par rapport aux sujets témoins, le risque à vie de maladie cardiovasculaire dans le groupe de femmes ayant connu des THG. Les femmes de ce groupe présentaient aussi une diminution importante de leur espérance de vie selon le modèle cardiométabolique, et avaient un âge prévu d'apparition de maladie cardiovasculaire plus bas. La prévention primaire précoce dans cette population à risque élevé pourrait améliorer les issues associées aux maladies cardiovasculaires et réduire le fardeau pour le système de santé.

      Key Words

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