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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Obstetrics and Gynaecology CanadaAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Effectiveness-based guidelines for the prevention of cardiovascular disease in women–2011 update: a guideline from the American Heart Association.Circulation. 2011; 123: 1243-1262
- The maternal health clinic: an initiative for cardiovascular risk identification in women with pregnancy-related complications.Am J Obstet Gynecol. 2014; 210: 438-439
- Pregnancy: a stress test for life.Curr Opin Obstet Gynecol. 2003; 15: 465-471
- The maternal health clinic: a new window of opportunity for early heart disease risk screening and intervention for women with pregnancy complications.J Obstet Gynaecol Can. 2013; 35: 831-839
- Ten-year, thirty-year, and lifetime cardiovascular disease risk estimates following a pregnancy complicated by preeclampsia.J Obstet Gynaecol Can. 2012; 34: 830-835
- General cardiovascular risk profile for use in primary care: the Framingham Heart Study.Circulation. 2008; 117: 743-753
- Development and validation of improved algorithms for the assessment of global cardiovascular risk in women: the Reynolds Risk Score.JAMA. 2007; 297: 611-619
- A history of preeclampsia identifies women who have underlying cardiovascular risk factors.Am J Obstet Gynecol. 2009; 200 (e1–8): 58
- Estimating the benefits of modifying risk factors of cardiovascular disease: a comparison of primary vs secondary prevention.Arch Intern Med. 1998; 158: 655-662
- Risk estimation of metabolic syndrome at one and three years after a pregnancy complicated by preeclampsia.J Obstet Gynaecol Can. 2012; 34: 836-841
- 2016 Canadian Cardiovascular Society guidelines for the management of dyslipidemia for the prevention of cardiovascular disease in the adult.Can J Cardiol. 2016; 32: 1263-1282
- Effectiveness-based guidelines for the prevention of cardiovascular disease in women–2011 update: a guideline from the American Heart Association.J Am Coll Cardiol. 2011; 57: 1404-1423
- Development of preeclampsia provides a window of opportunity for early cardiovascular risk screening and intervention.Expert Rev Obstet Gynecol. 2009; 4: 355-357
- 2012 update of the Canadian Cardiovascular Society guidelines for the diagnosis and treatment of dyslipidemia for the prevention of cardiovascular disease in the adult.Can J Cardiol. 2013; 29: 151-167
- Predicting the 30-year risk of cardiovascular disease: the Framingham Heart Study.Circulation. 2009; 119: 3078-3084
- Prediction of lifetime risk for cardiovascular disease by risk factor burden at 50 years of age.Circulation. 2006; 113: 791-798
- Years of life lost and healthy life-years lost from diabetes and cardiovascular disease in overweight and obese people: a modelling study.Lancet Diabetes Endocrinol. 2015; 3: 114-122
Statistics Canada. Table 7b: Complete life table, females, Ontario, 2009 to 2011. Life Tables, Canada, Provinces and Territories. Available at:http://www.statcan.gc.ca/pub/84-537-x/2013005/tbl/tbl7b-eng.htm. Ottawa: Statistics Canada; 2015. Accessed on November 16, 2018.
Heart and Stroke Foundation of Canada. Healthy weight and waist. Available at: http://www.heartandstroke.ca/get-healthy/healthy-weight/healthy-weight-and-waist. Ottawa: Heart and Stroke Foundation of Canada; 2017. Accessed on November 16, 2018.
Canadian Cardiovascular Society. Framingham Risk Score (FRS): estimation of 10-year cardiovascular disease (CVD) risk. Available at: https://ccs.ca/images/Guidelines/Tools_and_Calculators_En/FRS_eng_2017_fnl1.pdf. Ottawa: Canadian Cardiovascular Society; 2017. Accessed on November 16, 2018.
Cardiometabolic Age Risk Calculator. Available at: http://cardiometabolicage.com/. My Health Checkup; 2018. Accessed on November 16, 2018.
- Cardiovascular health after maternal placental syndromes (CHAMPS): population-based retrospective cohort study.Lancet. 2005; 366: 1797-1803
- Gestational diabetes and hypertensive disorders of pregnancy as vascular risk signals: an overview and grading of the evidence.Can J Cardiol. 2014; 30: 765-773
- The Canadian heart health strategy and action plan.Can J Cardiol. 2009; 25: 451-452
- General cardiovascular risk profile for use in primary care: the Framingham Heart Study.Circulation. 2008; 117: 743-753
- 2012 update of the Canadian Cardiovascular Society guidelines for the diagnosis and treatment of dyslipidemia for the prevention of cardiovascular disease in the adult.Can J Cardiol. 2013; 29: 151-167
- Predicting the 30-year risk of cardiovascular disease: the framingham heart study.Circulation. 2009; 119: 3078-3084
- Prediction of lifetime risk for cardiovascular disease by risk factor burden at 50 years of age.Circulation. 2006; 113: 791-798
- Years of life lost and healthy life-years lost from diabetes and cardiovascular disease in overweight and obese people: a modelling study.Lancet Diabetes Endocrinol. 2015; 3: 114-122
Article info
Publication history
Published online: January 14, 2019
Footnotes
Competing interests: See Acknowledgements.
Each author has indicated that they meet the journal's requirements for authorship.
Identification
Copyright
© 2018 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
