Preeclampsia and cardiovascular disease in a large UK pregnancy cohort of linked electronic health records: a CALIBER study

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Show simple item record Leon, Lydia J. McCarthy, Fergus P. Direk, Kenan Gonzalez-Izquierdo, Arturo Prieto-Merino, David Casas, Juan P. Chappell, Lucy 2019-10-17T13:12:13Z 2019-10-17T13:12:13Z 2019-09-23
dc.identifier.citation Leon, L. J., McCarthy, F. P., Direk, K., Gonzalez-Izquierdo, A., Prieto-Merino, D., Casas, J. P. and Chappell, L. (2019) 'Preeclampsia and Cardiovascular Disease in a Large UK Pregnancy Cohort of Linked Electronic Health Records', Circulation, 140(13), pp. 1050-1060. doi: 10.1161/CIRCULATIONAHA.118.038080 en
dc.identifier.volume 140 en
dc.identifier.issued 13 en
dc.identifier.startpage 1050 en
dc.identifier.endpage 1060 en
dc.identifier.issn 0009-7322
dc.identifier.doi 10.1161/CIRCULATIONAHA.118.038080 en
dc.description.abstract Background: The associations between pregnancy hypertensive disorders and common cardiovascular disorders have not been investigated at scale in a contemporaneous population. We aimed to investigate the association between preeclampsia, hypertensive disorders of pregnancy, and subsequent diagnosis of 12 different cardiovascular disorders. Methods: We used linked electronic health records from 1997 to 2016 to recreate a UK population-based cohort of 1.3 million women, mean age at delivery 28 years, with nearly 1.9 million completed pregnancies. We used multivariable Cox models to determine the associations between hypertensive disorders of pregnancy, and preeclampsia alone (term and preterm), with 12 cardiovascular disorders in addition to chronic hypertension. We estimated the cumulative incidence of a composite end point of any cardiovascular disorder according to preeclampsia exposure. Results: During the 20-year study period, 18 624 incident cardiovascular disorders were observed, 65% of which had occurred in women under 40 years. Compared to women without hypertension in pregnancy, women who had 1 or more pregnancies affected by preeclampsia had a hazard ratio of 1.9 (95% confidence interval 1.53–2.35) for any stroke, 1.67 (1.54–1.81) for cardiac atherosclerotic events, 1.82 (1.34–2.46) for peripheral events, 2.13 (1.64–2.76) for heart failure, 1.73 (1.38–2.16) for atrial fibrillation, 2.12 (1.49–2.99) for cardiovascular deaths, and 4.47 (4.32–4.62) for chronic hypertension. Differences in cumulative incidence curves, according to preeclampsia status, were apparent within 1 year of the first index pregnancy. Similar patterns of association were observed for hypertensive disorders of pregnancy, while preterm preeclampsia conferred slightly further elevated risks. Conclusions: Hypertensive disorders of pregnancy, including preeclampsia, have a similar pattern of increased risk across all 12 cardiovascular disorders and chronic hypertension, and the impact was evident soon after pregnancy. Hypertensive disorders of pregnancy should be considered as a natural screening tool for cardiovascular events, enabling cardiovascular risk prevention through national initiatives. en
dc.description.sponsorship National Institute for Health Research (Professorship (RP-2014-05-019); Clinical Academic Fellowship; University College London Hospitals Biomedical Research Centre) en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher Lippincott, Williams & Wilkins; American Heart Association en
dc.rights © 2019 American Heart Association, Inc. Published by Lippincott, Williams & Wilkins. en
dc.subject Cardiovascular diseases en
dc.subject Hypertension en
dc.subject Hypertension, pregnancy-induced en
dc.subject Preeclampsia en
dc.subject Pregnancy en
dc.title Preeclampsia and cardiovascular disease in a large UK pregnancy cohort of linked electronic health records: a CALIBER study en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Fergus P. McCarthy, The Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland. +353-21-490-3000 Email: en
dc.internal.availability Full text available en Access to this article is restricted until 6 months after publication by request of the publisher. en 2020-03-23
dc.description.version Accepted Version en
dc.contributor.funder National Institute for Health Research en
dc.contributor.funder UCLH Biomedical Research Centre en
dc.description.status Peer reviewed en
dc.identifier.journaltitle Circulation en
dc.internal.IRISemailaddress en
dc.identifier.eissn 1524-4539

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