Preeclampsia and Future Cardiovascular Health A Systematic Review and Meta-Analysis

Background-Preeclampsia is a pregnancy-specific disorder resulting in hypertension and multiorgan dysfunction. There is growing evidence that these effects persist after pregnancy. We aimed to systematically evaluate and quantify the evidence on the relationship between preeclampsia and the future risk of cardiovascular diseases. Methods and Results-We studied the future risk of heart failure, coronary heart disease, composite cardiovascular disease, death because of coronary heart or cardiovascular disease, stroke, and stroke death after preeclampsia. A systematic search of MEDLINE and EMBASE was performed to identify relevant studies. We used random-effects meta-analysis to determine the risk. Twenty-two studies were identified with >6.4 million women including >258 000 women with preeclampsia. Meta-analysis of studies that adjusted for potential confounders demonstrated that preeclampsia was independently associated with an increased risk of future heart failure ( risk ratio [ RR], 4.19; 95% confidence interval [ CI], 2.09-8.38), coronary heart disease ( RR, 2.50; 95% CI, 1.43-4.37), cardiovascular disease death ( RR, 2.21; 95% CI, 1.83-2.66), and stroke ( RR, 1.81; 95% CI, 1.29-2.55). Sensitivity analyses showed that preeclampsia continued to be associated with an increased risk of future coronary heart disease, heart failure, and stroke after adjusting for age ( RR, 3.89; 95% CI, 1.83-8.26), body mass index ( RR, 3.16; 95% CI, 1.41-7.07), and diabetes mellitus ( RR, 4.19; 95% CI, 2.09-8.38). Conclusions-Preeclampsia is associated with a 4-fold increase in future incident heart failure and a 2-fold increased risk in coronary heart disease, stroke, and death because of coronary heart or cardiovascular disease. Our study highlights the importance of lifelong monitoring of cardiovascular risk factors in women with a history of preeclampsia.