Key result
Preeclampsia is linked to increased CIMT and ~57% higher CAC odds up to 35 years later.
Why the study?
Uniform recommendations are lacking for routine postpartum CVD screening in women affected by preeclampsia, and it is unknown when subclinical atherosclerosis develops and when screening should commence.
Does a history of preeclampsia increase the risk of developing subclinical atherosclerosis in women?
Does a history of preeclampsia increase the risk of developing subclinical atherosclerosis in women?
Women with a history of preeclampsia exhibit signs of subclinical atherosclerosis that begin during pregnancy and persist up to 35 years postpartum, highlighting the need for long-term cardiovascular screening.
May support enhanced CV risk assessment in women with preeclampsia history; extends observational evidence of persistent subclinical atherosclerosis from pregnancy to 35 years.
Background Preeclampsia (PE) affects around 2-4% of all pregnancies globally, with the incidence increasing over the last 2 decades(1). PE is now a well-known risk factor for later-life cardiovascular disease (CVD)(2). Despite suggestion that women affected by PE should undergo routine postpartum screening for CVD, uniform recommendations are lacking. Subclinical atherosclerosis provides a window of opportunity to identify and treat those at risk before clinical CVD manifests. Carotid intimal-media thickness (CIMT), coronary artery calcium scoring (CAC) and ankle brachial index (ABI) are effective methods of detecting subclinical atherosclerosis(3-5). Purpose The aim of this systematic review was to ascertain when subclinical atherosclerosis develops in women with a history of PE and to establish when screening should commence in this high-risk group. Methods A systematic search of MEDLINE, EMBASE and CINAHL was performed according to PRISMA guidelines to identify all studies which explored subclinical atherosclerosis in women with a history of PE. Results 34 case-control studies with 20,235 women, including 3376 with a history of PE, were included in the final analysis. PE was associated with a significant increase in CIMT (0.94 (0.86, 1.01)) in 25 studies. This difference was already apparent during pregnancy (0.49 (0.34, 0.65)) and persisted for 12 months postpartum (0.66 (0.43, 0.88)) and beyond (1.16 (1.06, 1.25)). Pooled analysis of the 8 CAC studies also demonstrated that women with a history of PE were more likely to have subclinical atherosclerosis (OR 1.57 (1.39, 1.77)) up to 35 years postpartum. Conclusion Vascular changes in PE occur during pregnancy and persist long term. Our review highlights the importance of early follow up, monitoring of risk factors and aggressive lifestyle modifications in patients who have had PE. The persistence of these changes supports a need for monitoring beyond the 1-year time frame recommended in some current guidelines.
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Yao et al. (2025) studied this question. Preeclampsia was associated with increased CIMT during pregnancy (0.49), 12 months postpartum (0.66), and beyond (1.16), and higher CAC odds (OR 1.57) up to 35 years later.
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