Higher carotid artery backward pressure and load-dependent stiffness among women with a history of preeclampsia: association with cognitive functions

Introduction: Women with a history of preeclampsia (hxPE) show reduced executive function (EF) and processing speed (PS) compared with a healthy pregnancy (HP). Central (carotid) artery pulsatile pressure hemodynamics and stiffness are associated with reduced cognitive function with aging; but it is unknown if this relation exists in women with a hxPE. We hypothesized that higher carotid artery pulsatile pressure hemodynamics and stiffness would mediate reductions in cognitive function among women with a hxPE. Methods: Carotid artery applanation tonometry, B-mode ultrasonography, and wave separation analysis were used in 121 postpartum women (9 months-5 years after delivery, aged 18-45; n=59 hxPE and n=62 HP) to calculate forward (Pf) and backward (Pb) pressure wave amplitudes, and pulse pressure (PP). Carotid stiffness components were derived by participant-specific exponential modeling. EF and PS were represented as Z-scores. Mediation analysis determined the contribution of carotid outcomes in the association between preeclampsia status and cognitive function. Results: Women with a hxPE had higher carotid Pb, PP, and load-dependent stiffness compared with HP (body mass index and age adjusted, p=0.009, p=0.005, and p<0.001, respectively). After education and age adjustment, the hxPE group had significantly lower PS compared with HP (p=0.009); executive function was not different (p=0.08). No pulsatile pressure hemodynamic or stiffness factor mediated associations between preeclampsia status and PS (all p>0.05). Conclusion: Women with a hxPE have greater carotid PP, Pb and load-dependent stiffness, compared with a HP. Neither carotid artery pulsatile pressure hemodynamics or load-dependent stiffness mediated lower PS among women with a hxPE.