Consider Preeclampsia as a First Cardiovascular Event

Cardiovascular disease (CVD) is the leading cause of death in women worldwide. Preeclampsia (PE) is an important and acknowledged female-specific risk factor. Women with a history of PE have an elevated risk to develop hypertension in the decade following their index pregnancy. In this paper, we aim to provide recent insights in the future risk of preeclampsia and describe how prevention strategies can be optimized. The development of premature hypertension is caused by multiple factors such as genetics and a persistent enhanced inflammatory state after PE. Systemic inflammation accelerates endothelial dysfunction and promotes the process of atherosclerosis. In formerly preeclamptic women, signs of subclinical atherosclerosis are present at young age. Timely cardiovascular screening after PE is recommended; however, the how and when are yet to be determined. Given the large impact of a previous preeclamptic pregnancy on cardiovascular risk, the question arises whether we should not intensify secondary prevention in these high-risk women. Obstetric history can provide useful information about CVD risk in women after their reproductive life, especially if they had a pregnancy complicated by preeclampsia. Early detection of hypertension could optimize prevention and treatment strategies and mitigate CVD risk. For high-risk women, preeclampsia may be considered a first cardiovascular event that requires secondary prevention according to guidelines.