History of hypertensive disorders in pregnancy increased odds of aortic valve calcification in middle-aged women (8.2% vs 4.9%, aOR 1.42), but not aortic aneurysm.
Does a history of hypertensive disorders of pregnancy increase the risk of aortic valve calcification and aortic aneurysm in middle-aged women?
Women with a history of hypertensive disorders of pregnancy have an increased likelihood of asymptomatic aortic valve calcification in middle age, highlighting the need to consider pregnancy history in long-term cardiovascular risk assessment.
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Abstract Introduction Hypertensive disorders of pregnancy (HDP) affect 5-10% of pregnancies worldwide and are associated with an elevated risk of subsequent cardiovascular disease (CVD).(1) The potential link between HDP and valvular heart disease, as well as thoracic aortic pathology, has not been extensively studied and may yet play a significant role in the long-term cardiovascular health of affected women. Purpose The aim of this study was to investigate the presence of aortic valve calcification and aortic aneurysm in asymptomatic, middle-aged women with and without a history of HDP. Methods This study combined data from the prospective nationwide cohort "Swedish CArdioPulmonary bioImage Study" (SCAPIS) and the Swedish Medical Birth Register (MBR). Between 2013-2018, SCAPIS included 15 000 asymptomatic women, 50-64 years of age. Evaluations include detailed cardiovascular indicators such as imaging of the aorta and the aortic valve.(2) The MBR, established in 1973, contains data on more than 98% of all pregnancies resulting in childbirth in Sweden.(3) The exposures HDP, including preeclampsia and gestational hypertension in any pregnancy, were identified by ICD-codes. Aortic valve calcification was categorized as either present or absent, and aortic aneurysm was defined as a thoracic aortic diameter 4 cm. Both outcomes were assessed using computed tomography (CT). Risks were calculated using binary logistic regression analyses and presented as adjusted odds ratios (aOR) with 95% confidence intervals (CI). Confounders were determined based on a theoretical framework and selected through a directed acyclic graph. The final set of confounders included maternal age at last childbirth, BMI at 20 years of age, smoking and diabetes (type 1 or 2) in first trimester. Results After excluding 57 women with chronic hypertension, we included 12,402 parous women from SCAPIS with a registered birth in the MBR. No women in our cohort had pregestational aortic stenosis or aortic aneurysm, which otherwise would have constituted additional exclusion criteria. Aortic valve calcification was more prevalent in women with a history of HDP compared to those with a previous normotensive pregnancy, 61 (8.2%) vs. 554 (4.9%), adjusted odds ratio (aOR) 1.42 (95% CI 1.01–2.01). There was no significant difference in the prevalence of aortic aneurysm between women with a history of HDP and those with previous normotensive pregnancies, 13 (1.7%) vs. 179 (1.6%), aOR 1.30 (95% CI 0.72–2.38). Conclusion Women with a history of HDP exhibit an increased likelihood of asymptomatic aortic valve calcification in middle age, but no elevated risk of aortic aneurysm. These findings enhance our understanding of subclinical CVD in women with a history of HDP. Future research should focus on the risk of developing clinically significant aortic stenosis and investigate primary preventive strategies following HDP.Flow chart (Inclusion and exclusion) Results (aOR, 95% CI)
Bergman et al. (Sat,) reported a other. History of hypertensive disorders in pregnancy increased odds of aortic valve calcification in middle-aged women (8.2% vs 4.9%, aOR 1.42), but not aortic aneurysm.