Pre-eclampsia/Eclampsia Tied to Increased Risk of Heart Failure for at Least 10 Years

By Marilynn Larkin

December 06, 2021

NEW YORK (Reuters Health) - Women with pre-eclampsia/eclampsia were at increased risk for future heart failure (HF) for up to a decade in a large cohort study.

"While preeclampsia has previously been recognized as a risk factor for future cardiovascular disease, including HF, this study identified that preeclampsia independently increases the risk of both HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF) over the decade following pregnancy," Dr. Kathryn Lindley of Washington University in St. Louis told Reuters Health by email.

"While traditional risk factors such as hypertension and diabetes were also identified as risk factors for HFpEF," she said, "women with a history of preeclampsia remained more than twice as likely to develop HFpEF even after adjusting for those risk factors."

"These findings are particularly important as HFpEF disproportionately affects women and can be challenging to treat," she noted. "Increased education, screening, and lifestyle modifications and pharmacologic therapies may potentially be beneficial to reduce their risk."

As reported in the Journal of the American College of Cardiology, Dr. Lindley and colleagues studied data on more than 2.5 million women from 2006-2014 in databases from Florida and New York. Overall, including 128,029 with preeclampsia/eclampsia.

The women were followed from post-delivery discharge to the first instance of HFpEF hospitalization (primary outcome), death, or the end of the study period (September 2015).

HFpEF hospitalization was significantly more likely among women with preeclampsia/eclampsia. After adjusting for baseline hypertension and other covariates, those with preeclampsia/eclampsia were significantly more likely to be hospitalized for HfpEF (adjusted hazard ratio, 2.09).

The median age at HfpEF onset was 34 and the median time to onset was 32.2 months.

Preeclampsia/eclampsia was also independently associated with increased risk of 90-day HFrEF (aHR, 2.13) and of late HFrEF (aHR, 1.92).

After adjusting for other clinical and demographic factors, preeclampsia/ eclampsia remained a significant predictor for late HF (aHR, 1.66). The strongest predictors were diabetes mellitus, chronic hypertension, and Black race.

Dr. Michael Honigberg of Massachusetts General Hospital, Harvard Medical School in Boston, author of a related editorial, commented by email to Reuters Health, "This paper shows that women with preeclampsia or eclampsia have roughly double the risk of developing HFpEF in the 10 years following delivery."

"Absolute risks are low," he said, "because HFpEF is a condition almost exclusively seen in the elderly; however, this makes a detectable signal for HFpEF in reproductive-age women all the more striking and concerning."

"While we await further research to better understand mechanisms of HF development in women affected by preeclampsia and clarify therapeutic implications," he said, "the message for clinicians, for now, is that women with hypertensive disorders of pregnancy warrant close monitoring and management of cardiovascular disease risk factors following delivery, in accordance with recent guidance from the American Heart Association."

"Broad educational efforts are necessary in order for patients and clinicians to be aware of preeclampsia-associated health risks," he noted. "This is really important knowledge for primary care clinicians and OB/GYNs, arguably even more so than for cardiologists."

SOURCE: https://bit.ly/3EnTwD8 and https://bit.ly/3oj70KS Journal of the American College of Cardiology, online November 29, 2021.

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