Article, 2024

Vascular health years after a hypertensive disorder of pregnancy: The EPOCH study

American Heart Journal, ISSN 0002-8703, 1097-6744, Volume 272, Pages 96-105, 10.1016/j.ahj.2024.03.004

Contributors

Miller, Hayley E [1] Tierney, Seda [1] Stefanick, Marcia L [1] Mayo, Jonathan A 0000-0003-0361-4078 [1] Sedan, Oshra [1] Rosas, Lisa Goldman 0000-0003-4053-7972 [1] Melbye, Mads- 0000-0001-8264-6785 [2] Boyd, Heather Allison 0000-0001-6849-9985 [3] Stevenson, David K [1] Shaw, Gary Michael 0000-0001-7438-4914 [1] Winn, Virginia D 0000-0003-1136-2907 [1] Hlatky, Mark Andrew 0000-0003-4686-9441 (Corresponding author) [1]

Affiliations

  1. [1] Stanford University
    2. [NORA names: United States; America, North; OECD];
  2. [2] University of Copenhagen
    3. [NORA names: KU University of Copenhagen; University; Denmark; Europe, EU; Nordic; OECD];
  3. [3] Statens Serum Institut
    4. [NORA names: SSI Statens Serum Institut; Governmental Institutions; Denmark; Europe, EU; Nordic; OECD]

Abstract

BACKGROUND: Preeclampsia is associated with a two-fold increase in a woman's lifetime risk of developing atherosclerotic cardiovascular disease (ASCVD), but the reasons for this association are uncertain. The objective of this study was to examine the associations between vascular health and a hypertensive disorder of pregnancy among women ≥ 2 years postpartum. METHODS: Pre-menopausal women with a history of either a hypertensive disorder of pregnancy (cases: preeclampsia or gestational hypertension) or a normotensive pregnancy (controls) were enrolled. Participants were assessed for standard ASCVD risk factors and underwent vascular testing, including measurements of blood pressure, endothelial function, and carotid artery ultrasound. The primary outcomes were blood pressure, ASCVD risk, reactive hyperemia index measured by EndoPAT and carotid intima-medial thickness. The secondary outcomes were augmentation index normalized to 75 beats per minute and pulse wave amplitude measured by EndoPAT, and carotid elastic modulus and carotid beta-stiffness measured by carotid ultrasound. RESULTS: Participants had a mean age of 40.7 years and were 5.7 years since their last pregnancy. In bivariate analyses, cases (N = 68) were more likely than controls (N = 71) to have hypertension (18% vs 4%, P = .034), higher calculated ASCVD risk (0.6 vs 0.4, P = .02), higher blood pressures (systolic: 118.5 vs 111.6 mm Hg, P = .0004; diastolic: 75.2 vs 69.8 mm Hg, P = .0004), and higher augmentation index values (7.7 vs 2.3, P = .03). They did not, however, differ significantly in carotid intima-media thickness (0.5 vs 0.5, P = .29) or reactive hyperemia index (2.1 vs 2.1, P = .93), nor in pulse wave amplitude (416 vs 326, P = .11), carotid elastic modulus (445 vs 426, P = .36), or carotid beta stiffness (2.8 vs 2.8, P = .86). CONCLUSION: Women with a prior hypertensive disorder of pregnancy had higher ASCVD risk and blood pressures several years postpartum, but did not have more endothelial dysfunction or subclinical atherosclerosis.

Keywords

ASCVD risk, ASCVD risk factors, EndoPAT, Secondary outcomes, age, amplitude, analysis, artery ultrasound, association, atherosclerosis, atherosclerotic cardiovascular disease, atherosclerotic cardiovascular disease risk, augmentation, augmentation index, augmentation index values, beats, beta-stiffness, bivariate analysis, blood, blood pressure, cardiovascular disease, carotid, carotid artery ultrasound, carotid elastic modulus, carotid intima-media thickness, carotid intima-medial thickness, carotid ultrasound, cases, control, disease, disorders of pregnancy, dysfunction, elastic modulus, endothelial dysfunction, endothelial function, epoch, epoch study, factors, function, health, health years, high ASCVD risk, high blood pressure, history, hypertension, hypertensive disorders, hypertensive disorders of pregnancy, increase, index, index values, intima-media thickness, intima-medial thickness, lifetime risk, measurement of blood pressure, measurements, modulus, normotensive pregnancies, objective, outcomes, participants, postpartum, pre-menopausal women, preeclampsia, pregnancy, pressure, primary outcome, pulse, pulse wave amplitude, reactive hyperemia index, risk, risk factors, stiffness, study, subclinical atherosclerosis, test, thickness, ultrasound, values, vascular health, vascular testing, wave amplitude, woman's lifetime risk, women, year postpartum, years

Funders

  • National Center for Advancing Translational Sciences
  • National Heart Lung and Blood Institute

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