Beyond pregnancy: development of cardiovascular disease after preeclampsia

Abstract

In this thesis, we aimed to explore the cardiovascular health of women in the fifth and sixth decade of life in relation to pregnancy outcome, with a specific focus on women with preeclampsia. Additionally, we investigated the effect of uncomplicated pregnancy on arterial and metabolic health later in life. In particular, we assessed the impact of pregnancy on arterial stiffness and markers associated with arterial function, i.e. pro-NT and pro-RLX2. To explore these relationships, we investigated combined data of a number of well-established cohort studies, and conducted a newly established, multicenter prospective cohort study as part of a Dutch national consortium to promote CardiovasculaR hEalthy aging in Women (CREW consortium). Our results indicate accelerated atherosclerosis in coronary and carotid arteries after preeclampsia. Women with a history of preeclampsia showed cardiovascular abnormalities and ischemic stroke at a younger age. Further, we found that pregnancy itself is associated with increased BMI and an unfavorable CVD risk profile still present in the fifth and sixth decade of life. The results from this thesis confirm evidence for accelerated atherosclerosis in women after preeclampsia, as well as high prevalence of traditional and non-traditional cardiovascular risk factors. These results have several implications. First, the occurrence of early-age formation of coronary artery and carotid calcifications and plaques in women with previous preeclampsia confirms a shared etiological link between these two vascular disorders. Secondly, preeclampsia appears to result in cardiovascular damage at a much younger age than women without such a history. This may provide opportunities for early prevention strategies to reduce risk. However, this is expected to be a challenging task, as we still lack information about adherence, effectiveness and costs of such strategies within this group of apparently healthy young women. In conclusion, these results provide important new information on preeclampsia as a ‘failed stress test’ for cardiovascular disease, and appear to identify women with early damage to coronary arteries and other arterial atherosclerotic abnormalities. We hope these results will help to unravel paths towards early-age development of cardiovascular disease in women, and may improve care for women affected by preeclampsia.