Heart Failure in Women With Hypertensive Disorders of Pregnancy Insights From the Cardiovascular Disease in Norway Project

被引:49
作者
Honigberg, Michael C. [1 ,2 ,3 ,4 ,5 ,6 ]
Riise, Hilde Kristin Refvik [7 ]
Daltveit, Anne Kjersti [8 ]
Tell, Grethe S. [8 ,9 ]
Sulo, Gerhard [8 ]
Igland, Jannicke [8 ]
Klungsoyr, Kari [8 ,9 ]
Scott, Nandita S. [1 ,2 ,3 ]
Wood, Malissa J. [1 ,2 ,3 ]
Natarajan, Pradeep [1 ,2 ,4 ,5 ,6 ]
Rich-Edwards, Janet W. [10 ,11 ]
机构
[1] Harvard Med Sch, Massachusetts Gen Hosp, Cardiol Div, Boston, MA 02115 USA
[2] Harvard Med Sch, Massachusetts Gen Hosp, Dept Med, Boston, MA 02115 USA
[3] Harvard Med Sch, Massachusetts Gen Hosp, Corrigan Womens Heart Hlth Program, Cardiol Div, Boston, MA 02115 USA
[4] Broad Inst MIT & Harvard, Program Med & Populat Genet, Cambridge, MA 02142 USA
[5] Massachusetts Gen Hosp, Cardiovasc Res Ctr, Boston, MA 02114 USA
[6] Massachusetts Gen Hosp, Ctr Genom Med, Boston, MA 02114 USA
[7] Western Norway Univ Appl Sci, Dept Hlth Care Sci, Bergen, Norway
[8] Norwegian Inst Publ Hlth, Div Mental & Phys Hlth, Bergen, Norway
[9] Dept Global Publ Hlth & Primary Care, Bergen, Norway
[10] Brigham & Womens Hosp, Dept Med, Div Womens Hlth, 75 Francis St, Boston, MA 02115 USA
[11] Harvard TH Chan Sch Publ Hlth, Dept Epidemiol, Boston, MA USA
基金
欧洲研究理事会;
关键词
gestational age; heart failure; hypertension; pre-eclampsia; pregnancy; women; MEDICAL BIRTH REGISTRY; PREECLAMPSIA; MORTALITY; ASSOCIATION; MORBIDITY; VALIDITY; HISTORY; COHORT; RISK;
D O I
10.1161/HYPERTENSIONAHA.120.15654
中图分类号
R6 [外科学];
学科分类号
1002 ; 100210 ;
摘要
Hypertensive disorders of pregnancy (HDP) have been associated with heart failure (HF). It is unknown whether concurrent pregnancy complications (small-for-gestational-age or preterm delivery) or recurrent HDP modify HDP-associated HF risk. In this cohort study, we included Norwegian women with a first birth between 1980 and 2004. Follow-up occurred through 2009. Cox models examined gestational hypertension and preeclampsia in the first pregnancy as predictors of a composite of HF-related hospitalization or HF-related death, with assessment of effect modification by concurrent small-for-gestational-age or preterm delivery. Additional models were stratified by final parity (1 versus >= 2 births) and tested associations with recurrent HDP. Among 508 422 women, 565 experienced incident HF over a median 11.8 years of follow-up. After multivariable adjustment, gestational hypertension in the first birth was not significantly associated with HF (hazard ratio, 1.41 [95% CI, 0.84-2.35],P=0.19), whereas preeclampsia was associated with a hazard ratio of 2.00 (95% CI, 1.50-2.68,P<0.001). Among women with HDP, risks were not modified by concurrent small-for-gestational-age or preterm delivery (P-interaction=0.42). Largest hazards of HF were observed in women whose only lifetime birth was complicated by preeclampsia and women with recurrent preeclampsia. HF risks were similar after excluding women with coronary artery disease. In summary, women with preeclampsia, especially those with one lifetime birth and those with recurrent preeclampsia, experienced increased HF risk compared to women without HDP. Further research is needed to clarify causal mechanisms.
引用
收藏
页码:1506 / 1513
页数:8
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