Impact of preventive screening and lifestyle interventions in women with a history of preeclampsia: A micro-simulation study

被引：10

作者：

Lagerweij, G. R. ^{[1
,2
,11
,14
]}

Brouwers, L. ^{[2
,3
,11
,12
]}

De Wit, G. A. ^{[1
,4
]}

Moons, K. G. M. ^{[1
,14
]}

Benschop, L. ^{[2
,5
,10
,11
]}

Maas, A. H. E. M. ^{[6
,17
]}

Franx, A. ^{[3
,12
]}

Wermer, M. J. H. ^{[8
,13
]}

Roeters van Lennep, J. E. ^{[5
]}

van Rijn, B. B. ^{[3
,10
,12
]}

Koffijberg, H. ^{[1
,7
,14
,16
]}

Appelman, Y. ^{[9
]}

Baart, S. ^{[10
,11
]}

Benschop, L. ^{[2
,5
,10
,11
]}

Boersma, E. ^{[10
]}

Brouwers, L. ^{[2
,3
,11
,12
]}

Budde, R. P. J. ^{[10
]}

Cannegieter, S. C. ^{[13
]}

Dam, V. ^{[11
,14
]}

Eijkemans, R. ^{[14
]}

Fauser, B. C. J. M. ^{[12
]}

Ferrari, M. D. ^{[13
]}

Franx, A. ^{[3
,12
]}

de Groot, C. J. M. ^{[9
]}

Gunning, M. N. ^{[11
,12
]}

Hoek, A. ^{[15
]}

Koffijberg, H. ^{[1
,7
,14
,16
]}

Koster, M. P. H. ^{[10
]}

Kruit, M. C. ^{[13
]}

Lagerweij, G. R. ^{[1
,2
,11
,14
]}

Lambalk, C. B. ^{[9
]}

Laven, J. S. E. ^{[10
]}

Linstra, K. M. ^{[10
,11
,13
]}

van der Lugt, A. ^{[10
]}

Maas, A. H. E. M. ^{[6
,17
]}

van den Brink, A. Maassen ^{[10
]}

Meun, C. ^{[10
,11
]}

Middeldorp, S. ^{[18
]}

Moons, K. G. M. ^{[1
,14
]}

van Rijn, B. B. ^{[3
,10
,12
]}

van Lennep, J. E. Roeters ^{[10
]}

Roos-Hesselink, J. W. ^{[10
]}

Scheres, L. J. J. ^{[11
,18
]}

van der Schouw, Y. T. ^{[14
]}

Steegers, E. A. P. ^{[10
]}

Steegers-Theunissen, R. P. M. ^{[10
]}

Terwindt, G. M. ^{[13
]}

Velthuis, B. K. ^{[12
]}

Wermer, M. J. H. ^{[8
,13
]}

Zick, B. ^{[10
,13
]}

机构：

[1] Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, Stratenum 6-131,POB 85500, NL-3508 GA Utrecht, Netherlands

[2] Netherlands Heart Inst, Utrecht, Netherlands

[3] Univ Med Ctr Utrecht, Wilhelmina Childrens Hosp Birth Ctr, Utrecht, Netherlands

[4] Natl Inst Publ Hlth & Environm, Ctr Nutr Prevent & Healthcare, Utrecht, Netherlands

[5] Erasmus MC, Dept Obstet & Gynecol, Rotterdam, Netherlands

[6] Radboud Univ Nijmegen, Med Ctr, Dept Cardiol, Nijmegen, Netherlands

[7] Univ Twente, Dept Hlth Technol & Serv Res, Enschede, Netherlands

[8] Leiden Univ, Dept Neurol, Med Ctr, Leiden, Netherlands

[9] Vrije Univ, Med Ctr, Amsterdam, Netherlands

[10] Erasmus MC, Rotterdam, Netherlands

[11] Netherlands Heart Inst, Utrecht, Netherlands

[12] Univ Med Ctr Utrecht, Utrecht, Netherlands

[13] Leiden Univ, Med Ctr, Leiden, Netherlands

[14] Univ Med Ctr Groningen, Julius Ctr, Groningen, Netherlands

[15] Univ Med Ctr Groningen, Groningen, Netherlands

[16] Univ Twente, Enschede, Netherlands

[17] Radboud Univ Nijmegen, Med Ctr, Nijmegen, Netherlands

[18] Acad Med Ctr Amsterdam, Amsterdam, Netherlands

来源：

EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY | 2020年 / 27卷 / 13期

关键词：

Cardiovascular disease prevention; cost-effectiveness; lifestyle intervention; primary prevention; preeclampsia; HYPERTENSIVE PREGNANCY DISORDERS; CARDIOVASCULAR-DISEASE RISK; COST-EFFECTIVENESS; EUROPEAN-SOCIETY; TASK-FORCE; COMPLICATIONS; GUIDELINES; OPPORTUNITIES; ASSOCIATION; INFORMATION;

D O I：

10.1177/2047487319898021

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background Preeclampsia is a female-specific risk factor for the development of future cardiovascular disease. Whether early preventive cardiovascular disease risk screenings combined with risk-based lifestyle interventions in women with previous preeclampsia are beneficial and cost-effective is unknown. Methods A micro-simulation model was developed to assess the life-long impact of preventive cardiovascular screening strategies initiated after women experienced preeclampsia during pregnancy. Screening was started at the age of 30 or 40 years and repeated every five years. Data (initial and follow-up) from women with a history of preeclampsia was used to calculate 10-year cardiovascular disease risk estimates according to Framingham Risk Score. An absolute risk threshold of 2% was evaluated for treatment selection, i.e. lifestyle interventions (e.g. increasing physical activity). Screening benefits were assessed in terms of costs and quality-adjusted-life-years, and incremental cost-effectiveness ratios compared with no screening. Results Expected health outcomes for no screening are 27.35 quality-adjusted-life-years and increase to 27.43 quality-adjusted-life-years (screening at 30 years with 2% threshold). The expected costs for no screening are euro9426 and around euro13,881 for screening at 30 years (for a 2% threshold). Preventive screening at 40 years with a 2% threshold has the most favourable incremental cost-effectiveness ratio, i.e. euro34,996/quality-adjusted-life-year, compared with other screening scenarios and no screening. Conclusions Early cardiovascular disease risk screening followed by risk-based lifestyle interventions may lead to small long-term health benefits in women with a history of preeclampsia. However, the cost-effectiveness of a lifelong cardiovascular prevention programme starting early after preeclampsia with risk-based lifestyle advice alone is relatively unfavourable. A combination of risk-based lifestyle advice plus medical therapy may be more beneficial.

引用

页码：1389 / 1399

页数：11

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