Hypertensive disorders of pregnancy increase risk of CVD, regardless of prepregnancy risk factors

Hypertensive disorders of pregnancy are a significant marker of premature cardiovascular disease (CVD) risk in young women, even in those without prepregnancy cardiometabolic risk factors, a study found.

To better understand the association between hypertension in pregnancy and incident CVD in a diverse population, researchers assessed data from the All of Us Research Program, representing more than 50 health systems in the U.S. A total of 17,357 women with longitudinal pregnancy and postpartum data recorded between 2007 and 2022 were included. CVD was defined as a composite of ischemic heart disease, heart failure, and stroke. Results were stratified based on prepregnancy cardiometabolic risk factors, including hypertension, obesity, diabetes, hyperlipidemia, and/or chronic kidney disease. Median participant age was 30 years; 16% identified as Black or African American and 42% as Hispanic or Latino. Thirty-five percent of women reported a family income less than $25,000, and 37% had a high school education or less. Researchers also replicated their analyses using data from an independent health system (n=56,549; median age, 33 years) using data from 2016 to 2025. Findings were published by Circulation on Nov. 8.

Overall, 12% of studied pregnancies involved a hypertensive disorder, and over a median follow-up of 4.6 years, 701 women developed CVD. Hypertensive disorders were associated with an increased CVD risk overall (adjusted hazard ratio [aHR], 1.82; 95% CI, 1.49 to 2.22), both among women with and without prepregnancy risk factors (aHRs, 1.33 [95% CI, 1.00 to 1.77] and 2.06 [95% CI, 1.55 to 2.74], respectively). Additional analyses showed that obesity and hypertension were the dominant postpartum-acquired risk factors among women with hypertension during pregnancy but no prepregnancy risk factors. Similar associations between hypertension during pregnancy and later CVD were seen in the external replication cohort (aHR, 2.62; 95% CI, 2.17 to 3.16).

Limitations include a lack of data on lifestyle and behavioral factors and a relatively short follow-up period.

The findings indicate that optimizing cardiometabolic health before conception may reduce the risk of both pregnancy complications and CVD and that the postpartum period provides an opportunity to identify and treat emerging cardiovascular risk factors, the authors wrote.

“Integrating pregnancy complications into CVD risk stratification and promoting cardiometabolic health before, during and after pregnancy may reduce the growing burden of early-onset CVD among women,” they concluded.