Cardiovascular risk model performance in women with and without hypertensive disorders of pregnancy

Dam, Veerle; Onland‐Moret, N. Charlotte; Boer, Jolanda M. A.; Benschop, Laura; Franx, Arie; Moons, Karel G.M.; Boersma, Eric; Schouw, Yvonne T. van der

doi:10.1136/heartjnl-2018-313439

Cited by 12 publications

(7 citation statements)

References 27 publications

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“…All studies showed an increased unadjusted CVD risk in women with previous HDP, but previous HDP did not add to CVD risk prediction after adjustment for traditional CVD risk factors. 31–33 All of these studies were limited by not assessing CVD risk in women <40 years of age, and the study by Stuart et al. interestingly indicated that previous HDP may add to CVD prediction in women aged 40–49 years.…”

Section: Discussionmentioning

confidence: 99%

Risk prediction of maternal cardiovascular disease one year after hypertensive pregnancy complications or gestational diabetes mellitus

Moe

Sugulle

Dechend

et al. 2019

Eur J Prev Cardiolog

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Background Previous preeclampsia, gestational hypertension and gestational diabetes mellitus show a firm epidemiological association to maternal cardiovascular disease risk. Cardiovascular disease risk assessment is recommended in women after these pregnancy complications, but not offered in most countries. We therefore wanted to evaluate the applicability of currently recommended cardiovascular disease risk scores for women one-year postpartum of such pregnancy complications. Design and methods We tested applicability of three scoring systems, the Atherosclerotic Cardiovascular Disease (ASCVD) score, the Joint British Societies for the Prevention of Cardiovascular Disease (JBS3) score and Framingham 30 year Risk Score-Cardiovascular Disease (FRS-CVD) in 235 women one-year postpartum (controls: 94, gestational hypertension: 35, preeclampsia: 81, gestational diabetes mellitus: 25). Statistical analysis was performed with Mann–Whitney U test for continuous and Fisher’s mid-corrected p and Pearson’s r for dichotomous variables. A value of p < 0.050 was considered significant. Results Most women (87.7%) were below 40 years of age, rendering 10-year risk estimations recommended by American and European societies inapplicable. FRS-CVD could be assessed in all women. Significantly fewer could be assessed by the ASCVD (81.5%) and JBS3 (91.6%). All scoring systems showed small, but significant increases in risk scores for one or more of the pregnancy complication groups, but none at the risk magnitude for cardiovascular disease shown in epidemiological studies. Conclusion We demonstrate that ASCVD, JBS3 and FRS-CVD are inadequate in assessing cardiovascular disease risk one-year postpartum. We suggest that pregnancy complications need to be considered separately when evaluating maternal cardiovascular disease risk and need for postpartum follow-up.

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Section: Discussionmentioning

confidence: 99%

Risk prediction of maternal cardiovascular disease one year after hypertensive pregnancy complications or gestational diabetes mellitus

Moe

Sugulle

Dechend

et al. 2019

Eur J Prev Cardiolog

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“…Thus, for effective primary prevention at the time of, or following, maternity care it is important that all risk factors for CVD are considered and not only those directly pregnancy-related. Dam et al [44] investigated the performance of three commonly used CVD risk prediction models (SCORE, Framingham risk score, and Pooled Cohorts Equation) in women with a history of HDP and compared the performance to women with only normotensive pregnancies. They found the predictive performance of all models to be similar regardless of HDP history.…”

Section: Current Gap Of Knowledgementioning

confidence: 99%

Pregnancy Complication History in 10-Year Cardiovascular Disease Risk Prediction: a Review of Recent Evidence

Gunnarsson

Timpka

2019

Curr Epidemiol Rep

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Purpose of Review Women with prevalent pregnancy complications (including preterm birth and preeclampsia) have twice the risk of later cardiovascular disease (CVD) compared to unaffected women. Current prevention guidelines recommend that reproductive history should be part of a woman's CVD risk assessment. This review synthesizes recent findings on the value of history of pregnancy complications in 10-year CVD risk prediction. Recent Findings The associations between several pregnancy complications and CVD are still evident when conventional predictors are considered in middle age. However, comprehensive evaluation suggests that these associations translate into only minor, if any, clinically relevant improvements in prediction. Summary Current evidence suggests that 10-year CVD risk prediction in women is not substantially improved by history of pregnancy complications. Future studies should identify subgroups to target with prevention efforts post-pregnancy. In the meantime, conventional models are appropriate for estimating 10-year CVD risk in women with a history of pregnancy complications.

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“…Therefore, adding HDP to existing CVD risk prediction models does not seem to improve performance of the score because the predictive models work well already. 12 Once again, as epidemiologists, we are not surprised by the results of the Moe study and their final suggestion to use single markers rather than complex scores. In previous times, when the so-called metabolic syndrome was accepted by most, we suggested in countertrend the concrete possibility that it was nothing more than a constellation of markers, 13 like a whole orchestra that sounds very good, but in which, nevertheless, every single musical instrument is playing exactly the same music.…”

Section: A Commentmentioning

confidence: 94%

“…The well-known epidemiological CVD risk observed by other authors within 10 years after delivery in women with HDP or GDM is only marginally reflected by the calculation of long-term CVD risk. 12 It is substantially superfluous to go in search of such sophisticated scores given that ultimately, upon admission of the authors themselves, the scores added no conclusive information to the question on whether after one year from the delivery the mother has or not an increased risk of CVD. The reason for these results could be that female-specific factors, such as HDP and GDM, increase the risk of CVD through increasing the levels of the traditional cardiovascular risk factors already included in the score models.…”

Section: A Commentmentioning

confidence: 99%

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Pregnancy, a risk multiplier

Tikhonoff

Casíglia

2019

Eur J Prev Cardiolog

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The prevalence of hypertensive disorders of pregnancy (HDP), estimated to be between 3% and 10%, increased by 25% in the last decade and is expected to continue to grow with the rise of risk factors such as diabetes mellitus, obesity and advanced maternal age. 1 HDP accounts for 7.4% of maternal deaths during and shortly after delivery. Foetal growth restriction, preterm birth and perinatal death are also increased. 1 Prevalence of gestational diabetes mellitus (GDM) ranges from 3.8% to 7.8%. 2 In affluent societies it is simply unacceptable that a young, healthy women or a new-born suffer major problems or even die because of pregnancy. But the consequences of HDP and GDM can extend beyond pregnancy, increasing in the medium-long-term the risk of diabetes mellitus seven-fold and that of cardiovascular disease (CVD) two-fold, 1,2 pre-eclampsia being an even worse complication. As a consequence, a corpus of rules, suggestions, criteria and cut-off values on this topic has been appearing in medical literature in the last years. Furthermore, in a recent metaanalysis, Groenhof et al. 3 observed that the time point to commence screening for cardiovascular risk factors in women after a HDP is unknown. The paper by Moe et al. 4 must be seen in this frame.Pregnant women undergo dramatic changes in cardiovascular function (i.e. increased blood volume and cardiac output (CO)) ( Figure 1, upper panel) and experience blood pressure (BP) change (a decline, then an increase), hyperlipidaemia, accumulation of visceral fat and insulin resistance. This multisystem assault acts as a stressor, identifying women at higher risk of CVD later in life. 5 The complications of pregnancy could be considered as a failed stress test unmasking endothelial dysfunction and vascular or metabolic disease. 6 The American Heart Association puts women with history of HDP in the high-risk category for CVD, declaring that pregnancy provides an opportunity to estimate women's future risk. 7 However, how best to risk stratify or when and how to monitor these women is still under debate. Only 50% of the existing guidelines provide recommendation for follow-up beyond immediate post-partum, simply suggesting that women must be made aware of the risk and monitor BP yearly and renal functions and lipid profile every five years. 7Background and a premise

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Cardiovascular risk model performance in women with and without hypertensive disorders of pregnancy

Abstract: SCORE performed best in terms of both calibration and discrimination, while FRS and PCEs overpredicted risk in women with and without hHDP, but improved after recalibrating and refitting the models. No separate model for women with hHDP seems necessary, despite their higher baseline risk.

Cited by 12 publications

References 27 publications

Risk prediction of maternal cardiovascular disease one year after hypertensive pregnancy complications or gestational diabetes mellitus

Risk prediction of maternal cardiovascular disease one year after hypertensive pregnancy complications or gestational diabetes mellitus

Pregnancy Complication History in 10-Year Cardiovascular Disease Risk Prediction: a Review of Recent Evidence

Pregnancy, a risk multiplier

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