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Premature cardiovascular disease following a history of hypertensive disorder of pregnancy

  • Author Footnotes
    2 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Emily G. McDonald
    Correspondence
    Corresponding author at: Division of General Internal Medicine, Royal Victoria Hospital, The Glen Site, 1001 Decarie Blvd Rm D05.5840, Montreal, QC H4A3J1, Canada.
    Footnotes
    2 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Canada
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  • Author Footnotes
    2 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Natalie Dayan
    Footnotes
    2 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Canada
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  • Author Footnotes
    2 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Roxanne Pelletier
    Footnotes
    2 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Division of Clinical Epidemiology, McGill University Health Centre, Montréal, Québec
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  • Author Footnotes
    2 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Mark J. Eisenberg
    Footnotes
    2 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Division of Cardiology, Department of Medicine, McGill University, Canada
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  • Author Footnotes
    1 Dr Pilote holds a James McGill Chair in medicine.
    ,
    Author Footnotes
    2 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Louise Pilote
    Footnotes
    1 Dr Pilote holds a James McGill Chair in medicine.
    2 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Canada
    Search for articles by this author
  • Author Footnotes
    1 Dr Pilote holds a James McGill Chair in medicine.
    2 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

      Abstract

      Background

      Following an episode of hypertensive disorder of pregnancy (HDP) women have an increased risk of cardiovascular disease over their lifetime. At the time of acute coronary syndrome we compared clinical information between women with and without a history of hypertension in pregnancy to gain further insight into the pathophysiology of cardiovascular disease in this population.

      Methods

      GENESIS-PRAXY (GENdEr and Sex determInantS of cardiovascular disease: from bench to beyond—PRemature Acute Coronary SYdrome) is a prospective multicenter study, with recruitment between January 2009 and April 2013, including 242 parous women with premature acute coronary syndrome.

      Results

      The median age was 50 years (IQR 6) and HDP was common; 43 (17.8%) women had prior gestational hypertension, 33 (13.6%) preeclampsia and 166 (68.6%) a prior normotensive pregnancy. Women with a history of HDP commonly had chronic hypertension and diabetes and those presenting with ST-elevation myocardial infarction were more likely to have a history of preeclampsia (aOR 3.12, 95% CI 1.22–8.01) than were women with prior normotensive pregnancies. Neither gestational hypertension (aOR 1.40, 95% CI 0.60–3.26) nor preeclampsia (aOR 0.63, 95% CI 0.23–1.74) was associated with a higher composite risk of three-vessel, left main or proximal left anterior descending coronary disease.

      Conclusion

      In this study of women with premature cardiovascular disease, ST-elevation myocardial infarction was associated with a history of preeclampsia possibly because of persistent endothelial dysfunction. High-risk coronary lesions on angiography did not appear to have an association with preeclampsia or gestational hypertension despite a high burden of traditional risk factors.

      Keywords

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