Association Between Hypertensive Disorders of Pregnancy and Dementia: a Systematic Review and Meta-Analysis.
Association Between Hypertensive Disorders of Pregnancy and Dementia: a Systematic Review and Meta-Analysis.
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妊娠期高血压疾病与痴呆之间的关联：系统评价和荟萃分析。
DOI：
10.1161/hypertensionaha.122.19399
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Varner,MichaelW
中科院分区：
文献类型：
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作者：
Schliep,KarenC;Mclean,Hailey;Yan,Bin;Qeadan,Fares;Theilen,LaurenH;deHavenon,Adam;Majersik,JenniferJ;Østbye,Truls;Sharma,Surendra;Varner,MichaelW
背景：先前的荟萃分析报告，有妊娠期高血压疾病（HDP）病史的妇女，其晚期心血管疾病的风险增加2- 4倍。考虑到HDP的血管基础，它被假设也是后期痴呆的风险因素。我们的目标是总结HDP对痴呆症影响的证据，并考虑HDP与痴呆症亚型之间的独特关联。方法从截至2021年7月1日的在线电子数据库（PROSPERO标识符：CRD 42020185630）中确定了关于HDP与痴呆症之间关系的观察性研究。我们纳入了以英语发表的观察性研究。女性暴露于任何HDP和HDP亚型：妊娠期高血压、先兆子痫/子痫或其他/未指明的HDP。结果是任何痴呆和痴呆亚型：阿尔茨海默氏病，血管性痴呆，或其他/未指明dementias.ResultsFor我们的主要分析，我们包括5个队列研究，共183 874名妇女和2 309 705名妇女没有HDP。汇总分析发现，与没有任何类型的HDP的女性相比，患有任何类型HDP的女性患全因痴呆的风险高38%（校正后的风险比，1.38 [95%CI，1.18-1.61];P<0.01）。当检查HDP和痴呆亚型的相关性时，我们发现患有任何类型HDP的女性患血管性痴呆的风险比不患有任何类型HDP的女性高出3倍以上（调整后的风险比，3.14 [95%CI，2.32-4.24];P<0.01）。在更多种族/民族多样化的人群中进行进一步的研究，量化HDP对全因性痴呆，特别是血管性痴呆的影响，是有必要的。
BackgroundPrior meta-analyses report a 2- to 4-fold increased risk of later cardiovascular disease among women with a history of hypertensive disorders of pregnancy (HDP). Given HDP’s vascular underpinnings, it is hypothesized to also be a risk factor for later dementia. We aim to summarize the evidence for the impact of HDP on dementia and consider unique associations between HDP and dementia subtypes.MethodsObservational studies on the relationship between HDP and dementia were identified from online electronic databases to July 1, 2021 (PROSPERO identifier: CRD42020185630). We included observational studies published in English. Exposure among women was any HDP and HDP subtypes: gestational hypertension, preeclampsia/eclampsia, or other/unspecified HDP. Outcome was any dementia and dementia subtypes: Alzheimer’s disease, vascular dementia, or other/unspecified dementias.ResultsFor our primary analyses, we included 5 cohort studies with a total of 183 874 women with and 2 309 705 women without HDP. Pooled analysis found a 38% higher risk of all-cause dementia among women with, versus without, any type of HDP (adjusted hazard ratio, 1.38 [95% CI, 1.18–1.61];P<0.01). When examining association by HDP and dementia subtypes, we found that women with, versus without, any type of HDP had over a 3-fold higher risk of vascular dementia (adjusted hazard ratio, 3.14 [95% CI, 2.32–4.24];P<0.01).ConclusionsOur findings indicate that maternal history of HDP is an important risk factor for later development of vascular and all-cause dementia. Further research among more racially/ethnically diverse populations quantifying HDP’s effect on all-cause dementia, and specifically vascular dementia, is warranted.