Preeclamptic Women Are at Significantly Higher Risk of Future Cardiovascular Outcomes Over a 15-Year Period
Preeclamptic Women Are at Significantly Higher Risk of Future Cardiovascular Outcomes Over a 15-Year Period
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DOI：
10.1089/jwh.2019.7671
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发表时间：
2019-08-16
影响因子：
3.5
通讯作者：
Kostis, John B.
中科院分区：
文献类型：
--
作者：
Gastrich, Mary Downes;Zinonos, Stavros;Kostis, John B.
背景：先兆子痫（PE）可导致母婴死亡和严重的内科并发症。了解PE的未来短期和长期心血管（CV）结局对女性健康至关重要。材料与方法：一项回顾性匹配病例对照研究评估了15年期间（1999-2013年）诊断为PE的妊娠和产次为1的妊娠病例女性与未诊断为PE的妊娠非经产对照女性相比的CV结局风险。新泽西电子出生证明（EBC）数据库和心肌梗死数据采集系统（MIDAS），一个在新泽西的所有住院纵向随访的数据库，被用来进行分析。参与者年龄在18岁及18岁以上，人口统计数据与新泽西一致，新泽西州是一个具有一系列种族和民族多样性的州。妊娠后和15年期间的主要结局指标为心肌梗死（MI）、卒中、CV死亡和全因死亡。结果：PE女性患者（N = 6，360）比对照组（N = 325，347）更容易发生MI、卒中、CV死亡和全因死亡。在将病例与对照组的人口统计学和合并症匹配后，与匹配的对照组相比，PE病例的MI（合并症和人口统计学校正的p = 0.0196）、CV死亡（校正的p = 0.007）和全因死亡（校正的p = 0.0026）结局的风险比显著高于1。与匹配对照相比，PE女性的MI风险高3.94倍（95% CI：1.25-12.4），CV死亡风险高4.66倍（95% CI：1.52-14.26），全因死亡风险高2.32倍（95% CI：1.34-4.02）。结论：这项为期15年的研究表明，与对照组相比，首次妊娠时患有PE的女性发生不良CV结局的风险显著更高，并建议对该女性人群在出生后加强和持续CV监测。
Background: Preeclampsia (PE) may lead to maternal and infant mortality and severe medical complications. Understanding future short- and long-term cardiovascular (CV) outcomes of PE is important to women's health. Materials and Methods: A retrospective matched case-control study assessed the risks of CV outcomes over a 15-year period (1999-2013) in pregnant case women, with gravidity and parity of one, diagnosed with PE, compared to pregnant primiparous control women who were not diagnosed with PE. The New Jersey Electronic Birth Certificate (EBC) database and the Myocardial Infarction Data Acquisition System (MIDAS), a database of all hospital admissions in New Jersey with longitudinal follow-up, were used to conduct the analysis. Participants were 18 years and older with demographics consistent with New Jersey, a state with a range of racial and ethnic diversity. Main outcome measures postpregnancy and over this 15-year period were myocardial infarction (MI), stroke, CV death, and all-cause death. Results: Women with PE (N = 6,360) were more likely to suffer MI, stroke, CV death, and all-cause death than controls (N = 325,347). After matching cases to controls for demographics and comorbidities, hazard ratios of PE cases for the outcomes of MI (p adjusted for comorbidities and demographics = 0.0196), CV death (adjusted p = 0.007), and all-cause death (adjusted p = 0.0026) were significantly higher than 1 compared to matched controls. Women with PE had 3.94 (95% CI: 1.25-12.4) times higher hazard for MI, 4.66 (95% CI: 1.52-14.26) times higher hazard of CV death, and 2.32 (95% CI: 1.34-4.02) times higher hazard for all-cause death than matched controls. Conclusions: This 15-year study indicates that women who have PE with their first pregnancy have a significantly higher risk of adverse CV outcomes compared to controls and suggest a heightened and continued CV monitoring after birth for this population of women.