Recurrent pre-eclampsia and subsequent cardiovascular risk
Recurrent pre-eclampsia and subsequent cardiovascular risk
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DOI：
10.1136/heartjnl-2016-309671
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发表时间：
2017-02-01
期刊：
影响因子：
5.7
通讯作者：
Paradis, Gilles
中科院分区：
文献类型：
--
作者：
Auger, Nathalie;Fraser, William D.;Paradis, Gilles
目的探讨反复发作的子痫前期与长期心血管住院的关系。方法本研究确定了加拿大魁北克1989至2013年间分娩的所有孕妇在怀孕后25年内的心血管住院情况。暴露包括两次或两次以上分娩的复发性和非复发性先兆子痫(N=606820)，以及仅一次分娩的先兆子痫(N=501761)。心血管并发症的发生率、发生时间和风险使用根据年龄、既往疾病、社会经济剥夺和时期进行调整的加速失效时间模型来计算。结果复发性子痫前期患者的心血管住院率(281.4/1000)高于无复发性子痫前期患者(167.7/1000)和无先兆子痫患者(72.6‰)。平均心血管住院时间：复发组为10.5年，未复发组为11.6年，无先兆子痫组为12.7年，与无先兆子痫组相比，复发组为17.3%，无复发组为8.7%。与无先兆子痫相比，复发先兆子痫与心脏病风险(95%CI为1.69~2.29)和脑血管疾病风险(95%CI为2.25~4.05)的2倍相关。有一次分娩的先兆子痫患者的心血管住院风险是无先兆子痫患者的3倍(95%可信区间为2.96~3.25)。结论与无先兆子痫的患者相比，子痫前期复发患者的心血管住院风险更高，首次心血管事件发生的时间显著缩短。对反复发作的子痫前期妇女应及早进行心血管筛查。
Objective To determine the association between recurrent pre-eclampsia and long-term cardiovascular hospitalisation.Methods This study identified cardiovascular hospitalisations up to 25 years after pregnancy for all women who delivered between 1989 and 2013 in Quebec, Canada. Exposures included recurrent and non-recurrent pre-eclampsia in women with two deliveries or more (N=606 820), and pre-eclampsia in women with only one delivery (N=501 761). Incidence, timing and risk of cardiovascular complications were calculated using accelerated failure time models adjusted for age, pre-existing disease, socioeconomic deprivation and period. Outcomes included a range of cardiovascular hospitalisations and procedures.Results Women with recurrent pre-eclampsia had higher incidence of cardiovascular hospitalisation (281.4 per 1000) than women with non-recurrent (167.7 per 1000) or no pre-eclampsia (72.6 per 1000). Mean time to cardiovascular hospitalisation was 10.5 years for recurrent, 11.6 years for non-recurrent and 12.7 years for no pre-eclampsia, a difference of 17.3% for recurrent and 8.7% for non-recurrent relative to no pre-eclampsia. Compared with no pre-eclampsia, recurrent preeclampsia was associated with 2 times the risk of heart disease (95% CI 1.69 to 2.29) and 3 times the risk of cerebrovascular disease (95% CI 2.25 to 4.05). Pre-eclampsia in women with one delivery was associated with 3 times greater risk of cardiovascular hospitalisation compared with no pre-eclampsia in women with two deliveries or more (95% CI 2.96 to 3.25).Conclusions Recurrent pre-eclampsia is associated with higher risk of future cardiovascular hospitalisation compared with no pre-eclampsia, and significantly shorter time to first cardiovascular event. Cardiovascular screening should be performed earlier for women with recurrent pre-eclampsia.