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Hypertensive Disorders of Pregnancy and Cardiovascular Diseases: Current Knowledge and Future Directions

  • Pregnancy and Cardiovascular Disease (N Scott, Section Editor)
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Abstract

Purpose of the review

Cardiovascular diseases (CVDs) are the principal killers of women. In this review, we summarize data regarding CVD and mortality after hypertensive disorders of pregnancy (HDP), and highlight clinical, research and policy needs to mitigate this risk.

Recent findings

Robust data indicate that women with HDP have substantially higher risk of future CVD, with a 3.7-fold increase in the risk of chronic hypertension, a 4.2-fold increase in the risk of heart failure, an 81% increase in the risk of stroke, and double the risk of atrial arrhythmias, coronary heart disease, and mortality when compared to women with normotensive pregnancies. Potential explanations include (1) the effect of pregnancy as a “stress test” in women destined to develop CVD, (2) mediation by conventional risk factors, (3) long-term vascular damage sustained during the preeclamptic episode, and (4) preexisting abnormalities in arterial health predisposing women to HDP, and, subsequently, CVD.

Summary

Women with HDP have significantly increased risk of CVD and mortality. Risk scores including obstetric history are necessary to better estimate a woman’s cardiovascular risk. In addition, comprehensive policies promoting systematic risk assessment and modification after HDP are critically needed to improve health, wellness, and survival of affected women.

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Acknowledgements

Dr. Thais Coutinho is a Clinician Scientist supported by a Heart and Stroke Foundation of Ontario Clinician Scientist Phase I Award and holds the Chair of Women’s Heart Health at the University of Ottawa Heart Institute. Dr. Kara Nerenberg is a Clinician Scientist supported by a Heart and Stroke Foundation of Alberta New Investigator Award.

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Authors and Affiliations

  1. Canadian Women’s Heart Health Centre, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada

    Thais Coutinho MD

  2. Division of Cardiac Prevention & Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada

    Thais Coutinho MD

  3. Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada

    Thais Coutinho MD & Olabimpe Lamai MD

  4. Departments of Medicine, Obstetrics & Gynecology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    Kara Nerenberg MD, MSc

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  1. Thais Coutinho MD
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Correspondence to Thais Coutinho MD.

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This article is part of the Topical Collection on Pregnancy and Cardiovascular Disease

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Coutinho, T., Lamai, O. & Nerenberg, K. Hypertensive Disorders of Pregnancy and Cardiovascular Diseases: Current Knowledge and Future Directions. Curr Treat Options Cardio Med 20, 56 (2018). https://doi.org/10.1007/s11936-018-0653-8

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