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

  • Thais CoutinhoEmail author
  • Olabimpe Lamai
  • Kara Nerenberg
Pregnancy and Cardiovascular Disease (N Scott, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Pregnancy and Cardiovascular Disease

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.

Keywords

Preeclampsia Hypertensive disorders of pregnancy Cardiovascular disease Myocardial infarction Stroke Heart failure 

Notes

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.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Thais Coutinho
    • 1
    • 2
    • 3
    Email author
  • Olabimpe Lamai
    • 3
  • Kara Nerenberg
    • 4
  1. 1.Canadian Women’s Heart Health CentreUniversity of Ottawa Heart InstituteOttawaCanada
  2. 2.Division of Cardiac Prevention & RehabilitationUniversity of Ottawa Heart InstituteOttawaCanada
  3. 3.Division of CardiologyUniversity of Ottawa Heart InstituteOttawaCanada
  4. 4.Departments of Medicine, Obstetrics & Gynecology and Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryCanada

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