What is the association between a history of pre-eclampsia and the development of undiagnosed diastolic heart failure, hypertension, or atherosclerotic cardiovascular disease (ASCVD)?

From the Guidelines

I strongly recommend designing a retrospective cohort study to investigate the association between pre-eclampsia history and undiagnosed cardiovascular conditions, including diastolic heart failure, hypertension, and atherosclerotic cardiovascular disease, among VIRTUA Health patients, as supported by the most recent study 1. The study would involve identifying female patients aged 30-65 with documented pre-eclampsia history from electronic health records and matching them with controls without pre-eclampsia history based on age, race, and basic demographics.

• Data collection should include comprehensive cardiovascular assessments, such as:
  • Echocardiography to evaluate diastolic function
  • Ambulatory blood pressure monitoring to detect undiagnosed hypertension
  • Carotid ultrasound or coronary calcium scoring to assess atherosclerotic burden
• The primary outcome would be the prevalence of previously undiagnosed diastolic heart failure, hypertension, or atherosclerotic cardiovascular disease.
• Secondary analyses should examine time elapsed since pre-eclampsia and severity of pre-eclampsia as potential modifiers of cardiovascular risk, as suggested by 1 and 1. This project is clinically relevant because pre-eclampsia represents a female-specific cardiovascular risk factor that may be underrecognized in primary care settings, as highlighted in 1 and 1. The pathophysiological connection likely involves endothelial dysfunction, inflammatory processes, and metabolic changes during pre-eclampsia that may persist beyond pregnancy, creating lasting cardiovascular effects, as discussed in 1 and 1. The findings could inform development of targeted screening protocols for women with pre-eclampsia history in family medicine settings, potentially enabling earlier intervention for cardiovascular disease prevention, as recommended by 1.

From the Research

Study Design

To investigate the association between history of pre-eclampsia and undiagnosed diastolic heart failure or hypertension, or atherosclerotic cardiovascular disease, a retrospective cohort study can be conducted.

• The study population can include women with a history of pre-eclampsia and a control group of women without a history of pre-eclampsia.
• The study can utilize electronic health records to collect data on the history of pre-eclampsia, cardiovascular disease, and other relevant health information.

Inclusion and Exclusion Criteria

• Inclusion criteria: women with a history of pre-eclampsia, aged 18-50 years, with available electronic health records.
• Exclusion criteria: women with a history of cardiovascular disease prior to the diagnosis of pre-eclampsia, women with incomplete electronic health records.

Outcome Measures

• The primary outcome measure can be the incidence of undiagnosed diastolic heart failure or hypertension, or atherosclerotic cardiovascular disease in women with a history of pre-eclampsia compared to the control group.
• Secondary outcome measures can include the prevalence of cardiovascular risk factors, such as hypertension, diabetes, and hyperlipidemia, in women with a history of pre-eclampsia.

Data Analysis

• Descriptive statistics can be used to summarize the demographic and clinical characteristics of the study population.
• Logistic regression analysis can be used to examine the association between history of pre-eclampsia and the incidence of undiagnosed diastolic heart failure or hypertension, or atherosclerotic cardiovascular disease, adjusting for potential confounding variables [ 2, 3, 4 ].
• The study can also examine the relationship between the severity of pre-eclampsia and the risk of cardiovascular disease, as well as the impact of lifestyle modifications on cardiovascular risk reduction [ 5, 6 ].

Implications

• The study can provide valuable insights into the association between history of pre-eclampsia and undiagnosed diastolic heart failure or hypertension, or atherosclerotic cardiovascular disease, and inform the development of strategies for cardiovascular risk reduction in this population [ 2, 3, 4 ].
• The study can also highlight the importance of educating women with a history of pre-eclampsia about their increased risk of cardiovascular disease and the need for regular cardiovascular health checks [ 5 ].