Long-Term Cardiovascular Risk Screening in Women After Preeclampsia: A Prospective Cohort Study
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Keywords
Preeclampsia, cardiovascular disease, metabolic syndrome, postpartum screening, atherosclerotic cardiovascular disease risk, endothelial dysfunction, microalbuminuria
Abstract
Background: Preeclampsia, affecting 3-8% of pregnancies, has emerged as a significant predictor of future cardiovascular disease. Women with preeclampsia history demonstrate persistent endothelial dysfunction, metabolic abnormalities, and chronic inflammatory states extending beyond pregnancy. Despite recognition as a cardiovascular risk enhancer by major cardiology societies, systematic postpartum cardiovascular screening remains inadequately implemented, particularly in resource-limited settings.
Methods: A prospective observational cohort study enrolled 200 postpartum women (100 with previous preeclampsia, 100 age-matched controls with normotensive pregnancies) at a tertiary care center. Comprehensive cardiovascular assessment included blood pressure measurement, anthropometric evaluation, and biochemical profiling encompassing fasting glucose, complete lipid panel, high-sensitivity C-reactive protein (hsCRP), serum uric acid, and urine microalbumin-creatinine ratio. Metabolic syndrome was diagnosed using modified NCEP ATP III criteria, and 10-year atherosclerotic cardiovascular disease (ASCVD) risk was calculated using pooled cohort equations. Statistical analysis employed independent t-tests, chi-square tests, Pearson correlation, and multivariate logistic regression.
Results: Women with prior preeclampsia demonstrated significantly elevated systolic blood pressure (133.8±11.6 versus 118.2±9.8 mmHg, p<0.001), diastolic blood pressure (86.4±8.2 versus 74.6±7.1 mmHg, p<0.001), body mass index (27.8±3.6 versus 24.7±3.0 kg/m², p<0.001), and waist circumference (89.6±7.9 versus 80.1±6.4 cm, p<0.001). Biochemically, the preeclampsia group exhibited higher LDL-cholesterol (132.4±27.8 versus 107.6±21.4 mg/dL, p<0.001), triglycerides (168.2±42.6 versus 126.4±34.8 mg/dL, p<0.001), hsCRP (4.7±2.2 versus 2.0±1.2 mg/L, p<0.001), uric acid (5.9±1.1 versus 4.8±0.9 mg/dL, p<0.001), and microalbuminuria (38.6±17.4 versus 13.8±5.6 mg/g creatinine, p<0.001). Prevalence of chronic hypertension (44.0% versus 8.0%, p<0.001), metabolic syndrome (41.0% versus 17.0%, p<0.001), prediabetes (36.0% versus 14.0%, p<0.001), and intermediate-to-high ASCVD risk (28.0% versus 6.0%, p<0.001) was substantially elevated in the preeclampsia cohort.
Conclusion: Women with preeclampsia history demonstrate significantly increased cardiovascular and metabolic risk burden during early postpartum years. These findings underscore the critical importance of implementing structured postpartum cardiovascular screening protocols, lifestyle modification counseling, and preventive interventions to mitigate long-term cardiovascular morbidity in this high-risk population
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