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Pre-eclampsia raises heart disease risk

Pre-eclampsia should be incorporated into cardiovascular risk scores say authors of research suggesting it doubles a woman's risk of developing heart disease.

A UK study published in the BMJ has found the strongest evidence to date that pre-eclampsia not only increases a woman's chance of developing hypertension later but independently raises the risk of CHD.

Researchers reviewed 25 studies including nearly three and a half million women, two hundred thousand of whom had had pre-eclampsia.

Women with a history of pre-eclampsia were almost four times more likely to develop hypertension and twice as likely to develop heart disease.

Early onset pre-eclampsia – under 37 weeks gestation - was associated with an even greater risk of future CVD.

A second study, based on a Norwegian population of 3500 pregnant women, 133 of whom had pre-eclampsia, also found a convincing link between pre-eclampsia and sub-sequent cardiovascular disease.

Dr David Williams, consultant obstetric physician at University College London Hospital, and author of the UK review, said:

‘What is interesting is that three of the papers suggest that the risk [of developing cardiovascular disease] is independent of other risk factors. There is something about a history of pre-eclampsia which is additional to recognised risk factors.'

He added that he thought that there was a case for pre-eclampsia to be included in cardiovascular disease risk scores, for example QRISK

‘We should be asking middle aged women whether they have had pre-eclampsia,' he said.

Dr Kathryn Griffith, a GP in York, said that she thought that GPs would welcome further work to clarify the link and said: ‘If I see a patient with hypertension I would ask her whether she had had hypertension in pregnancy.

‘The risk of heart disease is definitely less well known [but] in order for it to be useful it would need to be included in a risk score.'

The UK study also found that women who had raised blood pressure in pregnancy – rather than a diagnosis of pre-eclampsia – had similar though slighty lower risks of future hypertension and CHD.

Pre-eclampsia affects 3.5% of first pregnancies in the developed world according to the World Health Organisation.

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