Association Between Hypertensive Disorders of Pregnancy, Lifestyle Factors, and Premature Cardiovascular Events

Abstract

Background Hypertensive disorders of pregnancy (HDP) increase the risk of future cardiovascular events. Objectives The objective of the study was to examine the association between lifestyle factors and premature (<50 years) cardiovascular (pCV) events in women with and without HDP. Methods Data from young parous women in the Australian Longitudinal Study on Women’s Health 1973-1978 cohort were linked with medical records. Time-varying Cox proportional hazards models were used to assess whether lifestyle factors were associated with pCV in those with and without HDP. Outcomes of pCV included stroke, ischemic heart disease, valvular heart disease, cardiomyopathy, select arrhythmias, valvular heart disease, pulmonary embolism, and deep vein thrombosis. Results Among 10,368 parous women (median follow-up: 16.5 years), 14.4% (1,493/10,368) had HDP and 4.3% (448/10,310) experienced a pCV event. HDP (adjusted HR [aHR]: 1.74; 95% CI: 1.32-2.31), obesity (aHR: 1.60; 95% CI: 1.19-2.15), and high saturated-fat intake (>319 g/day) (aHR: 1.67; 95% CI: 1.11-2.53) were associated with an increased risk of pCV. Breastfeeding (>16 months) (aHR: 0.66; 95% CI: 0.49-0.89) and high protein intake (>90 g/day) (aHR: 0.65; 95% CI: 0.43-0.96) were associated with a lower risk of pCV. The association between smoking, the Australian Recommended Food Score diet, and glycemic index with pCV events differed in women with and without HDP. Conclusions This study found that a HDP diagnosis was associated with pCV. Obesity and high saturated-fat intake were associated with increased pCV, whereas breastfeeding and high protein intake were associated with lower pCV. The impact of some risk factors on the development of pCV differs between women with and without HDP. These findings highlight the importance of prevention management in women with HDP.