PREECLAMPSIA AS A WINDOW INTO FUTURE CARDIOVASCULAR DISEASE: PATHOPHYSIOLOGICAL LINKS, LONG-TERM RISK, AND POSTPARTUM PREVENTION

Abstract

Preeclampsia is a hypertensive disorder of pregnancy that affects a substantial proportion of pregnancies and remains a leading cause of maternal and perinatal morbidity. Beyond its immediate obstetric consequences, a growing body of evidence indicates that women with a history of preeclampsia carry a higher long-term risk of chronic hypertension, ischemic heart disease, heart failure, stroke, and cardiovascular death. Shared risk factors, endothelial dysfunction, antiangiogenic imbalance, and vascular and myocardial changes that persist after delivery may explain this association, which allows pregnancy to be interpreted as an early cardiovascular stress test. At the same time, the history of preeclampsia is still inconsistently recorded in clinical practice, and postpartum follow-up is often fragmented between obstetric and primary care. This review aimed to analyze preeclampsia as a window into future cardiovascular disease, considering the pathophysiological links, the magnitude of long-term risk, and the opportunities for postpartum prevention. This is a narrative literature review, guided by a structured question based on the PICo strategy and directed at studies on the cardiovascular trajectory of women with a history of preeclampsia. The evidence shows a roughly twofold increase in the risk of coronary heart disease, a higher risk of heart failure and stroke, and an earlier onset of chronic hypertension, with a gradient according to the severity, timing, and recurrence of the disorder. Much of the excess risk appears to be mediated by conventional risk factors that emerge in the years following delivery, which favors early detection. Postpartum interventions targeting blood pressure have shown promising results, although evidence on hard cardiovascular outcomes is still lacking. It is concluded that preeclampsia should be incorporated into cardiovascular risk assessment, with structured postpartum follow-up and continuity of care throughout the female life course.