TY - JOUR
T1 - Association of Adverse Pregnancy Outcomes with Risk of Atherosclerotic Cardiovascular Disease in Postmenopausal Women
AU - Søndergaard, Marc Meller
AU - Hlatky, Mark A.
AU - Stefanick, Marcia L.
AU - Vittinghoff, Eric
AU - Nah, Gregory
AU - Allison, Matthew
AU - Gemmill, Alison
AU - Van Horn, Linda
AU - Park, Ki
AU - Salmoirago-Blotcher, Elena
AU - Sattari, Maryam
AU - Sealy-Jefferson, Shawnita
AU - Shadyab, Aladdin H.
AU - Valdiviezo, Carolina
AU - Manson, Jo Ann E.
AU - Parikh, Nisha I.
N1 - Funding Information:
Association; Associate Editor or global advisor of the Journal of the American College of Cardiology; independent outcome event adjudicator for the CANVAS, VEST PREDICTS, and VALOR CKD studies; is a member of the data and safety monitoring board for the TAILOR PCI trial; and is a consultant to the American Heart Association and the Medicines Company. Dr Vittinghoff has received salary support from the National Institutes of Health during the conduct of the study. Dr Salmoirago-Blotcher has received grants and personal fees from National Heart, Lung, and Blood Institute and personal fees from National Institute of Arthritis and Musculoskeletal and Skin Diseases outside the submitted work. No other disclosures were reported.
Funding Information:
program was funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, and US Department of Health and Human Services through contracts HHSN268201100046C, HHSN268201100001C, HHSN268201100002C, HHSN268201100003C, and HHSN268201100004C. This study was also supported, in part, by grant 1R01HL139844 from the National Heart, Lung, and Blood Institute. Mr Søndergaard was supported by a Danish American Research Exchange (DARE) award from the Lundbeck Foundation.
Publisher Copyright:
© 2020 American Medical Association. All rights reserved.
PY - 2020/12
Y1 - 2020/12
N2 - Importance: Atherosclerotic cardiovascular disease (ASCVD) may have unique risk factors in women. Most women have a history of pregnancy; common adverse pregnancy outcomes (APOs) appear to be associated with ASCVD, but prior studies have limitations. Objective: To assess whether APOs are associated with increased ASCVD risk independently of traditional risk factors. Design, Setting, and Participants: The APO history among participants in the Women's Health Initiative, a large multiethnic cohort of postmenopausal women, was assessed. The associations of 5 self-reported APOs (gestational diabetes, hypertensive disorders of pregnancy, low birth weight [ie, birth weight less than 2.49 kg], high birth weight [ie, birth weight greater than 4.08 kg], and preterm delivery by 3 weeks or more) with ASCVD were analyzed, adjusting for traditional ASCVD risk factors. Data were collected and analyzed in 2017. Exposures: APOs (gestational diabetes, hypertensive disorders of pregnancy, low birth weight, high birth weight, and preterm delivery). Main Outcomes and Measures: Adjudicated ASCVD. Results: A total of 48113 Women's Health Initiative participants responded to the survey; the median (interquartile range) age at time of enrollment was 60.0 (55.0-64.0) years. A total of 13482 participants (28.8%) reported 1 or more APOs. Atherosclerotic cardiovascular disease was more frequent in women who reported an APO compared with those without APOs (1028 of 13 482 [7.6%] vs 1758 of 30 522 [5.8%]). Each APO, analyzed separately, was significantly associated with ASCVD, and gestational diabetes, hypertensive disorders of pregnancy, low birth weight, and preterm delivery remained significant after adjustment for traditional ASCVD risk factors. When all APOs were analyzed together, hypertensive disorders of pregnancy (odds ratio, 1.27; 95% CI, 1.15-1.40) and low birth weight (odds ratio, 1.12; 95% CI, 1.00-1.26) remained independently associated with ASCVD. All findings were materially unchanged by additional adjustment for parity, body mass index, and socioeconomic factors. Conclusions and Relevance: In this large multiethnic cohort of women, hypertensive disorders of pregnancy and low birth weight were independently associated with ASCVD after adjustment for risk factors and other APOs.
AB - Importance: Atherosclerotic cardiovascular disease (ASCVD) may have unique risk factors in women. Most women have a history of pregnancy; common adverse pregnancy outcomes (APOs) appear to be associated with ASCVD, but prior studies have limitations. Objective: To assess whether APOs are associated with increased ASCVD risk independently of traditional risk factors. Design, Setting, and Participants: The APO history among participants in the Women's Health Initiative, a large multiethnic cohort of postmenopausal women, was assessed. The associations of 5 self-reported APOs (gestational diabetes, hypertensive disorders of pregnancy, low birth weight [ie, birth weight less than 2.49 kg], high birth weight [ie, birth weight greater than 4.08 kg], and preterm delivery by 3 weeks or more) with ASCVD were analyzed, adjusting for traditional ASCVD risk factors. Data were collected and analyzed in 2017. Exposures: APOs (gestational diabetes, hypertensive disorders of pregnancy, low birth weight, high birth weight, and preterm delivery). Main Outcomes and Measures: Adjudicated ASCVD. Results: A total of 48113 Women's Health Initiative participants responded to the survey; the median (interquartile range) age at time of enrollment was 60.0 (55.0-64.0) years. A total of 13482 participants (28.8%) reported 1 or more APOs. Atherosclerotic cardiovascular disease was more frequent in women who reported an APO compared with those without APOs (1028 of 13 482 [7.6%] vs 1758 of 30 522 [5.8%]). Each APO, analyzed separately, was significantly associated with ASCVD, and gestational diabetes, hypertensive disorders of pregnancy, low birth weight, and preterm delivery remained significant after adjustment for traditional ASCVD risk factors. When all APOs were analyzed together, hypertensive disorders of pregnancy (odds ratio, 1.27; 95% CI, 1.15-1.40) and low birth weight (odds ratio, 1.12; 95% CI, 1.00-1.26) remained independently associated with ASCVD. All findings were materially unchanged by additional adjustment for parity, body mass index, and socioeconomic factors. Conclusions and Relevance: In this large multiethnic cohort of women, hypertensive disorders of pregnancy and low birth weight were independently associated with ASCVD after adjustment for risk factors and other APOs.
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U2 - 10.1001/jamacardio.2020.4097
DO - 10.1001/jamacardio.2020.4097
M3 - Article
C2 - 32936228
AN - SCOPUS:85091894755
SN - 2380-6583
VL - 5
SP - 1390
EP - 1398
JO - JAMA cardiology
JF - JAMA cardiology
IS - 12
ER -