Cardiovascular morbidity and mortality after preeclampsia: A nationwide case-cohort study

OBJECTIVE: Preeclampsia originates in the placenta, resulting from shallow trophoblast invasion and narrow spiral arteries, causing placental malperfusion and hypoxia. The damaged placenta releases molecules into maternal circulation, leading to systemic vascular injury, endothelial dysfunction, hypertension, and multi-organ damage, effects that can persist after pregnancy. This study examined the long-term cardiovascular risks associated with preeclampsia. METHODS: The Medical Birth Register, Hospital Discharge Register, Care Register for Health Care, and the Causes of Death Register were linked during the study period of 1987-2022. The primary exposure was history of preeclampsia. Outcomes included hypertension, ischemic heart disease, stroke, pulmonary heart disease, heart failure, type 2 diabetes, thromboembolism and mortality related to these conditions. RESULTS: The study included 1 014 749 women with 2 050 970 deliveries, among which 47 961 involved preeclampsia. Follow-up was median 18.1 years for the preeclampsia group and 21.1 years for controls. Cardiovascular outcomes were statistically more frequent in women with preeclampsia: hypertension (15.4% vs. 7.0%), ischemic heart disease (2.9% vs. 1.7%), and stroke (2.3% vs. 1.3%). Women with preeclampsia had higher morbidity risk for all studied outcomes: hypertension (HR 2.90), ischemic heart disease (2.05), stroke (2.25), pulmonary heart disease (1.60), heart failure (2.52), type 2 diabetes (2.73) and thromboembolism (1.87). Women with a history of preeclampsia had a 2- to 3-fold risk of cardiovascular-related death. CONCLUSION: Preeclampsia significantly increases the long-term risk of cardiovascular disease and overall mortality. Continued risk assessment and management beyond postpartum are essential for women with a history of preeclampsia.