Recurrent severe preeclampsia and the risk of late cardiovascular complications

Preeclampsia (PE) is not only an acute obstetric complication but also a significant factor in long-term cardiovascular risk. This article analyzes the pathogenetic mechanisms linking recurrent severe PE with the development of chronic arterial hypertension, coronary heart disease, stroke, and heart failure in the long-term. Particular attention is paid to the two-stage PE model, as well as the key role for immune-inflammatory responses, oxidative stress, and hemostatic disorders. Recurrent PE is shown to cause cumulative damage to the vascular bed, transforming acute inflammation into chronic cardiovascular pathology. Neutrophil extracellular traps collectively resulting in innate immune activation, hypercoagulability, and endothelial damage, play a central role in the pathogenesis. Current approaches to preventing recurrent PE such as acetylsalicylic acid, calcium supplements, and low-molecular-weight heparins are discussed.