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Curr Hypertens Rep (2014) 16:472
DOI 10.1007/s11906-014-0472-6
PREECLAMPSIA (VD GAROVIC, SECTION EDITOR)
How Does Preeclampsia Predispose to Future Cardiovascular Disease?
Dawn C. Scantlebury & Sharonne N. Hayes
Published online: 6 August 2014# Springer Science+Business Media New York 2014
Abstract Over the last few decades, there has been increasing emphasis on cardiovascular disease in women and study of female-specific cardiovascular risk factors. Hypertension in pregnancy, and specifically preeclampsia, has been identified as one such risk factor. In this review, we explore the epidemiological evidence for preeclampsia as a risk factor for cardiovascular disease. We propose reasons for this association, giving evidence for potential pathways linking preeclampsia with future cardiovascular disease.
Keywords Hypertension in pregnancy . Preeclampsia . Coronary heart disease . Heart failure . Arrhythmias . Endothelial dysfunction . Renal failure . Microalbuminuria . Metabolic syndrome
Introduction
Cardiovascular disease is the leading cause of death in women worldwide [1]. In the United States, this is no different, with cardiovascular disease listed as the primary cause of 31.9 % of all deaths in 2010, and as a contributing factor in 54.5 %. Women accounted for over one-half of all cardiovascular deaths [2]. In the last three decades, it has become increasingly apparent that there are significant sex and gender differences
in the pathophysiology, clinical presentation, and response to treatment of cardiovascular disease. These differences highlight the need to study sex-specific cardiovascular risk factors, such as hormonal variations over the lifespan, and pregnancy-related disorders.
Hypertension occurring during pregnancy is one sex-specific disorder that has been identified as a major risk factor for cardiovascular disease in women. Hypertension is the most common medical condition encountered during pregnancy, affecting up to 10 % of pregnancies worldwide [3]. Hyper-tensive pregnancy disorders are classified into four separate conditions: preeclampsia-eclampsia, chronic hypertension, chronic hypertension with superimposed preeclampsia, and gestational hypertension. Gestational hypertension is defined as hypertension occurring after 20 weeks gestation without evidence of end-organ damage. Chronic hypertension is hypertension that predates pregnancy, or occurs prior to 20 weeks gestation and does not resolve postpartum. Preeclampsia is a multisystem disorder occurring after 20 weeks gestation, characterized by hypertension, endothelial dysfunction, and target organ damage. It may include renal dysfunction (e.g. protein-uria), hepatic dysfunction, hematologic manifestations (e.g. thrombocytopenia), and cerebral dysfunction which may...