妊娠高血压疾病发病时间与新发高血压和心血管疾病风险的关系。
The timing of onset of hypertensive disorders in pregnancy and the risk of incident hypertension and cardiovascular disease.
机构信息
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada.
出版信息
Int J Cardiol. 2018 Nov 1;270:273-275. doi: 10.1016/j.ijcard.2018.06.059. Epub 2018 Jun 18.
BACKGROUND
Previous studies suggest that women with hypertensive disorders of pregnancy (HDP) are at increased risk of subsequent cardiovascular disease (CVD). However, it is unclear whether this association differs by timing of onset of HDP.
METHODS
A population-based cohort of 146,748 women, aged 15-45 years, with a first recorded pregnancy were identified in the Clinical Practice Research Datalink. HDP were defined between 18 weeks gestation and 6 weeks postpartum and further sub-classified as early- (<34 weeks) and late-onset HDP (≥34 weeks). The primary outcome was incident CVD, and the secondary outcome was incident hypertension. We used marginal structural Cox models to account for time-varying exposure and confounding.
RESULTS
Compared with women with no HDP, those with early-onset HDP had a higher risk of developing incident CVD (HR 2.6, 95% CI 1.5, 4.3) and hypertension (HR 4.3, 95% CI 3.6, 5.0). Wide CIs precluded any conclusions regarding a difference in the risk of incident CVD and hypertension in women with early- vs late-onset HDP (HR 0.90, 95% CI 0.50, 1.62 and HR 1.06, 95% CI 0.87, 1.28, respectively).
CONCLUSION
HDP in at least one pregnancy was associated with an increased risk of subsequent CVD or hypertension, irrespective of time of diagnosis.
背景
先前的研究表明，患有妊娠高血压疾病（HDP）的女性发生后续心血管疾病（CVD）的风险增加。然而，HDP 发病时间不同，这种关联是否存在差异尚不清楚。
方法
在临床实践研究数据链中，确定了 146748 名年龄在 15-45 岁之间、首次记录妊娠的女性为人群基础队列。HDP 的定义是在妊娠 18 周后至产后 6 周内，并进一步细分为早发（<34 周）和晚发 HDP（≥34 周）。主要结局是 CVD 的发生，次要结局是高血压的发生。我们使用边缘结构 Cox 模型来解释随时间变化的暴露和混杂因素。
结果
与无 HDP 的女性相比，早发 HDP 女性发生 CVD （HR 2.6，95%CI 1.5，4.3）和高血压（HR 4.3，95%CI 3.6，5.0）的风险更高。宽置信区间排除了早发 HDP 女性与晚发 HDP 女性 CVD （HR 0.90，95%CI 0.50，1.62）和高血压（HR 1.06，95%CI 0.87，1.28）发生风险差异的任何结论。
结论
至少一次妊娠中 HDP 与随后 CVD 或高血压的风险增加有关，而与诊断时间无关。
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