Gladstone Rachel A, Pudwell Jessica, Nerenberg Kara A, Grover Steven A, Smith Graeme N
Department of Obstetrics and Gynaecology, Kingston Heath Sciences Centre, Queen's University, Kingston, ON.
Department of Medicine, University of Calgary, Calgary, AB; Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB.
J Obstet Gynaecol Can. 2019 Aug;41(8):1157-1167.e1. doi: 10.1016/j.jogc.2018.10.024. Epub 2019 Jan 14.
Hypertensive disorders of pregnancy (HDP) comprise an independent, sex-specific risk factor for cardiovascular disease (CVD) in women. This study examined the utility of CVD risk models proposed in the 2016 Canadian Cardiovascular Society (CCS) lipid guidelines to identify women requiring further screening or lipid treatment following HDP.
Using data collected from the postpartum Maternal Health Clinic (MHC) at Kingston General Hospital in Kingston, Ontario and the Preeclampsia New Emerging Team (PE-NET) cohort study, the study investigators used the models recommended by the CCS guidelines and the cardiometabolic model of life expectancy in each cohort to estimate CVD risk in women after HDP. (Canadian Task Force Classification II-2).
Using the 10-Year Modified Framingham Risk Score, all women were classified by the 2016 CCS Guidelines as low risk, requiring no follow-up. The 30-Year and Lifetime Risk Scores resulted in significant reclassification of women at risk in the PE-NET control and HDP groups (P < 0.001 and P < 0.0001, respectively); 49.2% of women with HDP were classified as high risk, requiring follow-up, compared with 14.3% of control subjects. Using the cardiometabolic model, median life expectancy was significantly lower and expected onset of CVD was earlier in the HDP group compared with the control group (P < 0.0001).
The 2016 CCS lipid guidelines' risk classification recommendations significantly underestimated lifelong CVD risk in the HDP group compared with the control group. Women with HDP also had a significant decrease in cardiometabolic life expectancy and an earlier predicted age at onset of CVD. Early primary prevention in this at-risk population may improve CVD outcomes and reduce the future burden on the health care system.
妊娠高血压疾病（HDP）是女性心血管疾病（CVD）的一个独立的、性别特异性风险因素。本研究探讨了2016年加拿大心血管学会（CCS）血脂指南中提出的心血管疾病风险模型在识别HDP后需要进一步筛查或血脂治疗的女性中的效用。
利用从安大略省金斯顿市金斯顿综合医院产后母婴健康诊所（MHC）收集的数据以及先兆子痫新兴团队（PE-NET）队列研究，研究人员使用CCS指南推荐的模型和每个队列中的心血管代谢预期寿命模型来估计HDP后女性的心血管疾病风险。（加拿大工作组分类II-2）。
使用10年改良弗明汉风险评分，根据2016年CCS指南，所有女性均被归类为低风险，无需随访。30年和终身风险评分导致PE-NET对照组和HDP组中有风险的女性出现显著重新分类（分别为P < 0.001和P < 0.0001）；49.2%的HDP女性被归类为高风险，需要随访，而对照组为14.3%。使用心血管代谢模型，与对照组相比，HDP组的中位预期寿命显著降低，心血管疾病的预期发病时间更早（P < 0.0001）。
与对照组相比，2016年CCS血脂指南的风险分类建议显著低估了HDP组终身心血管疾病风险。患有HDP的女性心血管代谢预期寿命也显著降低，心血管疾病预测发病年龄更早。对这一高危人群进行早期一级预防可能会改善心血管疾病结局，并减轻未来医疗保健系统的负担。
