Division of Translational Health Sciences, RTI International, 307 Waverly Oaks Road, #1023, Waltham, MA, 02452, USA.
Health Care Financing and Payment, RTI International, 3040 E Cornwallis Road, Durham, NC, USA.
Matern Child Health J. 2023 Oct;27(10):1774-1786. doi: 10.1007/s10995-023-03725-1. Epub 2023 Jun 6.
Approximately one-third of women in the U.S. experience an adverse pregnancy outcome (APO), which are recognized as sex-specific cardiovascular disease (CVD) risk factors. We examine if APOs confer additional CVD risk beyond that of traditional CVD risk factors.
Women, age 40-79, with a pregnancy history and no pre-existing CVD were identified in the electronic health record of one health system (n = 2306). APOs included any APO, hypertensive disease of pregnancy (HDP), and gestational diabetes (GDM). Hazard ratios of time to CVD event were estimated from survival models using Cox proportional hazard regression. Discrimination, calibration, and net reclassification of re-estimated CVD risk prediction models including APOs were examined.
There was no significant association between any APO, HDP, or GDM and time to CVD outcome in survival models (95% confidence intervals all include 1). Including any APO, HDP, GDM in the CVD risk prediction model did not significantly improve discrimination and there were no clinically relevant changes in net reclassification of cases and non-cases. The strongest predictor of time to CVD event in the survival models was Black race, with hazard ratios ranging from 1.59 to 1.62, statistically significant for all three models.
Women with APOs did not have an additional risk of CVD, controlling for traditional risk factors in the PCE and this sex-specific factor did not improve risk prediction. Black race was consistently a strong predictor of CVD even with data limitations. Further study of APOs can help determine how to best use this information for CVD prevention in women.
美国约有三分之一的女性经历不良妊娠结局（APO），这些结局被认为是特定于性别的心血管疾病（CVD）风险因素。我们研究 APO 是否会在传统 CVD 风险因素之外增加 CVD 风险。
在一个健康系统的电子健康记录中，我们确定了年龄在 40-79 岁之间、有妊娠史且无预先存在的 CVD 的女性（n=2306）。APO 包括任何 APO、妊娠高血压疾病（HDP）和妊娠期糖尿病（GDM）。使用 Cox 比例风险回归从生存模型中估计 CVD 事件时间的风险比。检查了包括 APO 在内的 CVD 风险预测模型的再估计的区分度、校准和净重新分类。
在生存模型中，任何 APO、HDP 或 GDM 与 CVD 结果之间均无显著关联（95%置信区间均包含 1）。在 CVD 风险预测模型中包含任何 APO、HDP、GDM 并不会显著提高区分度，并且病例和非病例的净重新分类没有临床相关变化。在生存模型中，CVD 事件时间的最强预测因素是黑人种族，其风险比范围为 1.59 至 1.62，所有三个模型均具有统计学意义。
在控制 PCE 中的传统风险因素后，患有 APO 的女性没有增加 CVD 的风险，并且这种特定于性别的因素并不能改善风险预测。即使存在数据限制，黑人种族仍然是 CVD 的一个强有力的预测因素。对 APO 的进一步研究可以帮助确定如何最好地利用这些信息来预防女性的 CVD。
