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Title: Hypertension in pregnancy and risk of coronary heart disease and stroke: A prospective study in a large UK cohort
Authors: Canoy D; Cairns BJ; Balkwill A; Wright FL; Khalil A; Beral V; Green J; Reeves G; Million Women Study Collaborators (incl. Canfell K)
Year: 2016
Journal Title: International Journal of Cardiology
Volume: 222
Page number start: 1012
Page number end: 1018
Abstract: Background Many studies investigating long-term vascular disease risk associated with hypertensive pregnancies examined risks in relatively young women among whom vascular disease is uncommon. We examined the prospective relation between a history of hypertension during pregnancy and coronary heart disease (CHD) and stroke in middle-aged UK women. Methods In 1996–2001, 1.1 million parous women (mean age = 56 years) without vascular disease at baseline reported their history of hypertension during pregnancy and other factors. They were followed for incident CHD and stroke (hospitalisation or death). Adjusted relative risks (RRs) were calculated using Cox regression. Results Twenty-six percent (290,008/1.1 million) reported having had a hypertensive pregnancy; 27% (79,163/290,008) of women with hypertensive pregnancy, but only 10% (82,145/815,560) of those without hypertensive pregnancy, reported being treated for hypertension at baseline. Mean follow-up was 11.6 years (mean ages at diagnosis/N of events: CHD = 65 years/N = 68,161, ischaemic stroke = 67 years/N = 8365, haemorrhagic stroke = 64 years/N = 5702). Overall, the RRs (95% confidence interval [CI]) of incident disease in women with hypertensive pregnancy versus those without such history were: CHD = 1.29 (1.27–1.31), ischaemic stroke = 1.29 (1.23–1.35), and haemorrhagic stroke = 1.14 (1.07–1.21). However, among women with hypertensive pregnancy who were not taking hypertension treatment at baseline, their RRs (95% CI) were only modestly increased: CHD = 1.17 (1.14–1.19), ischaemic stroke = 1.18 (1.11–1.25), and haemorrhagic stroke = 1.09 (1.02–1.18). Conclusion Hypertension during pregnancy was associated with increased CHD and stroke incidence in middle age, largely because such women also had hypertension in their 50s and 60s, which has a substantially greater effect on vascular disease risk than hypertension during pregnancy without hypertension later in life.
Division: Cancer Research Division
Funding Body: This research was supported by Cancer Research UK [Grant C570/A16491], Medical Research Council (Grant MR/K02700X/1), and Oxford University BHF Centre of Research Excellence [British Heart Foundation grant RE/13/1/30181 to B.J.C.]. KC was supported by a NHMRC Fellowship (GNT1082989)
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