Page 108 - Pro-active Management of Women’s Health after Cardiometabolic Complicated Pregnancies

106 | Part 3 Lifestyle intervention
effect on cardiovascular risk. This might have led to an over-estimation of the
possible effect.
Interpretation
We hypothesise that preeclampsia itself is a true risk factor, rather than a marker, for cardiovascular disease. Since transient endothelial dysfunction can last up to 2 years after preeclampsia202, it is likely that preeclampsia has a permanent effect on cardiovascular health. This may partly be reflected by permanent effects on cardiovascular risk factors. Indeed, Romundstad et al showed that the difference in cardiovascular risk factors of women after preeclampsia compared to women with a healthy pregnancy is 28-60% higher than the pre-pregnant difference207. However, preeclampsia may also directly increase cardiovascular risk through other yet unknown pathways.
Another explanation of the found independent additive effect of preeclampsia on cardiovascular risk might be a higher prevalence of thrombophilic factors in formerly preeclamptic women. Indeed, thrombophilic factors like Protein-C and -S deficiencies increase the risk of early-life cardiovascular disease208 209. However, whether these thrombophilic factors are more prevalent in formerly preeclamptic women is still unclear, but is modest at best4.
The studies we included to calculate the differences in cardiovascular risk factors between women with a history of preeclampsia and women with a healthy pregnancy (Table 3.2.3), were very heterogeneous. Preeclampsia has different phenotypes. For instance, preeclampsia can be early or late, severe or mild, with or without HELLP or IUGR. The observed odds-ratios we used were also based on very heterogeneous studies2. It is to be expected that each phenotype is differently associated with cardiovascular disease.