Page 109 - Pro-active Management of Women’s Health after Cardiometabolic Complicated Pregnancies

3.2 Effect of Lifestyle Interventions after Preeclampsia| 107
Limitations and strengths
To calculate our results, we had to make several assumptions. The first assumption we made was that cardiovascular risk factors have the same effect on cardiovascular risk in women as they do in men, since the cardiovascular risk prediction models used were mainly based on male cohorts. However, it is suggested that cardiovascular disease in women might have a different pathogenesis than cardiovascular disease in men210. The second assumption we made was that the effects of lifestyle interventions after preeclampsia are the same as the effects of lifestyle interventions in general or after any pregnancy, because specific literature was lacking. The third assumption we made was that the effects of lifestyle interventions will last for the time-span of the cardiovascular risk prediction models (10-30 years) since the studies we could use lasted for at most 6 years.
Our study has several limitations. First, the above-mentioned assumptions we had to make weaken the results of our study. Second, we only included studies that were published in Pubmed registered journals and that were written in English. This could have resulted in an overestimation in our calculations of the contribution of cardiovascular risk factors and effects of lifestyle interventions, due to publication-bias. Third, we were limited to use only cardiovascular risk factors that were used in the prediction models. Other cardiovascular risk factors, like ethnicity, apolipoproteins and others, we could not use in our model. This could have led to an over-estimation of the independent effect of preeclampsia on cardiovascular risk. Forth, due to heterogeneity of the included studies in table 3.2.3 and table 3.2.4, we could not perform meta-analyses for each risk factor. We therefor used less accurate medians and interquartile ranges in our calculations.