Hypertension and cardiometabolic disorders appear 5-10 years earlier in women with pre-eclampsia

Aims Despite increased cardiovascular (CV) disease risks after pre-eclampsia, guidelines remain indefinite on the necessity, timing, and frequency of CV risk assessment in these women. We aimed to provide prevalence-based recommendations on systematic follow-up after pre-eclampsia by evaluating the age-related prevalence of CV risk factors in former pre-eclamptic women compared to women with a history of normotensive gestation Methods A retrospective cohort study was performed amongst parous women, up to 30 years postpartum. Prevalence of CV risk and results constituents was assessed based on standardized clinical measurements and medical history, including hypertension, diabetes mellitus, hypercholesterolaemia, obesity, insulin resistance, chronic kidney disease, and micro-albuminuria We included 1040 women after pre-eclampsia and 518 normotensive gestated controls. Higher development rates of either/combined hypertension, diabetes mellitus, or hypercholesterolaemia were observed after pre-eclampsia than normotensive gestation (aHR 2.6 (95% CI 2.1–3.2)). These factors occurred on average 8 years earlier after pre-eclampsia (39 ± 9 years) than normotensive gestation (47 ± 8 years). With ageing, hypertension prevalence increased more steeply after pre-eclampsia (P-value interaction = 0.044). Cumulative proportion of hypertension exceeded the 10% cut-off for CV risk assessment initiation from 35 years onwards in women after pre-eclampsia, with an increase above the 5% cut-off for re-assessment every five years Conclusion Cardiovascular risk factors occur almost a decade earlier in former pre-eclamptic women compared to women after normotensive gestation, predominantly, but not exclusively, due to the early and accelerated development of hypertension. Systematic CV risk (re-)assessment is recommended at least five yearly in former pre-eclamptic women from 35 years of age onwards. Lay summary Despite well-known increased cardiovascular (CV) risks after pre-eclampsia, current guidelines remain indefinite on the necessity, timing, and frequency of CV risk assessment in these women, resulting in a knowledge-to-practice gap regarding preeclampsia aftercare. Timely management of increased risks is essential in prevention of later-life cardiovascular disease amongst these high-risk young women. By providing empirical data, this study shows that due to early and increased development rates of CV risk factors after pre-eclampsia, systematic CV risk (re-)assessment should be initiated at least five yearly from 35 years of age onwards in these women.