Optimising Women's Cardiovascular Health After Hypertensive Disorders of Pregnancy: A Translational Approach to Cardiovascular Disease Prevention

Abstract

Women who experience a hypertensive disorder of pregnancy (HDP) are among those at the highest risk of premature cardiovascular disease (CVD). In Canada, effective CVD prevention interventions tailored specifically for this high-risk population are urgently needed. The objective of this review is to summarise a broad range of mechanistic and clinical studies examining the association of HDPs with future CVD to inform postpartum clinical follow-up strategies focused on improving women's cardiovascular health. The current state of the science (animal model, observational, and intervention studies) largely support 2 main hypotheses explaining the epidemiologic link between HDPs and long-term risk of CVD. First, that the complicated pregnancy "unmasks" women who were predisposed to CVD before pregnancy (eg, women with subclinical atherosclerosis or prepregnancy CVD risk factors). And second, that HDP causes vascular dysfunction and/or worsens preexisting subclinical CVD risk factors. Despite this strong evidence, several knowledge gaps remain in the understanding of specific mechanisms linking these theories and the impacts of other important contributors (eg, intersectional factors). From a clinical perspective, given the consistent data demonstrating a high prevalence of CVD risk factors after HDP, routine care after pregnancy at minimum should include: 1) standardised assessment of pregnancy-associated CV risks, 2) early and regular screening of traditional CVD risk factors, 3) education and support for health behaviours as first-line therapy (including breastfeeding), 4) individualised pharmacotherapy (eg, statins, antihypertensives, or antiglycemic agents as clinically indicated), and 5) consideration of a woman's health goals, reproductive plans, and social context.