Preeclampsia brings the risk of premature cardiovascular disease in women closer to that of men

Background — It is not known if sex differences in the risk of premature cardiovascular disease (CVD) vary by whether a woman had preeclampsia or not. The current study determined whether prior preeclampsia brings a woman’s risk of CVD closer to that of a male counterpart.

Methods — Population-based cohort study in Ontario, Canada, 1993-2017. Participants were 55,186 women with prior preeclampsia, 110,372 randomly selected age- and region-matched men, as well as 110,372 similarly selected women who gave birth without prior preeclampsia. The primary outcome was a CVD composite outcome of any hospitalization or revascularization for coronary artery disease, cerebrovascular disease, peripheral artery disease, heart failure or dysrhythmia.

Results — Median follow-up was about 16 years. Relative to women without prior preeclampsia (1193 events; 7.5 per 10,000 person-years), men had the highest risk of CVD (3706 events; 24.3 per 10,000 person-years) – adjusted hazard ratio (aHR) 2.52 (95% CI 2.35-2.69). Women with a history of preeclampsia were also at higher risk (1252 events; 16.0 per 10,000 person-years) – aHR 1.17 (95% CI 1.08-1.28). Women with preeclampsia requiring preterm delivery were even more likely to experience CVD (21.5 per 10,000 person-years) – aHR 1.44 (95% CI 1.18-1.76). The absolute risk of CVD in men (22.5 per 10,000 person-years) was similar to women with preeclampsia and preterm delivery, but men had the highest aHR (2.48, 95% CI 2.11-2.93).

Conclusions — While men remain at significantly higher risk of CVD, a history of preeclampsia, especially with preterm birth, elevates a woman’s risk closer to that of a man.