Including Hypertensive Disorders of Pregnancy in CVD Risk Score Does Not Improve CVD Risk Prediction

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Participants in the Nurses’ Health Study II completed biennial questionnaires about health-related behaviors, reproductive history, and ascertainment of incident disease.
Participants in the Nurses’ Health Study II completed biennial questionnaires about health-related behaviors, reproductive history, and ascertainment of incident disease.

Including information about hypertensive disorders of pregnancy (HDP) and parity in established cardiovascular disease (CVD) risk scores does not improve discrimination or reclassification in low-risk women, according to a study published in the Journal of the American College of Cardiology.

A team of investigators analyzed data from the Nurses' Health Study II (NHSII), a longitudinal cohort study, to assess whether the addition of history of HDP in an established CVD risk score would improve CVD prediction in women who might not be classified as high-risk using current CVD screening.

Of the 116,429 women enrolled in NHSII, 67,406 were determined to be eligible for the analysis and contributed 106,230 observations. Eligible candidates were aged ≥40 years, had no previous CVD events, and were followed up from 1989 to 2013 for confirmed myocardial infarction, fatal coronary heart disease, or stroke. Two risk prediction models were used: an established CVD risk prediction model (Model A) and the same model with the addition of HDP and parity (Model B).

Results suggested that HDP and parity — independent of established CVD risk factors — were linked to 10-year CVD risk in crude analysis. Compared with women with a history of normotensive pregnancies and 2 births, the investigators noted significant links between CVD rates and women who had a history of normotensive pregnancy and 1 birth (hazard ratio [HR] 1.42) and women with HDP history and 2 births (HR, 2.02).

The investigators noted that the increased risks linked to history of normotensive pregnancy and 1 birth and history of HDP and 2 births with Model B were reduced but persisted between ages 40 and 49 years. HDP and parity were not independently associated with CVD risk for women aged 50 to 59 years. Thus, the authors reported that discrimination or risk reclassification was not improved by the addition of HDP and parity to risk prediction models.

“In this first test of the clinical utility of HDP and parity in predicting a woman's future risk of CVD, the additional inclusion of HDP and parity in risk prediction models did not improve model discrimination or risk reclassification across categories of predicted CVD risk, despite the fact that these novel markers were associated with CVD independent of established risk factors and improved model fit at ages 40 to 49 years,”
the researchers concluded.

“Further research is needed to test the impact of hypertensive disorders of pregnancy in diverse populations over the entire lifespan.”

Reference

Stuart JJ, Tanz LJ, Cook NR, et al. Hypertensive disorders of pregnancy and 10-year cardiovascular risk prediction. J Am Coll Cardiol. 2018;72(11)1252-1263.

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