Update on long-term cardiovascular risk after pre-eclampsia: a systematic review and meta-analysis

Background/introduction: There is a need for further studies on the cardiovascular risk of women experiencing pre-eclampsia (PE). Purpose: To update the literature regarding the association between a history of PE and subsequent cardiovascular diseases, including cardiovascular death, coronary heart diseases, heart failure, and stroke, focusing on the trend in the effect size estimates over time. Methods: Following PRISMA guidelines, from inception to May 2023, we performed a systematic review of PubMed, MEDLINE, Scopus, and EMBASE. Randomised, cohort or case-control studies in English were included if fulfilling the following criteria: 1) the association between pre-eclampsia and subsequent cardiovascular disease was adjusted for clinically relevant variables, 2) the presence of a control group, and 3) at least one year of follow-up. Pooled adjusted effect sizes (ESs) and 95% confidence intervals (CIs) were used as effect estimates and calculated with a random-effect model. Results: Twenty-two studies met the inclusion criteria. PE was associated with a higher risk of cardiovascular death (ES 2.08, 95% CI 1.70-2.54, I2 56%, p < 0.00001), coronary artery diseases (ES 2.04, 95% CI 1.76-2.38, I2 87%, p < 0.00001), heart failure (ES 2.47, 95% CI 1.89-3.22, I2 83%, p < 0.00001), and stroke (ES 1.75, 95% CI 1.52-2.02, I2 72%, p < 0.00001) after adjusting for potential confounders. This risk is evident in the first one- to-three years of follow-up and remains significant until 39 years of follow-up. Conclusions: Compared to women who experienced a normal pregnancy, those suffering from PE have about double the risk of lifetime cardiovascular disease.