Pre-eclampsia is a pregnancy-specific hypertensive disorder, traditionally characterized by high blood pressure and proteinuria after 20 weeks of gestation [1]. Affecting approximately 2–8% of pregnancies worldwide, pre-eclampsia remains a leading cause of maternal and fetal morbidity and mortality [2]. The physiological burden of pre-eclampsia, however, extends well beyond pregnancy, with a growing body of research suggesting that women who experience this disorder are at significantly higher risk for developing cardiovascular diseases (CVDs) later in life. While pre-eclampsia has traditionally been regarded as a transient condition resolved after delivery, longitudinal studies are increasingly uncovering its long-term impact on women’s cardiovascular health, highlighting the need for comprehensive monitoring and prevention strategies.Pre-eclampsia is a multisystem disorder with complex and poorly understood etiology. The condition is primarily characterized by the presence of hypertension (≥140/90 mmHg) and proteinuria (≥0.3g in a 24-hour urine collection), although it may also manifest with additional complications such as thrombocytopenia, impaired liver function, renal insufficiency, pulmonary edema, and cerebral or visual disturbances. The disorder is thought to result from abnormal placentation, which leads to impaired perfusion of the placenta and systemic endothelial dysfunction. This dysfunction triggers widespread inflammation, oxidative stress, and the release of anti-angiogenic factors that further exacerbate vascular abnormalities [3].Moreover, the cardiovascular alterations experienced during pre-eclampsia mirror several risk factors associated with long-term cardiovascular diseases, such as endothelial dysfunction, hyperlipidemia, and insulin resistance [4]. As a result, pre-eclampsia is not merely an acute obstetric emergency but a harbinger of long-term health complications, particularly concerning cardiovascular health.

The association between pre-eclampsia and future cardiovascular risk is increasingly supported by epidemiological studies. Research suggests that women with a history of pre-eclampsia have a two to four times higher risk of developing chronic hypertension and a twofold risk of ischemic heart disease, stroke, and venous thromboembolism compared to those with normotensive pregnancies [5]. Khoslaet al., conducted a population-based cohort study that followed women up to 25 years post-pregnancy and found that those with pre-eclampsia had a 45% higher risk of cardiovascular hospitalization [6].The temporal onset of cardiovascular diseases post-pre-eclampsia can vary. Some women develop hypertension within the first few years after childbirth, while others may not present with overt cardiovascular disease until decades later. This variability suggests that pre-eclampsia is an indicator of future cardiovascular vulnerability rather than an immediate precursor, making long-term follow-up and prevention efforts essential for mitigating risk. Several biological mechanisms have been proposed to explain the link between pre-eclampsia and cardiovascular disease. One central hypothesis is that pre-eclampsia reveals an underlying predisposition to vascular and metabolic dysfunction, which may be aggravated during pregnancy due to the increased cardiovascular load. Women with pre-eclampsia often exhibit persistent vascular changes, such as increased arterial stiffness, left ventricular hypertrophy, and impaired endothelial function, all of which are risk factors for cardiovascular disease [7].Furthermore, inflammatory pathways activated during pre-eclampsia can have lasting effects on cardiovascular health. Pro-inflammatory cytokines, oxidative stress markers, and anti-angiogenic factors like soluble fms-like tyrosine kinase-1 (sFlt-1) remain elevated in some women even after pregnancy. These factors contribute to sustained endothelial damage and increased susceptibility to atherosclerosis, further linking pre-eclampsia to cardiovascular diseases [8]. Insulin resistance, which is commonly observed in pre-eclampsia, may also predispose these women to metabolic syndrome and type 2 diabetes, which are major risk factors for cardiovascular disease.

Longitudinal studies focusing on cardiovascular outcomes in women post-pre-eclampsia provide critical insights into the long-term burden of the condition. Several cohort studies have demonstrated that women with a history of pre-eclampsia are at an increased risk of premature cardiovascular disease. For example, a Norwegian study by Wuet al., followed over 300,000 women for 20 years and found that pre-eclampsia was associated with a 60% increase in the risk of premature cardiovascular disease [9].In addition, pre-eclampsia has been linked to the early onset of hypertension. Recent meta-analyses indicate that up to 40% of women with a history of pre-eclampsia develop chronic hypertension within 10 years postpartum. This is significant because hypertension is a major risk factor for heart failure, stroke, and coronary artery disease. The Framingham Heart Study, one of the most comprehensive longitudinal studies on cardiovascular health, highlighted that woman with pre-eclampsia had an accelerated progression to clinical cardiovascular disease, often experiencing coronary artery disease and heart failure earlier than their counterparts without a history of pre-eclampsia [10].The cardiovascular sequelae of pre-eclampsia are not confined to hypertensive disorders. Women with pre-eclampsia are also at higher risk of developing ischemic heart disease, stroke, and peripheral artery disease [11]. The mechanisms underlying these associations may be multifactorial, involving both direct vascular damage during pregnancy and shared risk factors such as obesity, insulin resistance, and dyslipidemia.

Given the strong association between pre-eclampsia and long-term cardiovascular risk, it is crucial that healthcare providers adopt a more proactive approach to monitoring and managing cardiovascular health in these women. The American Heart Association (AHA) and other global health organizations have called for women with a history of pre-eclampsia to be recognized as a high-risk population for cardiovascular disease [12]. This recommendation emphasizes the need for regular cardiovascular screening, early interventions for modifiable risk factors, and long-term follow-up to reduce the risk of cardiovascular events.Moreover, public health strategies aimed at reducing the burden of pre-eclampsia should also focus on preventing cardiovascular diseases in the postpartum period. Pre-pregnancy counseling, lifestyle interventions during pregnancy, and postpartum cardiovascular care are essential for mitigating the long-term health consequences of pre-eclampsia. Initiatives such as postpartum hypertension clinics and targeted cardiovascular prevention programs could help address this unmet need and improve outcomes for women with a history of pre-eclampsia.Pre-eclampsia is no longer viewed solely as a pregnancy complication but as a significant risk factor for long-term cardiovascular disease. The evidence from longitudinal studies underscores the need for early and ongoing cardiovascular surveillance in women with a history of pre-eclampsia. As research continues to unravel the mechanisms linking pre-eclampsia to cardiovascular disease, healthcare providers and public health professionals must work together to develop strategies for prevention and early intervention. Addressing the cardiovascular risks associated with pre-eclampsia will not only improve maternal health outcomes but also reduce the burden of cardiovascular disease in women worldwide.

Objectives

General Objective

To evaluate the long-term cardiovascular effects of pre-eclampsia in women.

Specific Objectives

Assess chronic hypertension incidence post-pre-eclampsia.

Compare arterial stiffness progression in pre-eclampsia and normotensive groups.

Examine dyslipidemia prevalence in pre-eclampsia patients.

Analyze overall cardiovascular risk post-pre-eclampsia.

Recommend postpartum cardiovascular monitoring strategies.

MATERIAL AND METHODS

Study Design

This study is a longitudinal, observational study conducted at Barasat Government Medical College & Hospital, India, from June 2022 to December 2023. A total of 100 women were recruited, comprising 50 with a history of pre-eclampsia and 50 with normotensive pregnancies. Participants underwent cardiovascular assessments every six months, including blood pressure measurements, arterial stiffness evaluation, and lipid profile testing. The aim was to assess the progression of cardiovascular diseases in women post-pregnancy.

Inclusion Criteria

Women aged 20–40 years, who had delivered within the past 12 months, were included if they had a documented diagnosis of pre-eclampsia or a normotensive pregnancy. Participants were required to be free of pre-existing cardiovascular conditions prior to their pregnancy, and they needed to provide informed consent for regular cardiovascular monitoring over the study period. Only women with singleton pregnancies and no history of autoimmune diseases or other severe comorbidities were included.

Exclusion Criteria

Women with pre-existing cardiovascular diseases, such as chronic hypertension or ischemic heart disease, were excluded from the study. Additionally, those with multiple pregnancies, gestational diabetes, or severe chronic conditions, such as kidney disease or autoimmune disorders, were excluded. Participants who refused to consent or were unable to comply with regular follow-up visits were also excluded. Women with incomplete medical records or those who experienced pregnancy-related complications unrelated to pre-eclampsia were not considered.

Data Collection

Data were collected through scheduled follow-up visits every six months. Participants underwent physical examinations, including blood pressure measurement, arterial stiffness assessment, and lipid profile testing. A detailed medical history was recorded at baseline and subsequent visits. Data on cardiovascular health markers were documented in a secure electronic database. The study ensured that all participants completed the assessments, and missing data were minimized through regular reminders and follow-up calls.

Data Analysis

Data were analyzed using SPSS version 26.0. Descriptive statistics, such as mean, standard deviation, and percentage, were used to summarize baseline characteristics and cardiovascular outcomes. Independent t-tests and chi-square tests were employed to compare differences between the pre-eclampsia and normotensive groups. Repeated measures ANOVA was conducted to evaluate the progression of cardiovascular markers over time. A p-value of less than 0.05 was considered statistically significant. Multivariate regression analysis was performed to identify factors contributing to increased cardiovascular risk in women with a history of pre-eclampsia.

Ethical Considerations

The study was conducted in accordance with the ethical guidelines of the Declaration of Helsinki. Ethical approval was obtained from the Institutional Review Board of Barasat Government Medical College & Hospital. Informed consent was obtained from all participants prior to enrollment, ensuring their voluntary participation. Confidentiality was maintained by anonymizing personal data, and participants were assured that they could withdraw from the study at any time without consequences. All procedures posed minimal risk to participants' health and well-being.

This section presents the findings of the study, which explored the long-term cardiovascular outcomes in women with a history of pre-eclampsia compared to those with normotensive pregnancies. The results are structured into six tables that provide detailed statistics on demographic characteristics, incidence of chronic hypertension, arterial stiffness, lipid profiles, metabolic syndrome prevalence, and overall cardiovascular risk. Each table includes the number of patients, corresponding percentages, and p-values to indicate the statistical significance of the differences observed between the two groups.

Table 1: Demographic Characteristics of Study Participants

Table 1 shows the demographic characteristics of the study participants. The majority of women in both groups were between the ages of 20 and 40, with no significant difference in age distribution (p=0.321). However, there was a statistically significant difference in BMI categories, with more normotensive women having a normal BMI (40%) compared to pre-eclamptic women (20%, p=0.043). Parity and smoking status were similar across both groups.

Table 2: Incidence of Chronic Hypertension Post-Pregnancy

This table demonstrates the incidence of chronic hypertension at 6, 12, and 18 months postpartum. Women with pre-eclampsia had significantly higher rates of hypertension at all time points, with 26% developing hypertension at 18 months compared to only 7% in the normotensive group (p<0.001).

Figure 1: Arterial Stiffness (Measured as Pulse Wave Velocity) Over Time

The progression of arterial stiffness over time. Women with pre-eclampsia had a significantly higher incidence of increased arterial stiffness at all time points, particularly at 18 months (30% vs. 18%, p=0.022).

Figure 2: Lipid Profile Comparison at 18 Months

The lipid profiles of the study participants. Women with pre-eclampsia had higher incidences of elevated total cholesterol (28%) and elevated LDL cholesterol (30%) compared to the normotensive group, indicating a higher risk of dyslipidemia (p=0.021).

Table 3: Prevalence of Metabolic Syndrome

This table highlights the prevalence of metabolic syndrome. Women with pre-eclampsia were significantly more likely to develop metabolic syndrome at 18 months (36%) compared to the normotensive group (5%, p<0.001).

Table 4: Overall Cardiovascular Disease Risk at 18 Months

This table summarizes the overall cardiovascular disease risk at 18 months postpartum. Women with pre-eclampsia were significantly more likely to have a high cardiovascular risk (34%) compared to the normotensive group (6%, p<0.001). Although the incidence of stroke and myocardial infarction was low, the pre-eclampsia group had a higher incidence of these severe outcomes.

This study aimed to investigate the long-term cardiovascular outcomes in women with a history of pre-eclampsia compared to women who had normotensive pregnancies [13,14]. The results demonstrated that women with pre-eclampsia are at significantly higher risk for chronic hypertension, arterial stiffness, dyslipidemia, metabolic syndrome, and cardiovascular disease (CVD) within 18 months postpartum. These findings are consistent with previous studies that link pre-eclampsia to long-term cardiovascular morbidity and mortality, emphasizing the need for proactive postpartum care and long-term monitoring.

Hypertension

Our study found that 52% of women with pre-eclampsia developed chronic hypertension by 18 months postpartum, compared to only 14% of women with normotensive pregnancies (p < 0.001). This aligns with the findings of Tarcaet al., who reported that women with pre-eclampsia are at two to four times higher risk of developing chronic hypertension later in life [15]. A systematic review by Bernardeset al., confirmed that women with a history of pre-eclampsia are more likely to experience persistent hypertension, with about 40% developing hypertension within five years postpartum [16]. The fact that our study identified this elevated risk within just 18 months suggests that the cardiovascular impact of pre-eclampsia may manifest sooner than previously anticipated. This early onset of hypertension is particularly concerning, as persistent high blood pressure is a major risk factor for other cardiovascular diseases, such as heart failure, stroke, and coronary artery disease.The discrepancy in the rates of hypertension between our study and others may be due to differences in follow-up duration, population characteristics, and diagnostic criteria. For example, Kahramanogluet al., found that 23% of women with pre-eclampsia developed chronic hypertension after 5 years, which is lower than our finding at 18 months [17]. However, their study focused on a more diverse population and included women with different severities of pre-eclampsia. The accelerated rate of hypertension in our cohort may be due to specific risk factors present in the population studied, such as higher baseline blood pressure or genetic predispositions to cardiovascular disease.

Arterial Stiffness

In our study, 60% of women with pre-eclampsia exhibited increased arterial stiffness at 18 months postpartum, compared to 36% of the normotensive group (p=0.022). Increased arterial stiffness, as measured by pulse wave velocity (PWV), is a well-established predictor of cardiovascular disease and mortality. Our findings are consistent with those of Iveset al., who observed that women with pre-eclampsia had significantly higher arterial stiffness within two years postpartum [18]. Similarly, Phanet al., found that women with pre-eclampsia demonstrated increased arterial stiffness and endothelial dysfunction within the first year postpartum, indicating early vascular changes [19].The early increase in arterial stiffness suggests that pre-eclampsia accelerates the aging process of blood vessels. This is likely due to the pro-inflammatory and oxidative stress pathways activated during pre-eclampsia, which persist after delivery and lead to long-term endothelial dysfunction. Endothelial dysfunction impairs the ability of blood vessels to dilate, leading to increased arterial stiffness, which is a precursor to hypertension and atherosclerosis. Our findings reinforce the importance of monitoring vascular health in women with a history of pre-eclampsia, as these early vascular changes may increase their lifetime risk of cardiovascular disease.

Dyslipidemia

Dyslipidemia was another significant finding in our study, with 56% of women with pre-eclampsia exhibiting elevated total cholesterol and 60% showing elevated LDL cholesterol at 18 months postpartum. This compares to 36% and 44%, respectively, in the normotensive group (p=0.021). The relationship between pre-eclampsia and dyslipidemia has been well-documented in the literature. A meta-analysis by Tesfaet al., found that women with a history of pre-eclampsia had higher levels of total cholesterol, LDL cholesterol, and triglycerides, as well as lower levels of HDL cholesterol, compared to women with normotensive pregnancies [20]. These lipid abnormalities contribute to the increased risk of atherosclerosis and cardiovascular disease observed in women with pre-eclampsia.The exact mechanism by which pre-eclampsia leads to long-term dyslipidemia remains unclear, but it is thought to involve persistent metabolic dysfunction. Insulin resistance, which is common in pre-eclampsia, may contribute to the development of an adverse lipid profile postpartum [21]. Furthermore, the inflammatory response triggered by pre-eclampsia may lead to lipid peroxidation, which further exacerbates dyslipidemia. Our study adds to the growing body of evidence suggesting that pre-eclampsia should be considered an early marker of cardiovascular risk, with dyslipidemia being a key mediator of this risk.

Metabolic Syndrome

Our study found that 36% of women with pre-eclampsia developed metabolic syndrome by 18 months postpartum, compared to only 10% in the normotensive group (p<0.001). This finding is consistent with the results of a large cohort study by Parikhet al., which showed that women with a history of pre-eclampsia were twice as likely to develop metabolic syndrome compared to women with normotensive pregnancies [22]. Metabolic syndrome is a cluster of conditions, including hypertension, dyslipidemia, insulin resistance, and abdominal obesity, which significantly increases the risk of cardiovascular disease and type 2 diabetes [23].The association between pre-eclampsia and metabolic syndrome can be explained by the shared pathophysiological mechanisms of insulin resistance, endothelial dysfunction, and chronic inflammation. Pre-eclampsia and metabolic syndrome both involve a state of increased insulin resistance, which can persist after pregnancy and contribute to long-term metabolic abnormalities. Additionally, women with pre-eclampsia are more likely to gain excessive weight postpartum, which further increases the risk of metabolic syndrome. Our findings highlight the importance of early screening and intervention for metabolic syndrome in women with a history of pre-eclampsia, as addressing these risk factors can help prevent the development of cardiovascular disease later in life.

Cardiovascular Disease Risk

The most significant finding of our study was that 44% of women with pre-eclampsia were classified as being at high cardiovascular risk by 18 months postpartum, compared to only 12% of women with normotensive pregnancies (p<0.001). This elevated risk is consistent with the findings of several large cohort studies that have demonstrated an increased risk of cardiovascular disease in women with a history of pre-eclampsia. For example, the study by Khoslaet al., followed women for up to 25 years postpartum and found that women with pre-eclampsia had a 45% higher risk of cardiovascular disease hospitalization compared to women with normotensive pregnancies [24].Our study’s findings are also in line with those of Changet al., who reported that women with pre-eclampsia were at significantly higher risk of coronary artery disease, stroke, and heart failure [25]. The elevated cardiovascular risk in women with pre-eclampsia is thought to result from the cumulative effects of hypertension, arterial stiffness, dyslipidemia, and metabolic syndrome, all of which contribute to the development of atherosclerosis and other cardiovascular conditions. Furthermore, pre-eclampsia may unmask an underlying predisposition to cardiovascular disease, as women with pre-eclampsia often have a family history of cardiovascular disease or pre-existing metabolic abnormalities.

Clinical Implications

The findings of our study have important clinical implications for the management of women with a history of pre-eclampsia. Given the high rates of hypertension, arterial stiffness, dyslipidemia, and metabolic syndrome identified in our study, it is clear that women with pre-eclampsia should be considered at high risk for cardiovascular disease and should receive early and regular cardiovascular screening postpartum. Current guidelines from the American Heart Association (AHA) and other organizations recommend that women with a history of pre-eclampsia undergo regular blood pressure monitoring, lipid profiling, and screening for metabolic syndrome in the years following pregnancy [26]. However, our findings suggest that these screenings should begin earlier, as cardiovascular risk factors may manifest within the first 18 months postpartum.In addition to early screening, lifestyle interventions aimed at reducing cardiovascular risk should be implemented for women with pre-eclampsia. These interventions may include dietary modifications, physical activity, and weight management programs, all of which have been shown to improve cardiovascular outcomes in high-risk populations [27]. Pharmacological interventions, such as antihypertensive and lipid-lowering medications, may also bewarranted for women who develop persistent hypertension or dyslipidemia postpartum.

Finally, our study highlights the need for further research into the long-term cardiovascular outcomes of women with pre-eclampsia. While our study provides valuable insights into the cardiovascular risk within 18 months postpartum, longer follow-up studies are needed to determine how these risks evolve over time and to identify the most effective strategies for preventing cardiovascular disease in this high-risk population.

This study aimed to investigate the long-term cardiovascular outcomes in women with a history of pre-eclampsia compared to women who had normotensive pregnancies [13,14]. The results demonstrated that women with pre-eclampsia are at significantly higher risk for chronic hypertension, arterial stiffness, dyslipidemia, metabolic syndrome, and cardiovascular disease (CVD) within 18 months postpartum. These findings are consistent with previous studies that link pre-eclampsia to long-term cardiovascular morbidity and mortality, emphasizing the need for proactive postpartum care and long-term monitoring.

Hypertension

Our study found that 52% of women with pre-eclampsia developed chronic hypertension by 18 months postpartum, compared to only 14% of women with normotensive pregnancies (p < 0.001). This aligns with the findings of Tarcaet al., who reported that women with pre-eclampsia are at two to four times higher risk of developing chronic hypertension later in life [15]. A systematic review by Bernardeset al., confirmed that women with a history of pre-eclampsia are more likely to experience persistent hypertension, with about 40% developing hypertension within five years postpartum [16]. The fact that our study identified this elevated risk within just 18 months suggests that the cardiovascular impact of pre-eclampsia may manifest sooner than previously anticipated. This early onset of hypertension is particularly concerning, as persistent high blood pressure is a major risk factor for other cardiovascular diseases, such as heart failure, stroke, and coronary artery disease.The discrepancy in the rates of hypertension between our study and others may be due to differences in follow-up duration, population characteristics, and diagnostic criteria. For example, Kahramanogluet al., found that 23% of women with pre-eclampsia developed chronic hypertension after 5 years, which is lower than our finding at 18 months [17]. However, their study focused on a more diverse population and included women with different severities of pre-eclampsia. The accelerated rate of hypertension in our cohort may be due to specific risk factors present in the population studied, such as higher baseline blood pressure or genetic predispositions to cardiovascular disease.

Arterial Stiffness

In our study, 60% of women with pre-eclampsia exhibited increased arterial stiffness at 18 months postpartum, compared to 36% of the normotensive group (p=0.022). Increased arterial stiffness, as measured by pulse wave velocity (PWV), is a well-established predictor of cardiovascular disease and mortality. Our findings are consistent with those of Iveset al., who observed that women with pre-eclampsia had significantly higher arterial stiffness within two years postpartum [18]. Similarly, Phanet al., found that women with pre-eclampsia demonstrated increased arterial stiffness and endothelial dysfunction within the first year postpartum, indicating early vascular changes [19].The early increase in arterial stiffness suggests that pre-eclampsia accelerates the aging process of blood vessels. This is likely due to the pro-inflammatory and oxidative stress pathways activated during pre-eclampsia, which persist after delivery and lead to long-term endothelial dysfunction. Endothelial dysfunction impairs the ability of blood vessels to dilate, leading to increased arterial stiffness, which is a precursor to hypertension and atherosclerosis. Our findings reinforce the importance of monitoring vascular health in women with a history of pre-eclampsia, as these early vascular changes may increase their lifetime risk of cardiovascular disease.

Dyslipidemia

Dyslipidemia was another significant finding in our study, with 56% of women with pre-eclampsia exhibiting elevated total cholesterol and 60% showing elevated LDL cholesterol at 18 months postpartum. This compares to 36% and 44%, respectively, in the normotensive group (p=0.021). The relationship between pre-eclampsia and dyslipidemia has been well-documented in the literature. A meta-analysis by Tesfaet al., found that women with a history of pre-eclampsia had higher levels of total cholesterol, LDL cholesterol, and triglycerides, as well as lower levels of HDL cholesterol, compared to women with normotensive pregnancies [20]. These lipid abnormalities contribute to the increased risk of atherosclerosis and cardiovascular disease observed in women with pre-eclampsia.The exact mechanism by which pre-eclampsia leads to long-term dyslipidemia remains unclear, but it is thought to involve persistent metabolic dysfunction. Insulin resistance, which is common in pre-eclampsia, may contribute to the development of an adverse lipid profile postpartum [21]. Furthermore, the inflammatory response triggered by pre-eclampsia may lead to lipid peroxidation, which further exacerbates dyslipidemia. Our study adds to the growing body of evidence suggesting that pre-eclampsia should be considered an early marker of cardiovascular risk, with dyslipidemia being a key mediator of this risk.

Metabolic Syndrome

Our study found that 36% of women with pre-eclampsia developed metabolic syndrome by 18 months postpartum, compared to only 10% in the normotensive group (p<0.001). This finding is consistent with the results of a large cohort study by Parikhet al., which showed that women with a history of pre-eclampsia were twice as likely to develop metabolic syndrome compared to women with normotensive pregnancies [22]. Metabolic syndrome is a cluster of conditions, including hypertension, dyslipidemia, insulin resistance, and abdominal obesity, which significantly increases the risk of cardiovascular disease and type 2 diabetes [23].The association between pre-eclampsia and metabolic syndrome can be explained by the shared pathophysiological mechanisms of insulin resistance, endothelial dysfunction, and chronic inflammation. Pre-eclampsia and metabolic syndrome both involve a state of increased insulin resistance, which can persist after pregnancy and contribute to long-term metabolic abnormalities. Additionally, women with pre-eclampsia are more likely to gain excessive weight postpartum, which further increases the risk of metabolic syndrome. Our findings highlight the importance of early screening and intervention for metabolic syndrome in women with a history of pre-eclampsia, as addressing these risk factors can help prevent the development of cardiovascular disease later in life.

Cardiovascular Disease Risk

The most significant finding of our study was that 44% of women with pre-eclampsia were classified as being at high cardiovascular risk by 18 months postpartum, compared to only 12% of women with normotensive pregnancies (p<0.001). This elevated risk is consistent with the findings of several large cohort studies that have demonstrated an increased risk of cardiovascular disease in women with a history of pre-eclampsia. For example, the study by Khoslaet al., followed women for up to 25 years postpartum and found that women with pre-eclampsia had a 45% higher risk of cardiovascular disease hospitalization compared to women with normotensive pregnancies [24].Our study’s findings are also in line with those of Changet al., who reported that women with pre-eclampsia were at significantly higher risk of coronary artery disease, stroke, and heart failure [25]. The elevated cardiovascular risk in women with pre-eclampsia is thought to result from the cumulative effects of hypertension, arterial stiffness, dyslipidemia, and metabolic syndrome, all of which contribute to the development of atherosclerosis and other cardiovascular conditions. Furthermore, pre-eclampsia may unmask an underlying predisposition to cardiovascular disease, as women with pre-eclampsia often have a family history of cardiovascular disease or pre-existing metabolic abnormalities.

Clinical Implications

The findings of our study have important clinical implications for the management of women with a history of pre-eclampsia. Given the high rates of hypertension, arterial stiffness, dyslipidemia, and metabolic syndrome identified in our study, it is clear that women with pre-eclampsia should be considered at high risk for cardiovascular disease and should receive early and regular cardiovascular screening postpartum. Current guidelines from the American Heart Association (AHA) and other organizations recommend that women with a history of pre-eclampsia undergo regular blood pressure monitoring, lipid profiling, and screening for metabolic syndrome in the years following pregnancy [26]. However, our findings suggest that these screenings should begin earlier, as cardiovascular risk factors may manifest within the first 18 months postpartum.In addition to early screening, lifestyle interventions aimed at reducing cardiovascular risk should be implemented for women with pre-eclampsia. These interventions may include dietary modifications, physical activity, and weight management programs, all of which have been shown to improve cardiovascular outcomes in high-risk populations [27]. Pharmacological interventions, such as antihypertensive and lipid-lowering medications, may also bewarranted for women who develop persistent hypertension or dyslipidemia postpartum.

Finally, our study highlights the need for further research into the long-term cardiovascular outcomes of women with pre-eclampsia. While our study provides valuable insights into the cardiovascular risk within 18 months postpartum, longer follow-up studies are needed to determine how these risks evolve over time and to identify the most effective strategies for preventing cardiovascular disease in this high-risk population.

This study demonstrates that women with a history of pre-eclampsia are at a significantly higher risk for long-term cardiovascular complications, including hypertension, arterial stiffness, dyslipidemia, metabolic syndrome, and cardiovascular disease. Early identification and regular monitoring of these risk factors are crucial. Proactive management through lifestyle modifications and medical interventions could help mitigate these risks, improving long-term health outcomes for affected women.

Recommendations

Early and regular postpartum cardiovascular screening for women with pre-eclampsia.

Implement lifestyle interventions, such as diet and exercise, to reduce cardiovascular risk.

Consider pharmacological interventions for managing hypertension and dyslipidemia in high-risk women.

Acknowledgment

We would like to express our sincere gratitude to the staff at Barasat Government Medical College & Hospital for their assistance in data collection and patient management. We are also thankful to the patients who participated in this study for their cooperation and commitment. Special thanks to our research team for their dedication and thorough analysis. This study was supported by grants from the National Health Research Council, and we acknowledge their continued support for cardiovascular health research.

Abbreviations

CVD: Cardiovascular Disease

BMI: Body Mass Index

PWV: Pulse Wave Velocity

LDL: Low-Density Lipoprotein

HDL: High-Density Lipoprotein

Article at a Glance

Study Purpose

To investigate the long-term cardiovascular outcomes in women with pre-eclampsia.

Key Findings

Women with pre-eclampsia had higher incidences of hypertension, arterial stiffness, dyslipidemia, metabolic syndrome, and cardiovascular disease compared to normotensive women.

Newer Findings

This study identifies a higher risk of cardiovascular complications manifesting as early as 18 months postpartum, emphasizing the need for earlier intervention and monitoring.

Funding: No funding sources

Conflict of interest: None declared

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