Pre-eclampsia closely associated with premature onset of obstructive coronary artery stenosis: BMJ

When preterm labor or a stillbirth are involved, pre-eclampsia is more likely to lead to premature-onset obstructive coronary artery stenosis, says an article published in the British Medical Journal.

Premature coronary artery disease (CAD) and heart failure are more common in pre-eclamptic women than in non-pre-eclamptic women, especially in those with early onset pre-eclampsia aggravated by preterm delivery or a stillbirth. Numerous articles discuss the potential risk of CAD in the years after a pregnancy. Using non-invasive coronary CT angiography (CCTA), existing research has also established measurements of coronary artery calcification in women with and without a history of previous pregnancy problems. The current study conducted by Joel G. Ray and team assessed the risk of angiographically shown stenotic CAD, CAD severity, and multi-vessel disease with lower left ventricular ejection fraction (LVEF) in women who had previously had pre-eclampsia, including pre-eclampsia that required premature delivery or pre-eclampsia that resulted in a stillbirth.

In Ontario, Canada, which offers free healthcare and the gathering of angiographic data, a population-based cohort study was finished. Women who gave birth alive or still between the years of 2002 and 2020 and who had no known cardiac condition were included. Per mother, one birth was chosen at random. The major exposure contrasted pre-eclamptic women with those who did not have it. Obstructive coronary artery stenosis that had been angiographically confirmed was the main outcome, which was measured 42 days after the index birth. After adjusting for age, parity, income, rurality, diabetes, chronic hypertension, renal illness, drug use, and dyslipidemia, cause-specific hazard models that took competing hazards into account produced HRs.

The key findings of this study were:

1. The mean age was 31.1 years for the 42 252 women who had pre-eclampsia in the past and 30.6 years for the 1359 122 women who had pre-eclampsia never.

2. After 9 years of follow-up, there were 186 pre-eclamptic women who developed obstructive coronary artery stenosis (4.53 per 10,000 person-years), compared to 1237 women who did not (which resulted in an uncorrected HR of 4.41 and an adjusted HR of 2.07).

3. The adjusted HR for coronary stenosis was greatest in women who had pre-eclampsia and stillbirth or pre-eclampsia and preterm delivery compared to those who had neither.

In conclusion, women with and without pre-eclampsia may be able to gauge the course of CAD using non-invasive coronary imaging techniques like CCTA. Including non-invasive techniques may also offer a useful means to assess the regression of CAD lesions in pre-eclamptic women after intensive lifestyle and pharmaceutical therapy, such as lipid-lowering and antihypertensive drugs.

Reference:

Ray, J. G., Austin, P. C., Park, A. L., Cohen, E., Fang, J., & Chu, A. (2022). Severity of obstructive coronary artery stenosis after pre-eclampsia. In Heart (p. heartjnl-2022-321513). BMJ. https://doi.org/10.1136/heartjnl-2022-321513