Women with a history of preeclampsia accumulate cardiovascular risk factors earlier

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Women who have experienced preeclampsia are developing cardiovascular (CV) risk factors earlier than those with normotensive pregnancies, according to findings presented at ESC Preventive Cardiology 2025, a scientific congress of the European Society of Cardiology (ESC).¹

Preeclampsia affects between 2% and 5% of pregnant women and is marked by hypertension and proteinuria in those with previously normal blood pressure.² In addition to short-term maternal and fetal risks, it is known to double the long-term risk of cardiovascular disease (CVD) and stroke.

“Despite the known long-term risks after preeclampsia, guidelines do not include specific recommendations on the necessity, timing, and frequency of systematic CV assessment, which is likely due to a lack of empirical data,” said Emma Janssen, PhD, study author, Maastricht University Medical Centre, Netherlands.

She added, “As part of the Queen of Hearts study, we aimed to investigate the long-term prevalence of CV risk factors in women who experienced preeclampsia compared with normotensive pregnancies with no increased blood pressure to help guide proactive assessment, which in turn, may lead to more timely implementation of preventive strategies.”

Study design

The study, conducted in the Netherlands, included 1,040 women with a history of preeclampsia and 518 women with normotensive pregnancies. Participants were assessed postpartum through medical history, physical examination, 30-minute blood pressure readings, blood and urine sampling, vascular function tests, electrocardiography, and echocardiography.

Results

Researchers found that hypertension, diabetes mellitus, and hypercholesterolemia were more common after preeclampsia than after normotensive pregnancies. These risk factors appeared, on average, eight years earlier in the preeclampsia group (at 39 years of age) compared to the normotensive group (at 47 years).

Additionally, the rate of hypertension increased more steeply with age in the preeclampsia group, with prevalence crossing the 10% threshold considered significant for CVD risk assessment from age 35 onward.

“In women who have experienced preeclampsia, CV risk factors occur almost a decade early, predominantly, but not exclusively, due to the premature and accelerated development of hypertension,” said Janssen. “Systematic CV risk assessment is warranted from 35 years of age and should be repeated regularly, at least every 5 years, to enable these women to receive appropriate preventive measures to reduce their high risk of CVD and potential sequelae.”

Conclusion

Chahinda Ghossein-Doha, MD, PhD, FESC, principal investigator of the Queen of Hearts study and researcher at Erasmus University Medical Centre, emphasized the importance of follow-up care.

“After their prexeclampsia is managed, these women often fall through the net, without being referred for specialised follow-up," said Ghossein-Doha. "We need to be monitoring these young women regularly to detect any increase in risk factors in a period of their life when such an accumulation may be unexpected."

"For women after preeclampsia, taking steps to lead a heart-healthy lifestyle is important, as is discussing formal CV risk assessments with a healthcare professional," she concluded.

References:

1. European Society of Cardiology. Pre-eclampsia is associated with earlier onset and higher incidence of cardiovascular risk factors. Eurkalert. April 4, 2025. Accessed April 8, 2025. https://www.eurekalert.org/news-releases/1079130?

2. Poon LC, Shennan A, Hyett JA, et al. The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: A pragmatic guide for first-trimester screening and prevention [published correction appears in Int J Gynaecol Obstet. 2019 Sep;146(3):390-391. doi: 10.1002/ijgo.12892.]. Int J Gynaecol Obstet. 2019;145 Suppl 1(Suppl 1):1-33. doi:10.1002/ijgo.12802