Background and aims: Severe preeclampsia increases lifetime-risk for cardiovascular disease (CVD). It remains unclear when this risk translates to subclinical atherosclerosis and whether this is related to cardiovascular health (CVH) after pregnancy. Our aims were (1) to determine CVH after severe preeclampsia, (2) to relate CVH to carotid intima-media thickness (CIMT), as a marker of subclinical atherosclerosis and (3) to relate CVH to chronological and vascular age. Methods: A prospective cohort study was performed in women with previous severe pre-eclampsia. CVH, proposed by the American Heart Association, was assessed one year after pregnancy. The CVH score (range 0–14) includes seven metrics (blood pressure, total-cholesterol, glucose, smoking, physical activity, diet and body mass index [BMI]), each weighted as poor (0), intermediate (1) or ideal (2). Vascular age was determined by CIMT. We related CVH to delta age (chronological age - vascular age). Results: In 244 women, the median CVH score was 10 (90% range 7.0, 13.0). Low CVH (<10) was associated with a larger CIMT than high CVH (≥12) (median 626.3 μm vs. 567.0 μm, respectively). Higher CVH was also associated with a lower vascular age (−2.0 years, 95%CI −3.3, −0.60). Women with low CVH had a larger delta age (22.5 years [90% range −3.9, 49.6) than women with high CVH (16.5 years [90% range −11.9, 43.3). Conclusions: CVH is inversely related to subclinical atherosclerosis and to vascular age one year after severe preeclampsia. Especially low CVH is associated with a large difference between chronological age and vascular age. CVH counseling might provide the opportunity for timely cardiovascular prevention.

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Keywords Cardiovascular health, Carotid intima-media thickness, Preeclampsia, Risk factors
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Series VSNU Open Access deal
Journal Atherosclerosis
Benschop, H.A.M, Schelling, S.J. (Sara JC.), Duvekot, J.J, & Roeters van Lennep, J.E. (2020). Cardiovascular health and vascular age after severe preeclampsia: A cohort study. Atherosclerosis, 292, 136–142. doi:10.1016/j.atherosclerosis.2019.11.023