Does pregnancy complication history improve cardiovascular disease risk prediction?: Findings from the HUNT study in Norway

Amanda R Markovitz; Jennifer J Stuart; Julie Horn; Paige L Williams; Eric B Rimm; Stacey A Missmer; Lauren J Tanz; Eirin B Haug; Abigail Fraser; Simon Timpka; Bjørnar Klykken; Håvard Dalen; Pål R Romundstad; Janet W Rich-Edwards; Bjørn Olav Åsvold

doi:10.1093/eurheartj/ehy863

Does pregnancy complication history improve cardiovascular disease risk prediction? Findings from the HUNT study in Norway

Amanda R Markovitz, Jennifer J Stuart, Julie Horn, Paige L Williams, Eric B Rimm, Stacey A Missmer, Lauren J Tanz, Eirin B Haug, Abigail Fraser, Simon Timpka, Bjørnar Klykken, Håvard Dalen, Pål R Romundstad, Janet W Rich-Edwards, Bjørn Olav Åsvold

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Abstract

Aim: To evaluate whether history of pregnancy complications [pre-eclampsia, gestational hypertension, preterm delivery, or small for gestational age (SGA)] improves risk prediction for cardiovascular disease (CVD).

Methods and results: This population-based, prospective cohort study linked data from the HUNT Study, Medical Birth Registry of Norway, validated hospital records, and Norwegian Cause of Death Registry. Using an established CVD risk prediction model (NORRISK 2), we predicted 10-year risk of CVD (non-fatal myocardial infarction, fatal coronary heart disease, and non-fatal or fatal stroke) based on established risk factors (age, systolic blood pressure, total and HDL-cholesterol, smoking, anti-hypertensives, and family history of myocardial infarction). We evaluated whether adding pregnancy complication history improved model fit, calibration, discrimination, and reclassification. Among 18 231 women who were parous, ≥40 years of age, and CVD-free at start of follow-up, 39% had any pregnancy complication history and 5% experienced a CVD event during a median follow-up of 8.2 years. While pre-eclampsia and SGA were associated with CVD in unadjusted models (HR 1.96, 95% CI 1.44-2.65 for pre-eclampsia and HR 1.46, 95% CI 1.18-1.81 for SGA), only pre-eclampsia remained associated with CVD after adjusting for established risk factors (HR 1.60, 95% CI 1.16-2.17). Adding pregnancy complication history to the established prediction model led to small improvements in discrimination (C-index difference 0.004, 95% CI 0.002-0.006) and reclassification (net reclassification improvement 0.02, 95% CI 0.002-0.05).

Conclusion: Pre-eclampsia independently predicted CVD after controlling for established risk factors; however, adding pre-eclampsia, gestational hypertension, preterm delivery, and SGA made only small improvements to CVD prediction among this representative sample of parous Norwegian women.

Original language	English
Article number	ehy863
Number of pages	10
Journal	European Heart Journal
Early online date	27 Dec 2018
DOIs	https://doi.org/10.1093/eurheartj/ehy863
Publication status	E-pub ahead of print - 27 Dec 2018

Keywords

Prediction
Stroke
Coronary heart disease
Pregnancy
Women’s health

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Professor Abigail Fraser
- Abigail.Fraserbristol.acuk
- Bristol Medical School (PHS) - Professor of Epidemiology
- Bristol Poverty Institute
- Bristol Population Health Science Institute
- MRC Integrative Epidemiology Unit
- Centre for Academic Primary Care
Person: Academic , Member

Cite this

Markovitz, A. R., Stuart, J. J., Horn, J., Williams, P. L., Rimm, E. B., Missmer, S. A., Tanz, L. J., Haug, E. B., Fraser, A., Timpka, S., Klykken, B., Dalen, H., Romundstad, P. R., Rich-Edwards, J. W., & Åsvold, B. O. (2018). Does pregnancy complication history improve cardiovascular disease risk prediction? Findings from the HUNT study in Norway. European Heart Journal, Article ehy863. Advance online publication. https://doi.org/10.1093/eurheartj/ehy863

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title = "Does pregnancy complication history improve cardiovascular disease risk prediction?: Findings from the HUNT study in Norway",

abstract = "Aim: To evaluate whether history of pregnancy complications [pre-eclampsia, gestational hypertension, preterm delivery, or small for gestational age (SGA)] improves risk prediction for cardiovascular disease (CVD).Methods and results: This population-based, prospective cohort study linked data from the HUNT Study, Medical Birth Registry of Norway, validated hospital records, and Norwegian Cause of Death Registry. Using an established CVD risk prediction model (NORRISK 2), we predicted 10-year risk of CVD (non-fatal myocardial infarction, fatal coronary heart disease, and non-fatal or fatal stroke) based on established risk factors (age, systolic blood pressure, total and HDL-cholesterol, smoking, anti-hypertensives, and family history of myocardial infarction). We evaluated whether adding pregnancy complication history improved model fit, calibration, discrimination, and reclassification. Among 18 231 women who were parous, ≥40 years of age, and CVD-free at start of follow-up, 39% had any pregnancy complication history and 5% experienced a CVD event during a median follow-up of 8.2 years. While pre-eclampsia and SGA were associated with CVD in unadjusted models (HR 1.96, 95% CI 1.44-2.65 for pre-eclampsia and HR 1.46, 95% CI 1.18-1.81 for SGA), only pre-eclampsia remained associated with CVD after adjusting for established risk factors (HR 1.60, 95% CI 1.16-2.17). Adding pregnancy complication history to the established prediction model led to small improvements in discrimination (C-index difference 0.004, 95% CI 0.002-0.006) and reclassification (net reclassification improvement 0.02, 95% CI 0.002-0.05).Conclusion: Pre-eclampsia independently predicted CVD after controlling for established risk factors; however, adding pre-eclampsia, gestational hypertension, preterm delivery, and SGA made only small improvements to CVD prediction among this representative sample of parous Norwegian women.",

keywords = "Prediction, Stroke, Coronary heart disease, Pregnancy, Women{\textquoteright}s health",

author = "Markovitz, {Amanda R} and Stuart, {Jennifer J} and Julie Horn and Williams, {Paige L} and Rimm, {Eric B} and Missmer, {Stacey A} and Tanz, {Lauren J} and Haug, {Eirin B} and Abigail Fraser and Simon Timpka and Bj{\o}rnar Klykken and H{\aa}vard Dalen and Romundstad, {P{\aa}l R} and Rich-Edwards, {Janet W} and {\AA}svold, {Bj{\o}rn Olav}",

year = "2018",

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doi = "10.1093/eurheartj/ehy863",

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Markovitz, AR, Stuart, JJ, Horn, J, Williams, PL, Rimm, EB, Missmer, SA, Tanz, LJ, Haug, EB, Fraser, A, Timpka, S, Klykken, B, Dalen, H, Romundstad, PR, Rich-Edwards, JW & Åsvold, BO 2018, 'Does pregnancy complication history improve cardiovascular disease risk prediction? Findings from the HUNT study in Norway', European Heart Journal. https://doi.org/10.1093/eurheartj/ehy863

TY - JOUR

T1 - Does pregnancy complication history improve cardiovascular disease risk prediction?

T2 - Findings from the HUNT study in Norway

AU - Markovitz, Amanda R

AU - Stuart, Jennifer J

AU - Horn, Julie

AU - Williams, Paige L

AU - Rimm, Eric B

AU - Missmer, Stacey A

AU - Tanz, Lauren J

AU - Haug, Eirin B

AU - Fraser, Abigail

AU - Timpka, Simon

AU - Klykken, Bjørnar

AU - Dalen, Håvard

AU - Romundstad, Pål R

AU - Rich-Edwards, Janet W

AU - Åsvold, Bjørn Olav

PY - 2018/12/27

Y1 - 2018/12/27

N2 - Aim: To evaluate whether history of pregnancy complications [pre-eclampsia, gestational hypertension, preterm delivery, or small for gestational age (SGA)] improves risk prediction for cardiovascular disease (CVD).Methods and results: This population-based, prospective cohort study linked data from the HUNT Study, Medical Birth Registry of Norway, validated hospital records, and Norwegian Cause of Death Registry. Using an established CVD risk prediction model (NORRISK 2), we predicted 10-year risk of CVD (non-fatal myocardial infarction, fatal coronary heart disease, and non-fatal or fatal stroke) based on established risk factors (age, systolic blood pressure, total and HDL-cholesterol, smoking, anti-hypertensives, and family history of myocardial infarction). We evaluated whether adding pregnancy complication history improved model fit, calibration, discrimination, and reclassification. Among 18 231 women who were parous, ≥40 years of age, and CVD-free at start of follow-up, 39% had any pregnancy complication history and 5% experienced a CVD event during a median follow-up of 8.2 years. While pre-eclampsia and SGA were associated with CVD in unadjusted models (HR 1.96, 95% CI 1.44-2.65 for pre-eclampsia and HR 1.46, 95% CI 1.18-1.81 for SGA), only pre-eclampsia remained associated with CVD after adjusting for established risk factors (HR 1.60, 95% CI 1.16-2.17). Adding pregnancy complication history to the established prediction model led to small improvements in discrimination (C-index difference 0.004, 95% CI 0.002-0.006) and reclassification (net reclassification improvement 0.02, 95% CI 0.002-0.05).Conclusion: Pre-eclampsia independently predicted CVD after controlling for established risk factors; however, adding pre-eclampsia, gestational hypertension, preterm delivery, and SGA made only small improvements to CVD prediction among this representative sample of parous Norwegian women.

AB - Aim: To evaluate whether history of pregnancy complications [pre-eclampsia, gestational hypertension, preterm delivery, or small for gestational age (SGA)] improves risk prediction for cardiovascular disease (CVD).Methods and results: This population-based, prospective cohort study linked data from the HUNT Study, Medical Birth Registry of Norway, validated hospital records, and Norwegian Cause of Death Registry. Using an established CVD risk prediction model (NORRISK 2), we predicted 10-year risk of CVD (non-fatal myocardial infarction, fatal coronary heart disease, and non-fatal or fatal stroke) based on established risk factors (age, systolic blood pressure, total and HDL-cholesterol, smoking, anti-hypertensives, and family history of myocardial infarction). We evaluated whether adding pregnancy complication history improved model fit, calibration, discrimination, and reclassification. Among 18 231 women who were parous, ≥40 years of age, and CVD-free at start of follow-up, 39% had any pregnancy complication history and 5% experienced a CVD event during a median follow-up of 8.2 years. While pre-eclampsia and SGA were associated with CVD in unadjusted models (HR 1.96, 95% CI 1.44-2.65 for pre-eclampsia and HR 1.46, 95% CI 1.18-1.81 for SGA), only pre-eclampsia remained associated with CVD after adjusting for established risk factors (HR 1.60, 95% CI 1.16-2.17). Adding pregnancy complication history to the established prediction model led to small improvements in discrimination (C-index difference 0.004, 95% CI 0.002-0.006) and reclassification (net reclassification improvement 0.02, 95% CI 0.002-0.05).Conclusion: Pre-eclampsia independently predicted CVD after controlling for established risk factors; however, adding pre-eclampsia, gestational hypertension, preterm delivery, and SGA made only small improvements to CVD prediction among this representative sample of parous Norwegian women.

KW - Prediction

KW - Stroke

KW - Coronary heart disease

KW - Pregnancy

KW - Women’s health

U2 - 10.1093/eurheartj/ehy863

DO - 10.1093/eurheartj/ehy863

M3 - Article (Academic Journal)

C2 - 30596987

SN - 0195-668X

JO - European Heart Journal

JF - European Heart Journal

M1 - ehy863

ER -