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IF 14.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JAMA cardiology Pub Date : 2025-04-02 DOI:10.1001/jamacardio.2025.0328

Upasana Tayal, Constantinos Kallis, Georgie M Massen, Nora Rossberg, Emily L Graul, Jennifer K Quint

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引用次数: 0

摘要

重要性：妊娠期高血压疾病对扩张型心肌病的影响尚不清楚：目的：确定妊娠期高血压疾病是否与扩张型心肌病的长期风险有关：这项在英格兰进行的基于人群的队列研究使用了以下链接的电子健康记录数据库：临床实践研究数据链（CPRD）妊娠登记、CPRD Aurum（初级保健）、医院事件统计（Hospital Episode Statistics）住院患者护理以及国家统计局死亡率数据。参与者包括14 083名首次妊娠并患有妊娠高血压疾病的患者组成的暴露队列（观察指标日期：1997年1月至2018年12月；随访指标日期：1997年1月至2018年12月）：暴露组群：妊娠高血压疾病（子痫前期、妊娠高血压）：主要结果和测量方法：采用 Cox 比例危险模型估算发生扩张型心肌病的危险比（HRs）：队列中包括 14 083 名首次妊娠患有妊娠高血压疾病的孕妇和 70 415 名首次妊娠血压正常的孕妇。与血压正常的首次妊娠相比，患有妊娠期高血压疾病的首次妊娠患扩张型心肌病的风险高出 93%（调整后 HR，1.93 [95% CI，1.33-2.81]；P = .001；根据孕妇年龄调整）。HDP患者扩张型心肌病的中位数（IQR）为产后5.1（0.7-10.6）年，而血压正常的初孕妇产后10.6（4.2-15.8）年。在调整了产妇年龄、出生年份、妊娠糖尿病、妊娠后糖尿病、妊娠后高血压、总奇数、种族和社会经济地位后，两者之间的关系仍然显著（调整后 HR，1.55 [95% CI，1.04-2.31]；P = .03）。存在剂量反应；子痫前期（调整后 HR，1.85 [95% CI，1.24-2.76]；P = .002）和重度子痫前期（调整后 HR，4.29 [95% CI，2.32-7.96]；P 结论：子痫前期和重度子痫前期患者发生 DCM 的风险较高：妊娠期高血压疾病患者发生扩张型心肌病的风险更高。高龄产妇和产后高血压与妊娠期高血压疾病后发生扩张型心肌病的风险较高有关。这些发现支持对有妊娠高血压疾病史的患者保持长期临床警惕。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Hypertensive Disorders of Pregnancy and Long-Term Risk of Dilated Cardiomyopathy.

Importance: The impact of hypertensive disorders of pregnancy on developing dilated cardiomyopathy is unknown.

Objective: To determine whether hypertensive disorders of pregnancy are associated with long-term risk of dilated cardiomyopathy.

Design, setting, and participants: This population-based cohort study performed in England used the following linked electronic health records databases: Clinical Practice Research Datalink (CPRD) Pregnancy Register, CPRD Aurum (primary care), Hospital Episode Statistics Admitted Patient Care, and Office for National Statistics mortality data. Participants included an exposed cohort of 14 083 patients in their first pregnancy with hypertensive disorders of pregnancy (index date observed: January 1997 to December 2018; followed up until July 2023) and unexposed cohort of 70 415 with normotensive pregnancies randomly sampled from the Pregnancy Register (5:1 ratio).

Exposure: Hypertensive disorder of pregnancy (preeclampsia, gestational hypertension).

Main outcomes and measures: Cox proportional hazards models were fitted to estimate hazard ratios (HRs) of developing dilated cardiomyopathy.

Results: The cohort included 14 083 individuals with a hypertensive disease of pregnancy during their first pregnancy and 70 415 individuals with normotensive first pregnancies. A first-time pregnancy complicated by a hypertensive disorder of pregnancy, compared with a normotensive first-time pregnancy, was associated with a 93% higher risk of developing dilated cardiomyopathy (adjusted HR, 1.93 [95% CI, 1.33-2.81]; P = .001; adjusted for maternal age). Dilated cardiomyopathy developed a median (IQR) of 5.1 (0.7-10.6) years post partum in those with HDP and 10.6 (4.2-15.8) years post partum in those with normotensive first pregnancies. The association remained significant after adjusting for maternal age, birth year, gestational diabetes, postpregnancy diabetes, postpregnancy hypertension, total parity, ethnicity, and socioeconomic status (adjusted HR, 1.55 [95% CI, 1.04-2.31]; P = .03). There was a dose response; there was a higher risk of DCM in those with preeclampsia (adjusted HR, 1.85 [95% CI, 1.24-2.76]; P = .002) and severe preeclampsia (adjusted HR, 4.29 [95% CI, 2.32-7.96]; P < .001). Maternal age (adjusted HR per year of age, 1.06 [95% CI, 1.03-1.08]; P < .001) and postpartum incident hypertension (adjusted HR, 1.68 [95% CI, 1.16-2.42]; P = .006) were independently associated with the development of DCM.

Conclusions: Patients with hypertensive disorders of pregnancy had a greater risk of developing dilated cardiomyopathy. Older maternal age and postpartum hypertension were associated with higher risk of dilated cardiomyopathy after a hypertensive disorder of pregnancy. These findings support long-term clinical vigilance of patients with a history of hypertensive disorders of pregnancy.

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来源期刊

JAMA cardiology Medicine-Cardiology and Cardiovascular Medicine

CiteScore

45.80

自引率

1.70%

发文量

264

期刊介绍： JAMA Cardiology, an international peer-reviewed journal, serves as the premier publication for clinical investigators, clinicians, and trainees in cardiovascular medicine worldwide. As a member of the JAMA Network, it aligns with a consortium of peer-reviewed general medical and specialty publications. Published online weekly, every Wednesday, and in 12 print/online issues annually, JAMA Cardiology attracts over 4.3 million annual article views and downloads. Research articles become freely accessible online 12 months post-publication without any author fees. Moreover, the online version is readily accessible to institutions in developing countries through the World Health Organization's HINARI program. Positioned at the intersection of clinical investigation, actionable clinical science, and clinical practice, JAMA Cardiology prioritizes traditional and evolving cardiovascular medicine, alongside evidence-based health policy. It places particular emphasis on health equity, especially when grounded in original science, as a top editorial priority.