Prevalence of Subclinical Coronary Artery Disease Assessed by Coronary Computed Tomography Angiography in 45- to 55-Year-Old Women With a History of Preeclampsia
Authors: Gerbrand A. Zoet, Laura Benschop, Eric Boersma, Ricardo P.J. Budde, Bart C.J.M. Fauser, Yolanda van der Graaf, Christianne J.M. de Groot, Angela H.E.M. Maas, Jeanine E. Roeters van Lennep, Eric A.P. Steegers, Frank L. Visseren, Bas B. van Rijn, Birgitta K. Velthuis, Arie Franx, Yolande E. Appelman, Sara J. Baart, Laura Brouwers, Suzanne C. Cannegieter, Veerle Dam, M.C.J. Eijkemans, Michel D. Ferrari, Marlise N. Gunning, Annemieke Hoek, Erik Koffijberg, M.P.H. Koster, Mark Kruit, Giske R. Lagerwij, C.B. Lambalk, Joop S. Laven, Katie Linstra, Aad van der Lugt, Antoinette Maassen van den Brink, Cindy Meun, Saskia Middeldorp, Karel G.M. Moons, Jolien W. Roos-Hesselink, Luuk J.J. Scheres, Regine P.M. Steegers-Theunissen, Gisela M. Terwindt, Marieke J.H. Wermer
Journal: Circulation (2018)

◼ calcification of joints and arteries ◼ coronary artery disease ◼ preeclampsia ◼ pregnancy ◼ women P reeclampsia is associated with an increased risk of coronary artery disease (CAD), although evidence on premature CAD development after preeclampsia is limited. 1 A cross-sectional study among 491 postmenopausal women with a mean age of 67 years showed an increased prevalence of coronary artery calcification (CAC) in participants with self-reported high blood pressure during any previous pregnancy in comparison with women without such a history. 2 However, the association between hypertensive pregnancy, CAC, and coronary plaque formation has not been reconfirmed in prospective studies, and there are no data on the timeline by which atherosclerosis develops in women with previous preeclampsia.The aim of this study is to compare the prevalence of coronary artery atherosclerosis of asymptomatic women aged 45 to 55 years who have a history of preeclampsia with a population-based reference cohort.The rationale and design of the CREW-IMAGO study (Cardiovascular Risk Profile: Imaging and Gender-Specific Disorders) have been published previously (URL: http://www.trialregister.nl/trialreg/index.asp.Unique identifier: NTR5531). 3Asymptomatic women, aged 45 to 55 years, with a history of preeclampsia 10 to 20 years earlier were included in this multicenter, prospective cohort study.Medical records, including pregnancy characteristics and hospital admission, were available for all women.Outcomes were compared with women of similar age and ethnicity who participated in the MESA study (Multi-Ethnic Study of Atherosclerosis). 4 MESA is a prospective cohort study measuring CAC and traditional cardiovascular risk factors in 6814 multiethnic participants without a history of physician-diagnosed cardiovascular or neurovascular disease.For our analyses, MESA data were restricted to all participating women of white descent aged 45 to 55 years, resulting in a reference group of 387 women.Routine cardiovascular risk assessment included medical and pregnancy history, age, body mass index, waist circumference, blood pressure, and a venous blood sample assessing lipid profile, fasting plasma glucose, glycohemoglobin, and high-sensitivity C-reactive protein.CAC score (CACS) and contrast-enhanced coronary computed tomography angiography (CCTA) were performed in women with previous preeclampsia.In the MESA cohort only CACS was performed.CAC scores were converted to MESA percentiles adjusted for age, sex, and ethnicity.The primary outcome was the prevalence of CACS >0 Agatston units and any coronary atherosclerotic plaques on CCTA.Secondary outcomes included CACS ≥100 Agatston units, CACS ≥95th MESA percentile, and presence of a significant (≥50%) luminal stenosis on CCTA.