Objective: To elucidate whether preeclampsia (PE) and the gestational age at onset of the disease (early-onset vs late-onset PE) has an impact on the risk of long-term cardiovascular complications. Methods: MedLine and Scopus databases were searched until April 15, 2020 utilizing combinations of the relevant MeSH terms, key words, and word variants for "pre-eclampsia" "cardiovascular disease" and "outcome". Inclusion criteria were: (a) cohort or case-control design; (b) inclusion of women with a diagnosis of pre-eclampsia at the time of the first pregnancy; (c) enough data to compare each outcome in: (I) women with a diagnosis of pre-eclampsia versus women with normal pregnancies and/or (II) women with early-onset pre-eclampsia versus women with late-onset pre-eclampsia. The primary outcome was a composite score of cardiovascular morbidity including either maternal death, major cardiovascular and cerebrovascular events, hypertension need for anti-hypertensive therapy, type 2 diabetes mellitus dyslipidaemia, metabolic syndrome; secondary outcomes were the individual components of the primary outcome analysed separately. Data were combined using a random-effect generic inverse variance approach. Results: MOOSE guidelines and PRISMA statement were followed. Seventy-three studies were included. Women with a prior history of PE had a higher risk of cardiovascular morbidity during life (OR: 2.05, 95% CI 1.9-2.3), death (OR: 2.18, 95% CI 1.73-1.93), major cardiovascular events (OR: 1.80, 95% CI 1.6-2.0), hypertension (OR: 3.93, 95% CI 3.1-50), need for anti-hypertensive medication (OR: 4.44, 95% CI 2.4-8.2), dyslipidaemia (OR: 1.32, 95% CI 1.3-1.4), diabetes (OR: 2.14, 95% CI 1.5-3.0), abnormal renal function (OR: 3.37, 95% CI 2.3-5.0) and metabolic syndrome (OR: 4.30, 95% CI 2.6-7.1) compared to those with no history of PE. More importantly, the strength of this association persisted when considering women who had PE ≤1, 1 to 10 and >10 years before the occurrence of these outcomes. When stratifying the analysis according to time at onset of PE, women with previous early-onset PE were at higher risk of composite adverse cardiovascular outcome (OR: 1.75, 95% CI 1.0-2.9), cardiovascular events (OR: 5.63, 95% CI 1.5-21.4) hypertension (OR: 1.48, 95% CI 1.3-1.7), dyslipidaemia (OR: 1.51, 95% CI 1.3-1.8), abnormal renal function (OR: 1.51. 95% CI 1.1-2.2) and metabolic syndrome (OR: 1.66, 95% CI 1.1-2.5) compared to women with late PE. Conclusions: Preeclampsia as well as early-onset and late-onset PE all represent risk factors for adverse cardiovascular events later in life. Early-onset PE is associated with a higher burden of cardiovascular mortality and morbidity compared to late-onset PE. This article is protected by copyright.

Cardiovascular events following pregnancies complicated by preeclampsia with emphasis on the comparison between early and late onset forms: a systematic review and meta-analysis / Dall'Asta, A; D'Antonio, F; Saccone, G; Buca, D; Mastantuoni, E; Liberati, M; Flacco, M E; Frusca, T; Ghi, T. - In: ULTRASOUND IN OBSTETRICS & GYNECOLOGY. - ISSN 0960-7692. - 57:5(2021), pp. 698-709. [10.1002/uog.22107]

Cardiovascular events following pregnancies complicated by preeclampsia with emphasis on the comparison between early and late onset forms: a systematic review and meta-analysis

Saccone, G;Mastantuoni, E;
2021

Abstract

Objective: To elucidate whether preeclampsia (PE) and the gestational age at onset of the disease (early-onset vs late-onset PE) has an impact on the risk of long-term cardiovascular complications. Methods: MedLine and Scopus databases were searched until April 15, 2020 utilizing combinations of the relevant MeSH terms, key words, and word variants for "pre-eclampsia" "cardiovascular disease" and "outcome". Inclusion criteria were: (a) cohort or case-control design; (b) inclusion of women with a diagnosis of pre-eclampsia at the time of the first pregnancy; (c) enough data to compare each outcome in: (I) women with a diagnosis of pre-eclampsia versus women with normal pregnancies and/or (II) women with early-onset pre-eclampsia versus women with late-onset pre-eclampsia. The primary outcome was a composite score of cardiovascular morbidity including either maternal death, major cardiovascular and cerebrovascular events, hypertension need for anti-hypertensive therapy, type 2 diabetes mellitus dyslipidaemia, metabolic syndrome; secondary outcomes were the individual components of the primary outcome analysed separately. Data were combined using a random-effect generic inverse variance approach. Results: MOOSE guidelines and PRISMA statement were followed. Seventy-three studies were included. Women with a prior history of PE had a higher risk of cardiovascular morbidity during life (OR: 2.05, 95% CI 1.9-2.3), death (OR: 2.18, 95% CI 1.73-1.93), major cardiovascular events (OR: 1.80, 95% CI 1.6-2.0), hypertension (OR: 3.93, 95% CI 3.1-50), need for anti-hypertensive medication (OR: 4.44, 95% CI 2.4-8.2), dyslipidaemia (OR: 1.32, 95% CI 1.3-1.4), diabetes (OR: 2.14, 95% CI 1.5-3.0), abnormal renal function (OR: 3.37, 95% CI 2.3-5.0) and metabolic syndrome (OR: 4.30, 95% CI 2.6-7.1) compared to those with no history of PE. More importantly, the strength of this association persisted when considering women who had PE ≤1, 1 to 10 and >10 years before the occurrence of these outcomes. When stratifying the analysis according to time at onset of PE, women with previous early-onset PE were at higher risk of composite adverse cardiovascular outcome (OR: 1.75, 95% CI 1.0-2.9), cardiovascular events (OR: 5.63, 95% CI 1.5-21.4) hypertension (OR: 1.48, 95% CI 1.3-1.7), dyslipidaemia (OR: 1.51, 95% CI 1.3-1.8), abnormal renal function (OR: 1.51. 95% CI 1.1-2.2) and metabolic syndrome (OR: 1.66, 95% CI 1.1-2.5) compared to women with late PE. Conclusions: Preeclampsia as well as early-onset and late-onset PE all represent risk factors for adverse cardiovascular events later in life. Early-onset PE is associated with a higher burden of cardiovascular mortality and morbidity compared to late-onset PE. This article is protected by copyright.
2021
Cardiovascular events following pregnancies complicated by preeclampsia with emphasis on the comparison between early and late onset forms: a systematic review and meta-analysis / Dall'Asta, A; D'Antonio, F; Saccone, G; Buca, D; Mastantuoni, E; Liberati, M; Flacco, M E; Frusca, T; Ghi, T. - In: ULTRASOUND IN OBSTETRICS & GYNECOLOGY. - ISSN 0960-7692. - 57:5(2021), pp. 698-709. [10.1002/uog.22107]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11588/825095
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