A new study published in the Journal of the American College of Cardiology has revealed a strong connection between hypertensive disorders of pregnancy (HDP) and early-onset heart disease in women.
Women with a history of HDP—conditions like gestational hypertension, chronic hypertension, and preeclampsia—are at higher risk of developing coronary artery disease (CAD) earlier in life.
They are also more likely to experience a type of heart attack, known as MINOCA (myocardial infarction with non-obstructive coronary arteries), where the arteries appear normal but the heart attack still occurs.
The Impact of Hypertensive Disorders of Pregnancy
HDP affects approximately 15% of women during their reproductive years and is marked by high blood pressure during pregnancy. While these conditions often resolve after childbirth, their effects can persist, increasing the long-term health risks for both mothers and their children.
The study found that compared to women with normal blood pressure during pregnancy, those with a history of HDP faced several significant risks:
- Early onset of coronary artery disease: On average, CAD developed seven years earlier in women with HDP.
- More severe coronary artery disease: Women with HDP were twice as likely to develop severe atherosclerosis, where arteries become narrowed by plaque buildup.
- Higher risk of MINOCA: Women with HDP were twice as likely to experience MINOCA, a form of heart attack without visible arterial blockages.
Dr. Vesna Garovic, a nephrologist at the Mayo Clinic and senior author of the study, highlighted the importance of early heart disease screening for women with a history of HDP. MINOCA, in particular, is more common in women than men, making tailored care and monitoring essential.
Why Does HDP Lead to Heart Disease?
The study identified two mechanisms that may link HDP to coronary artery disease:
- Microvascular dysfunction: This occurs when the small blood vessels that supply the heart with blood do not function properly, reducing blood flow.
- Endothelial dysfunction: This happens when the cells lining blood vessels fail to work as they should, causing vessels to narrow instead of dilate.
These issues contribute to the narrowing or blockage of small blood vessels and arteries, increasing the likelihood of CAD and non-obstructive heart disease. Researchers believe these dysfunctions may interact, creating an environment where heart disease becomes more likely.
Expanding Research on HDP and Women’s Health
Dr. Garovic’s research has shown that the effects of HDP extend beyond the heart, linking it to:
- Atherosclerosis and stroke
- Kidney disease
- Brain inflammation and damage
- Accelerated aging at the cellular level
- Increased risk of early-onset hypertension in children born to affected mothers
Her work aims to better understand the underlying causes of HDP and its long-term impacts. Identifying specific biomarkers, genetic factors, and mechanisms could lead to new treatments for conditions like preeclampsia, which have seen limited therapeutic advances over the years.
Implications for Care
The findings underscore the need for healthcare providers to screen women with a history of HDP for both traditional and non-traditional risk factors of heart disease, including stress, autoimmune conditions, and microvascular dysfunction.
By addressing these risks early, clinicians can help prevent heart disease and improve outcomes for women.
This research also emphasizes the importance of educating women about the potential long-term health effects of pregnancy complications. By raising awareness and providing targeted care, it may be possible to reduce the risk of heart disease and improve quality of life for women with a history of HDP.
Further studies are needed to deepen understanding of the link between HDP and heart disease, but this research is a critical step toward improving care and treatment for millions of women worldwide.
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The research findings can be found in the Journal of the American College of Cardiology.
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