Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis

• Published in: BMJ Vol. 335; no. 7627; pp. 974 - 977
• Main Authors: Bellamy, Leanne, Casas, Juan-Pablo, Hingorani, Aroon D, Williams, David J
• Format: Journal Article
• Language: English
• Published: London British Medical Journal Publishing Group 10.11.2007; British Medical Association; BMJ Publishing Group LTD; BMJ Publishing Group; BMJ Publishing Group Ltd
• Edition: International edition
• Subjects: Age Factors; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Breast cancer; Cancer; Cardiology. Vascular system; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - etiology; Cardiovascular Diseases - mortality; Cause of Death; Disease risk; Diseases of mother, fetus and pregnancy; Eclampsia; Female; Follow-Up Studies; General aspects; Gynecology. Andrology. Obstetrics; Humans; Hypertension; Medical sciences; Meta-analysis; Mortality; Myocardial ischemia; Neoplasms - etiology; Neoplasms - mortality; Pre-Eclampsia - mortality; Preeclampsia; Pregnancy; Pregnancy. Fetus. Placenta; Risk Factors; Systematic review; Women; Pregnancy disorders; Cardiovascular disease; Systematic review; Malignant tumor; Evidence-based medicine; Pregnancy toxemia; Metaanalysis; Vascular disease; Preeclampsia; Atherosclerosis; Risk factor; Cardiovascular risk; Bibliographic review; Cancer
• ISSN: 0959-8138; 0959-8146; 1756-1833; 1468-5833; 1756-1833
• DOI: 10.1136/bmj.39335.385301.BE

Objective To quantify the risk of future cardiovascular diseases, cancer, and mortality after pre-eclampsia.Design Systematic review and meta-analysis.Data sources Embase and Medline without language restrictions, including papers published between 1960 and December 2006, and hand searching of reference lists of relevant articles and reviews for additional reports.Review methods Prospective and retrospective cohort studies were included, providing a dataset of 3 488 160 women, with 198 252 affected by pre-eclampsia (exposure group) and 29 495 episodes of cardiovascular disease and cancer (study outcomes).Results After pre-eclampsia women have an increased risk of vascular disease. The relative risks (95% confidence intervals) for hypertension were 3.70 (2.70 to 5.05) after 14.1 years weighted mean follow-up, for ischaemic heart disease 2.16 (1.86 to 2.52) after 11.7 years, for stroke 1.81 (1.45 to 2.27) after 10.4 years, and for venous thromboembolism 1.79 (1.37 to 2.33) after 4.7 years. No increase in risk of any cancer was found (0.96, 0.73 to 1.27), including breast cancer (1.04, 0.78 to 1.39) 17 years after pre-eclampsia. Overall mortality after pre-eclampsia was increased: 1.49 (1.05 to 2.14) after 14.5 years.Conclusions A history of pre-eclampsia should be considered when evaluating risk of cardiovascular disease in women. This association might reflect a common cause for pre-eclampsia and cardiovascular disease, or an effect of pre-eclampsia on disease development, or both. No association was found between pre-eclampsia and future cancer.