Background/Purpose:

Pre-pregnancy cardiovascular health has been associated with preeclampsia during pregnancy, as well as future cardiovascular disease (CVD). Preeclampsia is related to endothelial dysfunction, hypertension, permanent vascular damage and increased arterial stiffness in the mother, factors associated with future CVD. It is unclear whether pregnancy unmasks endothelial vulnerability to injury which manifests as preeclampsia or whether the preeclampsia itself causes damage leading to CVD. Patients with SLE are at increased risk for preeclampsia as well as CVD and stroke. However, the relationship between these conditions has not been thoroughly examined among women with SLE.

Methods:

Using a population-based Swedish register linkage, we identified all singleton pregnancies in the Medical Birth Register (1987-2012) among mothers with prevalent SLE and a large general population comparator (non-SLE). SLE was defined as ³2 SLE ICD-coded visits (inpatient, outpatient non-primary care, or both) with at ³1 visit coded by specialist who manages SLE. Primary CVD outcomes included any recorded MI or stroke based on ICD10 codes in the Patient or Death Register. Power permitting, stroke and MI were considered separately. Multivariable-adjusted stratified Cox models estimated hazard ratios and 95% confidence intervals (HR, 95% CI) among all deliveries, using robust variance estimators to account for autocorrelation (multiple pregnancies), time-varying covariates, and calendar year as the stratification variable. Preeclampsia and maternal hypertensive disorders were time-varying, such that once a woman was exposed to a preeclampsia-complicated pregnancy, she remained exposed. Sensitivity analysis restricted to first births only. HRs and 95% CIs estimated the association between preeclampsia and CVD in SLE vs non-SLE. We calculated the relative excess risk due to interaction (RERI) to assess for non-additivity.

Results:

Among 1207 SLE pregnancies, 19.4% were preeclampsia-exposed compared to 6.9% of the 18784 non-SLE pregnancies. SLE mothers were more likely to have pregestational hypertension and diabetes, renal disease, and DVT/pulmonary embolism. Among women with SLE, these pregestational comorbidities were more common in those with preeclampsia (renal disease history in 37% vs. 9% among normotensives). Any preeclampsia was associated with a 2.7-fold increased rate of CVD in both women with SLE and from the general population (RERI=18.8 (-5.3 to 42.9)). We found a significant interaction on the additive scale for stroke as the outcome (RERI=35.2 (1.1, 69.5); preeclampsia was associated with a roughly 4.5-fold increased rate of stroke in SLE but not associated with stroke in non-SLE.

Conclusion:

We confirmed that women with preeclampsia are at increased risk of future CVD, regardless of whether they had SLE during pregnancy or not. There was an excess risk of stroke specifically among women with SLE when compared to women from the general population.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/preeclampsia-and-incident-cardiovascular-disease-in-sle-pregnancy/