Accelerated macrovascular atherosclerosis after preeclampsia: a meta-analysis

Objective. Preeclampsia leads to a two-to-eight fold in­creased risk of ischemic heart and cerebral disease. The underlying atherosclerotic process is progressive and starts at a young age. When detected early, preventive medication can be initiated to prevent an ischemic disease later in life. This meta-analysis aims to determine mac­rovascular prevalence of subclinical atherosclerosis over time in women after preeclamptic compared to non-pre­eclamptic pregnancies.
Materials and Methods. A systematic search identified studies reporting prevalence of atherosclerosis on CT or ultrasound in both formerly preeclamptic and non-pre­eclamptic women. Newcastle-Ottawa scale assessed quality. Logistic regression calculated odds ratios (OR) as measure of effect size for atherosclerosis prevalence. The random ef­fects model with pooled results gave the overall odds ratio. Meta-regression determined effect of maternal age on ath­erosclerosis prevalence.
Results. Ten studies included 13,177 women with average age 48.7 years (range 33.2-59.5). Four studies used ultrasound (ca­rotid) and six used CT (coronary). Overall, preeclampsia relat­ed to increased risk of atherosclerosis (OR 1.57 (95%CI 1.39- 1.78)) with a prevalence of 30%. Atherosclerosis prevalence increases more with maternal age in formerly preeclamptic women (> 10% per decade) compared to non-preeclamptic women suggesting accelerated atherosclerosis. This increased risk is significant from age 44 onwards.
Conclusions. Formerly preeclamptic women are at increased risk of early-onset atherosclerosis and have accelerated rates of atherosclerosis at relatively young age. Early risk evalua­tion with timely interventions should be implemented in the formerly preeclamptic group to reduce the CVD burden.