Heart disease is the leading cause of death in the UK. Pre-eclampsia is defined as high blood pressure and protein in the urine after 20 weeks of pregnancy. Women with pre-eclampsia appear to have long term health problems and those include high blood pressure and heart attacks later in life. It remains unclear how other blood pressure problems in pregnancy affect long term health. However, we do not know if this increased risk also applies to other cardiovascular (heart) disorders that have become much more frequent in recent years, such as heart failure or atrial fibrillation. In addition, we do not know if some women (according to ethnicity or onset of pre-eclampsia in pregnancy) are at higher risk of having these cardiovascular complications. We want to do a study to answer these important questions. Results from this study will provide accurate important information to help women understand the long term risks that may occur following complicated pregnancy.
Cardiovascular disease (CVD) remains the leading cause of mortality in women in the United Kingdom. Pre-eclampsia is a disease of placental aetiology and is characterised by hypertension and proteinuria. Hypertensive disorders of pregnancy are a term used to classify hypertensive complications occurring during pregnancy and may be divided into 1. Chronic hypertension 2. Gestational hypertension 3. Pre-eclampsia de novo or superimposed on chronic hypertension and 4. White coat hypertension. 1-3 We hypothesise that women whose pregnancies are complicated by hypertensive disorders of pregnancy are at long term increased risk of cardiovascular disorders, but the magnitude of the association will vary by CVD disorders and certain characteristics of the women. This study aims to estimate the association of differing phenotypes of pre-eclampsia and other hypertensive disorders of pregnancy with a full spectrum of cardiovascular disorders of relevance to the current British population. We will conduct a cohort study and use risk ratios to estimate binary outcomes. For continuous measures, transformations that approximate to the normal distribution, will be used as appropriate, and multivariate cox proportional hazard models (adjusting for key confounders) will be used to estimate the hazard ratio of the exposures on the outcomes of interest.
Transient ischaemic attacks; All sub-types of stroke; Hypertension; Stable angina; Unstable angina; Myocardial infarction; Peripheral vascular disease; Heart failure and its sub-phenotypes; Venous thromboembolism; Atrial fibrillation; Ventricular arrhythmia; Vascular dementia.
Ruth Gilbert - Chief Investigator - University College London ( UCL )
Ruth Gilbert - Corresponding Applicant - University College London ( UCL )
Aisha Gohar - Collaborator - University Medical Centre Utrecht
Alicia Uijl - Collaborator - Utrecht University
Arturo Gonzalez-Izquierdo - Collaborator - University College London ( UCL )
Fergus McCarthy - Collaborator - University College Cork
Folkert Asselbergs - Collaborator - University College London ( UCL )
Lucy Chappell - Collaborator - King's College London (KCL)
Lydia Leon - Collaborator - University College London ( UCL )
Pia Hardelid - Collaborator - University College London ( UCL )
Rolf H.H. Groenwold - Collaborator - University Medical Centre Utrecht
Spiros Denaxas - Collaborator - University College London ( UCL )
Stefan Koudstaal - Collaborator - University College London ( UCL )
Juan Pablo Casas Romero - Chief Investigator - University College London ( UCL )
Juan Pablo Casas Romero - Corresponding Applicant - University College London ( UCL )
HES Admitted Patient Care;ONS Death Registration Data;Practice Level Index of Multiple Deprivation