Preeclampsia linked to greater heart disease risk

Preeclampsia linked to greater heart disease risk | Image Credit: © HENADZY - © HENADZY - stock.adobe.com.

Heart disease is more likely in patients with preeclampsia, according to a recent study conducted by Minttu Venetkoski, MD.¹

The data indicated a 1.5-fold increase in cardiovascular disease (CVD) risk among women with preeclampsia. As 5% of pregnancies are impacted by this condition, Venetkoski recommended that women entering menopause explain their preeclampsia history to their doctors.

“When such women entered menopause and used hormone therapy to alleviate menopausal symptoms, it simultaneously reduced their risk for cardiovascular disease,” Venetkoski said.

Shared risk factors between preeclampsia and CVD

As other risk factors of heart disease, such as hypertension, smoking, and high cholesterol, are often prioritized by doctors over preeclampsia history, Venetkoski also called for more health care providers to consider hypertensive disorders of pregnancy when determining heart risk in their patients. She noted that the postmenopausal period comprises 40% of a woman’s life.

Approximately 1 in 3 deaths have been linked to CVD, making it the leading cause of death worldwide.² Additionally, a 2-fold increase in CVD prevalence was observed between 2009 and 2017. Genetic and lifestyle factors have been linked to CVD risk, including family history of ischemic heart disease (IHD) and certain genetic loci.

This highlights opportunities to reduce the risk of CVD events. This includes risk factors being modified by preeclampsia, such as chronic hypertension, which is 2-fold to 5-fold more likely in patients with prior preeclampsia. Additional risks associated with preeclampsia include dyslipidemia, metabolic syndrome, and chronic kidney disease.

Potential biological pathways

Despite data identifying these associations, experts have noted uncertainty surrounding the mechanisms between preeclampsia history and CVD risk. However, they have hypothesized that pre-existing vascular pathology may initially manifest as preeclampsia, then later present as CVD, making pregnancy a stress test indicating an underlying heart disorder.

There are multiple risk factors of both preeclampsia and CVD presenting before pregnancy that support this hypothesis. Additionally, preeclampsia has been indicated as a mediator of accelerated vessel fibrosis and excessive salt sensitivity of blood pressure, making it a potential cause of declining cardiovascular health.

Venetkoski further detailed the link between preeclampsia and CVD in the paper “Pre-eclampsia and cardiovascular risk: a long-term nationwide cohort study on over 120 000 Finnish women,” published in BMJ Open in 2022.³ The study obtained data from hospitalized women for preeclampsia determine the impact of preeclampsia on future CVD risk.

Of participants, over 50% were aged under 30 years on the index date, and nulliparity status was reported in 65% of those with preeclampsia. A mean follow-up duration of 33.4 years was reported in preeclampsia patients and 33.6 years in controls. IHD and stroke were the most common cardiovascular outcomes observed.

Long-term outcomes in preeclampsia patients

Preeclampsia patients were significantly more likely to present with cardiovascular outcomes vs controls, with a hazard ratio of 1.66 for myocardial infarction (MI), 1.63 for MI death, and 1.52 for any IHD. IHD and stroke were both reported in 1% of women with preeclampsia, vs 0.6% of controls.

The risk of IHD was increased by 15% from preeclampsia with severe features or eclampsia vs preeclampsia without severe features, while MI risk was increased by 19% and stroke risk by 26%. Additionally, age-related associations were reported, with greater risks found from preeclampsia at a younger age.

Overall, the results indicated a link between preeclampsia and increased stroke risk. Investigators recommended identifying women with preeclampsia as having a high risk of CVD requiring active surveillance and early treatment of risk factors.

“As many as 34% of all Finnish female deaths were caused by CVD in 2019,” wrote investigators. “If we apply this proportion to our preeclamptic population, we can approximate preeclampsia to cause 17 additional CVD deaths among 100 women exposed to preeclampsia.”

References

1. Pre-eclampsia increases risk of heart disease. University of Helsinki. September 3, 2025. Accessed September 8, 2025. https://www.eurekalert.org/news-releases/1096844.
2. Venetkoski M. Menopausal hormone therapy and cardiovascular risk in women with a history of pre-eclampsia. Helsinki University Hospital. Accessed September 8, 2025.
3. Venetkoski M, Joensuu J, Gissler M, Ylikorkala O, Mikkola TS, Savolainen-Peltonen H. Pre-eclampsia and cardiovascular risk: a long-term nationwide cohort study on over 120 000 Finnish women. BMJ Open. 2022;12(12):e064736. doi:10.1136/bmjopen-2022-064736