The Role of Adverse Pregnancy Outcomes in Conventional Cardiovascular Risk Prediction.
Objective: Approximately one-third of women in the U.S. experience an adverse pregnancy outcome (APO), which are recognized as sex-specific cardiovascular disease (CVD) risk factors. We examine if APOs confer additional CVD risk beyond that of traditional CVD risk factors. Methods: Women, age 40–79,...
| Publicado en: | Maternal & Child Health Journal Vol. 27; no. 10; pp. 1774 - 1787 |
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| Autores principales: | , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Springer Nature
Oct2023
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=172312471&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 172312471 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10927875 N9J jtl: Maternal & Child Health Journal issn: 10927875 maglogo: N pubinfo: dt: Oct2023 vid: 27 iid: 10 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 172312471 164128385 172312471 172312471 10.1007/s10995-023-03725-1 172312471 ppf: 1774 ppct: 13 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: The Role of Adverse Pregnancy Outcomes in Conventional Cardiovascular Risk Prediction. aug: au: Reddy, Shivani M. Wiecha, Nathaniel Nguyen, Crystal T. Barch, Daniel H. affil: https://ror.org/052tfza37 Division of Translational Health Sciences, RTI International, 307 Waverly Oaks Road, #1023, 02452, Waltham, MA, USA sug: subj: Pregnancy Outcomes Adverse Effects Cardiovascular Risk Factors Risk Assessment Human Pregnancy Female Adult Middle Age Aged Electronic Health Records Pregnancy-Induced Hypertension Diabetes Mellitus, Gestational Funding Source Cox Proportional Hazards Model Cardiovascular Diseases Prevention and Control Retrospective Design Prospective Studies Data Analysis Software Bivariate Statistics ROC Curve Descriptive Statistics Confidence Intervals Adult: 19-44 years Middle Aged: 45-64 years Aged: 65+ years Female ab: Objective: Approximately one-third of women in the U.S. experience an adverse pregnancy outcome (APO), which are recognized as sex-specific cardiovascular disease (CVD) risk factors. We examine if APOs confer additional CVD risk beyond that of traditional CVD risk factors. Methods: Women, age 40–79, with a pregnancy history and no pre-existing CVD were identified in the electronic health record of one health system (n = 2306). APOs included any APO, hypertensive disease of pregnancy (HDP), and gestational diabetes (GDM). Hazard ratios of time to CVD event were estimated from survival models using Cox proportional hazard regression. Discrimination, calibration, and net reclassification of re-estimated CVD risk prediction models including APOs were examined. Results: There was no significant association between any APO, HDP, or GDM and time to CVD outcome in survival models (95% confidence intervals all include 1). Including any APO, HDP, GDM in the CVD risk prediction model did not significantly improve discrimination and there were no clinically relevant changes in net reclassification of cases and non-cases. The strongest predictor of time to CVD event in the survival models was Black race, with hazard ratios ranging from 1.59 to 1.62, statistically significant for all three models. Conclusion: Women with APOs did not have an additional risk of CVD, controlling for traditional risk factors in the PCE and this sex-specific factor did not improve risk prediction. Black race was consistently a strong predictor of CVD even with data limitations. Further study of APOs can help determine how to best use this information for CVD prevention in women. Significance: Adverse pregnancy outcomes (APOs), such as gestational diabetes or hypertensive disease of pregnancy, are recognized as sex-specific cardiovascular disease (CVD) risk factors. While professional societies recommend considering APOs in cardiovascular risk assessment, CVD risk prediction calculators only include traditional risk factors. This study adds to the small body of research on the quantitative contribution of APOs to CVD risk prediction by using a contemporary, diverse cohort derived from an electronic health record. Including APOs did not improve risk prediction beyond traditional risk factors. How to best incorporate a history of APOs into CVD prevention requires further study. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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