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Cardiovasc Diabetol. 2018 Sep 10;17(1):124. doi: 10.1186/s12933-018-0764-2.

Midlife development of type 2 diabetes and hypertension in women by history of hypertensive disorders of pregnancy.

Author information

1
Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. simon.timpka@med.lu.se.
2
Genetic and Molecular Epidemiology Unit, Lund University Diabetes Centre, Clinical Sciences Malmö, Lund University, Malmö, Sweden. simon.timpka@med.lu.se.
3
Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
4
Harvard T.H. Chan School of Public Health, Boston, MA, USA.
5
Forum South, Clinical Studies Sweden, Skåne University Hospital, Lund, Sweden.
6
Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden.
7
Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
8
MRC Integrative Epidemiology Unit at the University of Bristol, University of Bristol, Bristol, UK.
9
NIHR Biomedical Research Centre, The University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK.
10
Genetic and Molecular Epidemiology Unit, Lund University Diabetes Centre, Clinical Sciences Malmö, Lund University, Malmö, Sweden.
11
Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.

Abstract

BACKGROUND:

Women with history of hypertensive disorders of pregnancy (HDP) are at increased risk of early onset cardiovascular disease and type 2 diabetes (T2D). We aimed to investigate the extent to which HDP is also associated with midlife development of T2D and hypertension above and beyond established risk factors.

METHODS:

We included parous women who attended population-based structured clinical visits at age 50 and 60 years in Sweden 1991-2013 (N = 6587). Women with prior diabetes mellitus, stroke, or ischemic heart disease at age 50 years were excluded. Data on reproductive history were collected from registries. To study the association between history of HDP and the between-visits development of T2D, hypertension, and clinical risk factors of cardiometabolic disease (body mass index (BMI), blood pressure, and total cholesterol), we utilized multivariable adjusted regression models (logistic, log binomial, and linear regression, respectively). Models included data on outcome risk factors at age 50 years, e.g. BMI, 75 g 2 h oral glucose tolerance test result, and mean arterial pressure, respectively.

RESULTS:

Between ages 50 and 60 years, 5.8% of initially disease-free women developed T2D and 31.6% developed hypertension. History of HDP was associated with increased risk of developing T2D between age 50 and 60 years even when adjusting for risk factors, including BMI, at age 50 years (odds ratio (OR) 1.96, 95% confidence interval (CI) 1.29-2.98). By contrast, the higher risk of developing hypertension observed in women with history of HDP (relative risk (RR) 1.47, 95% CI 1.22-1.78) was attenuated when adjusted for risk factors (RR 1.09, 95% CI 0.94-1.25). Participants with a history of HDP had higher mean BMI and blood pressure at age 50 years, with levels roughly corresponding to those observed at age 60 years in unaffected women.

CONCLUSIONS:

Women with history of HDP are not only at higher risk of cardiometabolic disease during their reproductive years, but HDP is also associated with midlife T2D development above and beyond established risk factors.

KEYWORDS:

Epidemiology; Gestational hypertension; Hypertension; Hypertensive disorders of pregnancy; Preeclampsia; Type 2 diabetes

PMID:
30200989
PMCID:
PMC6130069
DOI:
10.1186/s12933-018-0764-2
[Indexed for MEDLINE]
Free PMC Article

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