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  • Markovitz, Amanda RHarvard T.H. Chan School of Public Health (author)

Does pregnancy complication history improve cardiovascular disease risk prediction? : Findings from the HUNT study in Norway

  • Article/chapterEnglish2019

Publisher, publication year, extent ...

  • 2018-12-27
  • Oxford University Press (OUP),2019

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  • LIBRIS-ID:oai:lup.lub.lu.se:012a4050-c682-4d23-8ec6-88c45da46131
  • https://lup.lub.lu.se/record/012a4050-c682-4d23-8ec6-88c45da46131URI
  • https://doi.org/10.1093/eurheartj/ehy863DOI

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  • Language:English
  • Summary in:English

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  • Subject category:art swepub-publicationtype
  • Subject category:ref swepub-contenttype

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  • Aim: To evaluate whether history of pregnancy complications [pre-eclampsia, gestational hypertension, preterm delivery, or small for gestational age (SGA)] improves risk prediction for cardiovascular disease (CVD).Methods and results: This population-based, prospective cohort study linked data from the HUNT Study, Medical Birth Registry of Norway, validated hospital records, and Norwegian Cause of Death Registry. Using an established CVD risk prediction model (NORRISK 2), we predicted 10-year risk of CVD (non-fatal myocardial infarction, fatal coronary heart disease, and non-fatal or fatal stroke) based on established risk factors (age, systolic blood pressure, total and HDL-cholesterol, smoking, anti-hypertensives, and family history of myocardial infarction). We evaluated whether adding pregnancy complication history improved model fit, calibration, discrimination, and reclassification. Among 18 231 women who were parous, ≥40 years of age, and CVD-free at start of follow-up, 39% had any pregnancy complication history and 5% experienced a CVD event during a median follow-up of 8.2 years. While pre-eclampsia and SGA were associated with CVD in unadjusted models (HR 1.96, 95% CI 1.44-2.65 for pre-eclampsia and HR 1.46, 95% CI 1.18-1.81 for SGA), only pre-eclampsia remained associated with CVD after adjusting for established risk factors (HR 1.60, 95% CI 1.16-2.17). Adding pregnancy complication history to the established prediction model led to small improvements in discrimination (C-index difference 0.004, 95% CI 0.002-0.006) and reclassification (net reclassification improvement 0.02, 95% CI 0.002-0.05).Conclusion: Pre-eclampsia independently predicted CVD after controlling for established risk factors; however, adding pre-eclampsia, gestational hypertension, preterm delivery, and SGA made only small improvements to CVD prediction among this representative sample of parous Norwegian women.

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  • Stuart, Jennifer JHarvard T.H. Chan School of Public Health (author)
  • Horn, JulieNorwegian University of Science and Technology (author)
  • Williams, Paige LHarvard T.H. Chan School of Public Health (author)
  • Rimm, Eric BBrigham and Women's Hospital / Harvard Medical School (author)
  • Missmer, Stacey ABoston Children's Hospital (author)
  • Tanz, Lauren JBrigham and Women's Hospital / Harvard Medical School (author)
  • Haug, Eirin BNorwegian University of Science and Technology (author)
  • Fraser, AbigailUniversity of Bristol (author)
  • Timpka, SimonLund University,Lunds universitet,Genetisk och molekylär epidemiologi,Forskargrupper vid Lunds universitet,Genetic and Molecular Epidemiology,Lund University Research Groups,Brigham and Women's Hospital / Harvard Medical School(Swepub:lu)med-stp (author)
  • Klykken, BjørnarNord-Trøndelag Health Trust (author)
  • Dalen, HåvardSt. Olav’s University Hospital (author)
  • Romundstad, Pål RNorwegian University of Science and Technology (author)
  • Rich-Edwards, Janet WBrigham and Women's Hospital / Harvard Medical School,Harvard University (author)
  • Åsvold, Bjørn OlavSt. Olav’s University Hospital (author)
  • Harvard T.H. Chan School of Public HealthNorwegian University of Science and Technology (creator_code:org_t)

Related titles

  • In:European Heart Journal: Oxford University Press (OUP)40:14, s. 1113-11201522-96450195-668X

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