Author + information
- Received May 1, 2018
- Revision received May 17, 2018
- Accepted May 21, 2018
- Published online September 3, 2018.
- Jennifer J. Stuart, ScDa,b,∗ (, )@BrighamWomens@HarvardChanSPH,
- Lauren J. Tanz, ScDa,b,
- Nancy R. Cook, ScDa,c,
- Donna Spiegelman, ScDa,d,e,
- Stacey A. Missmer, ScDa,f,g,
- Eric B. Rimm, ScDa,e,h,
- Kathryn M. Rexrode, MD, MPHb,c,
- Kenneth J. Mukamal, MD, MPHh,i and
- Janet W. Rich-Edwards, ScDa,b
- aDepartment of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- bDivision of Women’s Health, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- cDivision of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- dDepartment of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- eChanning Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- fDivision of Adolescent and Young Adult Medicine, Department of Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
- gDepartment of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, Michigan
- hDepartment of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- iDivision of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- ↵∗Address for correspondence:
Jennifer J. Stuart, ScD, Division of Women’s Health, 1620 Tremont Street, 3rd Floor, Boston, Massachusetts 02120.
Background Hypertensive disorders of pregnancy (HDP) affect 10% to 15% of women and are associated with a 2-fold increased risk of cardiovascular disease (CVD).
Objectives This study sought to determine whether inclusion of HDP in an established CVD risk score improves prediction of CVD events in women.
Methods The analysis comprised 106,230 ≤10-year observations contributed by 67,406 women, age ≥40 years, free of prior CVD, with data available on model covariates in the Nurses’ Health Study II. Participants were followed up for confirmed myocardial infarction, fatal coronary heart disease, or stroke from 1989 to 2013. We fit an established CVD risk prediction model (Model A: age, total cholesterol and high-density lipoprotein cholesterol, systolic blood pressure, antihypertensive medication use, current smoking, diabetes mellitus) and compared it to the same model plus HDP and parity (Model B); Cox proportional hazards models were used to obtain predicted probabilities for 10-year CVD risk.
Results HDP and parity were associated with 10-year CVD risk independent of established CVD risk factors, overall and at ages 40 to 49 years. However, inclusion of HDP and parity in the risk prediction model did not improve discrimination (Model A: C-index = 0.691; Model B: C-index = 0.693; p value for difference = 0.31) or risk reclassification (net reclassification improvement = 0.4%; 95% confidence interval: −0.2 to 1.0%; p = 0.26).
Conclusions In this first test of the clinical utility of HDP and parity in CVD risk prediction, additional inclusion of HDP and parity in an established risk score did not improve discrimination or reclassification in this low-risk population; this might be because of the known associations between HDP and established CVD risk factors in the reference model.
The National Institutes of Health funded this research through these grants: UM1 CA176726, R01 HL088521, R01 HL34594, and R01 CA67262. This work was supported by awards from the American Heart Association (12PRE9110014, 13GRNT17070022). Dr. Stuart was supported by training grant T32HL098048 from the National Heart, Lung, and Blood Institute, and by training grant T32HD060454 from the National Institute of Child Health and Human Development. Dr. Tanz was supported by F31HL131222 from the National Heart, Lung, and Blood Institute under the Ruth L. Kirschstein National Research Service Award. All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 1, 2018.
- Revision received May 17, 2018.
- Accepted May 21, 2018.
- 2018 American College of Cardiology Foundation