Objective: To determine the association between placental lesions and
lifetime cardiovascular disease (CVD) risk screening at 6 months
postpartum following preeclampsia (PE). Design: Observational cohort
study. Setting: Tertiary care centres in Ottawa and Kingston, Ontario,
Canada. Population: Women diagnosed with PE who received cardiovascular
screening at 6 months postpartum. Methods: Placentas from women
diagnosed with PE were evaluated for histopathological lesions according
to a standardised synoptic data collection form with blinding to
clinical outcomes apart from gestational age at delivery. At 6 months
postpartum, each participant was screened for cardiovascular risk
factors and a lifetime cardiovascular risk score was calculated. A risk
score >35% was deemed high risk for lifetime CVD. Main
Outcome Measures: The association between placental lesions and lifetime
CVD risk was assessed using odds ratios (OR, 95% confidence intervals).
Results: Of the 85 participants, 53 (62.4%) screened high-risk for
lifetime CVD. High-risk women had more severe lesions of maternal
vascular malperfusion (MVM). MVM lesions with a severity score
>2 resulted in a 3-fold increased risk of screening high
risk for lifetime CVD (OR 3.10 [1.20-7.92]). MVM lesion score
>2 was moderately predictive of high-risk screening (AUC
0.63 [0.51,0.75]; sensitivity: 71.8% [54.6,84.4]; specificity:
54.7% [41.5,67.3]). When clinical data was added, the model’s
predictive performance improved (AUC 0.73 [0.62,0.84] sensitivity
78.4% [65.4,87.5]; specificity 51.6% [34.8,68.0]).
Conclusions: PE women with MVM are more likely to screen high-risk for
lifetime CVD compared to women without these lesions. Placenta pathology
may provide a unique modality to identify women for postpartum
cardiovascular screening.
Telomere length, cardiovascular risk and arteriosclerosis in human kidneys: an observational cohort study