Research presented Tuesday at Scientific Sessions indicates that race and ethnicity modify the association between hypertensive disorders of pregnancy and heart failure, but do not modify the association between hypertensive disorders of pregnancy and myocardial infarction.
Presenter Leila Beach, MD, noted that it’s well-established that race and ethnicity play a role in both cardiovascular disease outcomes and hypertensive disorders of pregnancy. But her study is the first to try to determine if race and ethnicity mediate the increased risk of cardiovascular disease following hypertensive disorders of pregnancy. The study reviewed the hospital discharge data of 1.5 million female patients in California.
“What was novel is that we found that African-American women who had hypertensive disorders in pregnancy were actually at much lower hazard of heart failure hospitalization than women in other racial or ethnic groups,” said Beach, clinical instructor at the University of California, San Francisco, School of Medicine. “And Asian-American women who had hypertensive disorders during pregnancy had a significantly higher hazard of heart failure hospitalization. This is not necessarily what we expected to find because, for the population at large, it’s well established that African-Americans are at higher risk for heart failure and that’s in large part driven by hypertension.”
Beach said it also was interesting that they did not see the same results for myocardial infarction. The study showed that hypertensive disorders of pregnancy were associated with future heart attack risk, but the results did not indicate that race or ethnicity significantly mediated the hazard for MI hospitalization. In the study, hazard ratios for future MI ranged from 2.7 for gestational hypertension to 6.0 for chronic hypertension.
“Why race and ethnicity mediate the hazard for heart failure and not for MI is something we don’t have pinned down at this point,” she said. “Even without understanding the mechanisms that are driving the difference, I think the implications are significant for the care of women who have a history of hypertensive disorders of pregnancy, especially as medicine becomes more personalized.”
Beach said the study also confirmed a lot of what is generally known in the literature.
“We found that, indeed, women had a much higher hazard for heart failure and heart attack hospitalization if they had hypertensive disorders of pregnancy,” she said. “We also found that the prevalence of hypertensive disorders of pregnancy was highest among black women and lowest in Asian-American women. That’s something that has been seen before in other cohorts in other states.”