Abstract Body (Do not enter title and authors here): Background Women with a history of adverse pregnancy outcomes (APOs) are at increased risk of developing cardiovascular disease (CVD). Whether maintaining higher cardiovascular health is associated with a lower risk of CVD in this population is not known.
Aims To evaluate the association between Life’s Essential 8 (LE8) and incident CVD in women with a history of APOs.
Methods We included 2,263 participants with a prior diagnosis of APOs (including hypertensive disorders of pregnancy, gestational diabetes, placental abruption, small for gestational age, or preterm birth) and 107,260 parous participants without a history of APOs from the UK Biobank, all of whom were free of CVD at baseline. LE8 was calculated at baseline (range 0-100). Multivariable-adjusted Cox models were used to estimate the hazard ratio (HR) and 95% confidence interval (CI) between LE8 score and incident total and subtypes of CVD. We also examined the interaction between LE8 score and incident CVD among individuals with and without a history of APOs.
Results Over a mean 13.5 years of follow-up, 197 incident CVD events were documented in women with a history of APOs. Compared to women in the bottom tertile of LE8 score (<67), those in the top tertile (>76) had a lower incidence of total CVD, HR (95% CI) of 0.44 (0.29, 0.65), CHD [0.30 (0.17, 0.55)] and AF [0.47 (0.24, 0.92)]. We observed a significant interaction between history of APOs, LE8 score, and incident CVD (Table 1). Women with a history of APO who maintained high LE8 score were at similar risk as those without APO with a high LE8 score, 0.95 (0.63, 1.44), whereas there was an excess risk observed for those with an intermediate (HR with vs. without APO: 1.72 vs 1.25) and low LE8 scores (HR with vs. without APO: 2.48 vs 1.81).
Conclusion Among women with a history of APOs, better cardiovascular health as assessed using the LE8 score was associated with a significantly lower incidence of incident CVD. Additionally, women with a history of APOs who maintained high LE8 scores had similar risk of CVD as women without a history of APOs.