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Abstract(s)
Há evidências crescentes de que a pré-eclâmpsia, a principal causa de morbimortalidade materna e perinatal, possa também ser um fator de risco para eventos cardiovasculares no futuro. A presente revisão sistemática da literatura tem como objetivo compreender se a pré-eclâmpsia influencia o risco cardiovascular da mulher a longo prazo.
Metodologia: A pesquisa de literatura foi efetuada na base de dados MEDLINE, utilizando como interface a PubMed, incluindo estudos coorte prospetivos, retrospetivos e revisões sistemáticas com meta-análises publicados nos últimos dez anos, nos idiomas Inglês e Português, publicados em jornais e revistas científicas. Resultados primários: eventos cardíacos fatais ou não fatais, doença cerebrovascular fatal ou não fatal, doença arterial periférica, tromboembolismo, doença renal e hipertensão arterial, diagnosticados apenas depois de 6 semanas após o parto, com um follow-up médio de pelo menos 5 anos e controlados para fatores de confusão.
Resultados: Dezanove artigos cumpriram os critérios de inclusão. Mulheres com história de pré-eclâmpsia apresentaram um aumento do risco de desenvolver, a longo prazo, hipertensão arterial (2-4 vezes superior), doença renal (3-4 vezes superior) e doença cardiovascular (2 vezes superior), quando comparadas com mulheres com gravidezes não complicadas. O risco de desenvolver hipertensão, doença cardiovascular e doença renal relaciona-se com a gravidade da pré-eclâmpsia, o seu período de início, a sua recorrência e a gravidez em que a pré-eclâmpsia surge.
Conclusão: Os resultados desta revisão sistemática sugerem que a pré-eclâmpsia é um importante fator de risco de desenvolvimento prematuro de doença cardiovascular. Apesar da existência desta associação, permanece incerto se a pré-eclâmpsia é um agente causal de lesão endotelial sistémica que, a longo prazo, se manifesta sob a forma de doença cardiovascular ou se é uma manifestação clínica de fatores de risco cardiovasculares pré-existentes, que apenas se manifestam num período de stress como o da gravidez, revelando um fenótipo de doença cardiovascular subjacente. Os resultados desta revisão sistemática salientam a importância da identificação e seguimento de mulheres com história de pré-eclâmpsia. São necessários mais estudos que determinem o papel especifico da pré-eclâmpsia como fator de risco independente de doença cardiovascular no futuro; avaliem o papel dos marcadores inflamatórios, envolvidos na fisiopatologia da pré-eclâmpsia, no desenvolvimento a longo prazo de lesão endotelial; determinem a efetividade dos protocolos de seguimento e o papel de estratégias preventivas na melhoria dos resultados cardiovasculares.
There is increasing evidence that preeclampsia, the main cause of maternal and perinatal morbimortality, may also be a risk factor for cardiovascular events in the future. This systematic review of the literature aims to understand whether preeclampsia has influence in the long term risk of cardiovascular disease in women. Methods: Prospective and retrospective cohort studies and systematic reviews with meta-analyses, published in the last ten years, in English and Portuguese, in scientific journals were included from Medline searches using Pubmed as interface. Primary outcomes: fatal or non-fatal cardiac events, fatal or non-fatal cerebrovascular disease, peripheral arterial disease, thromboembolism, renal disease and arterial hypertension, diagnosed more than 6 weeks postpartum, with an average follow-up of at least 5 years and controlled for confounders. Results: Nineteen articles met eligibility criteria. Compared to women with uncomplicated pregnancies, women with a history of preeclampsia had an increased risk of long-term development of hypertension (approximately 2-4 times), renal disease, (approximately 3-4 times) and cardiovascular disease (approximately 2 times). The risk of developing hypertension, cardiovascular disease and renal disease is associated with the severity of preeclampsia, its time of onset, its recurrence and the pregnancy in which preeclampsia arises. Conclusions: The results of this systematic review suggest that preeclampsia is an important risk factor for premature development of cardiovascular disease. Despite this association, it remains uncertain whether preeclampsia is a causative agent of systemic endothelial lesion that in long-term manifests as cardiovascular disease, or if it is a clinical manifestation of pre-existing cardiovascular risk factors that only emerge in a period of stress such as pregnancy, revealing an underlying cardiovascular disease phenotype. These results emphasize the importance of the identification and follow-up of women with a history of preeclampsia. Further studies are needed to determine the specific role of preeclampsia as an independent risk factor for cardiovascular disease in the future; evaluate the role of inflammatory markers involved in the pathophysiology of preeclampsia and in the long-term development of endothelial lesion; to determine the effectiveness of follow-up protocols and the role of preventive strategies in improving cardiovascular outcomes.
There is increasing evidence that preeclampsia, the main cause of maternal and perinatal morbimortality, may also be a risk factor for cardiovascular events in the future. This systematic review of the literature aims to understand whether preeclampsia has influence in the long term risk of cardiovascular disease in women. Methods: Prospective and retrospective cohort studies and systematic reviews with meta-analyses, published in the last ten years, in English and Portuguese, in scientific journals were included from Medline searches using Pubmed as interface. Primary outcomes: fatal or non-fatal cardiac events, fatal or non-fatal cerebrovascular disease, peripheral arterial disease, thromboembolism, renal disease and arterial hypertension, diagnosed more than 6 weeks postpartum, with an average follow-up of at least 5 years and controlled for confounders. Results: Nineteen articles met eligibility criteria. Compared to women with uncomplicated pregnancies, women with a history of preeclampsia had an increased risk of long-term development of hypertension (approximately 2-4 times), renal disease, (approximately 3-4 times) and cardiovascular disease (approximately 2 times). The risk of developing hypertension, cardiovascular disease and renal disease is associated with the severity of preeclampsia, its time of onset, its recurrence and the pregnancy in which preeclampsia arises. Conclusions: The results of this systematic review suggest that preeclampsia is an important risk factor for premature development of cardiovascular disease. Despite this association, it remains uncertain whether preeclampsia is a causative agent of systemic endothelial lesion that in long-term manifests as cardiovascular disease, or if it is a clinical manifestation of pre-existing cardiovascular risk factors that only emerge in a period of stress such as pregnancy, revealing an underlying cardiovascular disease phenotype. These results emphasize the importance of the identification and follow-up of women with a history of preeclampsia. Further studies are needed to determine the specific role of preeclampsia as an independent risk factor for cardiovascular disease in the future; evaluate the role of inflammatory markers involved in the pathophysiology of preeclampsia and in the long-term development of endothelial lesion; to determine the effectiveness of follow-up protocols and the role of preventive strategies in improving cardiovascular outcomes.
Description
Keywords
Doença Cardiovascular Gravidez Hipertensão Arterial Pré-Eclâmpsia Risco Cardiovascular