A Systematic Evaluation And META Analysis Of Cardiovascular And Cerebrovascular Events In Pregnant Women With Preeclampsia

ObjectiveThe relationship between pregnancy complicated with preeclampsia(PE)and major adverse cardiovascular events(MACE)was evaluated by evidencebased medicine.MethodsThe subject words and free words were combined to search,and PubMed,Embase,Web of Science,Cochrane Library,ClinicalTrials.gov,China Biomedical Literature Database(CBM),Wanfang database were searched by computer.All retrospective controlled studies or cohort studies published from January 2007 to October 2021 on the incidence of postpartum cardiovascular events in pregnant women with preeclampsia were searched,The clinical data of "pregnancy and preeclampsia" on the FDA website and the documents of the 2021 ESC annual meeting were manually retrieved.Evaluate the quality of the retrieved documents and eliminate the low quality.Stata 16 software was used for statistical analysis.The continuous variables were represented by the mean difference(MD).The relative risk(RR)was used as the effect index for the secondary variables,and the 95%confidence interval(95%CI).When P<0.05,the difference was statistically significant.12 test is used to analyze the heterogeneity among the studies,and if 12≥50%,it indicates that there is heterogeneity among the studies.The meta-analysis uses the random effect model method;When I2 is less than 5 0%,it means that there is homogeneity among the studies;When the meta-analysis is a fixed effect model,if the number of studies with the same outcome index is≥10,the publication bias will be evaluated by funnel chart.The risk of adverse cardiovascular events(MACEs)is defined as(including stroke,heart failure(HF),hypertension,and cardiac death).The relationship between pregnancy with preeclampsia(PE)and several adverse cardiovascular events.result1.A total of 1270 literatures were retrieved.According to the inclusion criteria of this study,the inconsistent study design and no cardiovascular outcome studies were excluded.Finally,a total of 12 literatures were included,including 2450414 cases,including 87941Women with a history of preeclampsia and 2362473 pregnantwomen not affected by preeclampsia.2.Meta analysis showed that based on the random effect model(I2=95.0%>5 0%),the risk of postpartum hypertension in pregnant women with preeclampsia was higher than that in pregnant women without preeclampsia.The difference was statistically significant[RR=5.96,95%CI(3.51～10.12)][Z=6.650,P=0.000].Publication bias test showed that most of the literatures were located in the funnel,The left and right distribution is symmetrical,and there is no obvious publication bias.3.There was no statistical heterogeneity(I2=0%)in the study with heart failure(HF)as the outcome index.Using the fixed effect model meta-analysis,pregnant women with preeclampsia had an increased risk of postpartum heart failure(HF)[RR=4.26,95%CI(2.22～8.15)][Z=4.368,P=0.000].Sensitivity analysis shows that no single study has an impact on the overall test results,suggesting that the test results have good stability.Using Stata software egger’s method,the P values were>0.05,and there was no publication bias in the results.It can be concluded that pregnant women with preeclampsia are more prone to heart failure after delivery.4.Taking the risk of stroke and cerebrovascular disease as the outcome index,there was a high heterogeneity between the studies(I2=97.6%;P<0.001).Using the random effect model,the results showed that the risk of postpartum stroke of pregnant women with preeclampsia was higher than that of pregnant women without preeclampsia[RR=5.88,95%CI(1.22,28.20)].The difference between the two groups was statistically significant[Z=2.213,P=0.027].However,there was no evidence of publication bias(P=0.764).At the same time,sensitivity analysis was used to find the causes of heterogeneity.No single study had an impact on the overall test results,suggesting that the test results have good stability.5.Follow up showed that the increased risk of postpartum psychogenic death(95%confidence interval)in women with preeclampsia was 5.26(1.17 to 23.53),and there was high heterogeneity between the two groups(I2=97.2%;P<0.001).The difference between the two groups was statistically significant[Z=2.169,P=0.030].However,there was no evidence of publication bias(P=0.764).Sensitivity analysis was used to find the causes of heterogeneity.No single study had an impact on the overall test results,suggesting that the test results have good stability.Conclusion(1)the risk of early hypertension,cerebrovascular and cardiac death in women with a history of preeclampsia is about doubled.Further research is needed to identify the mechanisms behind these associations and to identify effective prevention strategies.(2)This association may reflect the common risk factors of preeclampsia and cardiovascular and cerebrovascular diseases.(3)Women with a history of preeclampsia should be screened for cardiovascular risk delivery to determine who needs targeted treatment interventions.Benefiting from cardiovascular risk assessment,it may identify the risk several years before the onset of cardiovascular and cerebrovascular disease,and provide a window of prevention and intervention for pregnant women with preeclampsia.