Role of epigenetic markers in cardiovascular disease following hypertensive disorders of pregnancy

Cardiovascular disease (CVD) is the leading cause of death among women globally. Pregnancy complications, such as hypertensive disorders of pregnancy (HDP), are known to increase the risk of developing CVD. Over 10% of pregnancies globally are affected by HDP, a condition characterized by increased blood pressure and a multiorgan disorder (preeclampsia) associated with a 2- to 8-fold higher risk of hypertension, ischemic heart disease, stroke, and heart failure. Altered epigenetic regulation of angiogenesis, endothelial function, and gene expression may help explain the link between HDP and later-life CVD risk. However, studies investigating how epigenetic modifications mediate the progression from HDP to CVD remain limited. This review provides an overview on how epigenetic mechanisms may influence the long-term cardiovascular consequences of HDP. It also highlights key research gaps, including the need for long-term longitudinal studies to show causality. Further research on this topic may result in better screening, prevention strategies, and personalized therapies for women's cardiovascular health. However, epigenetic markers should be viewed as complementary to established clinical predictors, with near-term value in mechanistic risk refinement rather than as replacements for current approaches.