Life’s Essential 8 and cardiovascular disease in women with a history of adverse pregnancy outcomes

AIMS: To assess whether better cardiovascular health (CVH) is associated with a lower long-term risk of cardiovascular disease (CVD) in women with a history of adverse pregnancy outcomes (APOs). METHODS AND RESULTS: Using data from the UK Biobank prospective cohort, we included 2263 participants with prior APOs and 107 260 participants without prior APOs. Life's Essential 8 (LE8) score was assessed at baseline. Multivariable-adjusted Cox models were used to estimate the associations between LE8 score and CVD events. Over a median 13.5 years of follow-up, 11 134 incident CVD events were documented. Among women with prior APOs, the incidence of total CVD was significantly lower in the top tertile compared with the bottom tertile, with a hazard ratio (HR) [95% confidence interval (CI)] of 0.43 (0.29, 0.65). A similar trend was observed in women without APOs, with an HR (95% CI) of 0.55 (0.53, 0.58). With respect to the individual CVD outcomes, among women with APOs, only the associations with coronary heart disease (CHD), HR (95% CI) for T3 vs. T1: 0.30 (0.17, 0.55), and atrial fibrillation (AF): 0.47 (0.24, 0.91) achieved statistical significance. Women with high LE8 score and prior APOs had a similar long-term cardiovascular risk compared with women with high LE8 score and no prior APOs [0.95 (0.63, 1.44)]. CONCLUSION: Among women with a history of APOs, better CVH as assessed using LE8 was associated with a significantly lower incidence of CVD, particularly CHD and AF. The excess risk associated with APOs appears to be attenuated among those with a high LE8 score.