Cardiovascular risk after preeclampsia: The effect of communicating risk factors on intended healthy behavior

Figures & data

Table 1. Risk communication to participants.

Cardiovascular risk factor Feedback to participant

Smoking Smoking cessation always has a positive effect on your health, but for most it is very difficult. Proper preparation and guidance increases the chance to stop successfully. More information can be found at www.rokeninfo.nl or you can discuss it with your general practitioner.

Alcohol intake >2 units/day Do not drink more than 2 units of alcohol a day. Information on reducing or stopping drinking alcohol can be found at www.alcoholinfo.nl or you can discuss it with your general practitioner.

BMI ≥25 kg/m^2 and/or waist circumference >88 cm Reduce your weight to a BMI of 25 or lower and/or reduce your abdominal size to 88 cm or less. In your case, your BMI is 25 at . kg. Rapid weight loss is discouraged because it is not healthy and most often weight increases again. Responsible weight loss is a good balance between nutrition and exercise. The advice is to exercise 30 min a day for at least 5 days a week. Examples of exercise are cycling, firmly walking or gardening. Healthy nutrition means: Restrict use of cream butter, hard margarines, fatty meat, dairy products, and snacks. Eat two servings (100–150 gr) fish per week, of which at least one portion of fatty fish. Use 150 to 200 g of vegetables daily and two pieces (200 g) of fruit daily. Limit use of salt up to 6 g daily; do not add salt to food. More information on healthy nutrition and healthy lifestyle can be found at www.voedingscentrum.nl and www.thuisarts.nl/gezonde-leefstijl. Your general practitioner can further inform you about additional guidance.

Blood pressure ≥140/90 mmHg Repeat blood pressure measurement by your general practitioner. If blood pressure is increased again, it may be necessary to use medication to lower your blood pressure.

Abnormal result in laboratory We have found an abnormal result in blood and/or urine analysis. The results have been submitted to your general practitioner. Our advice is to make an appointment with your general practitioner to discuss the results.

Abnormal result in cardiac ultrasound We have found an abnormal result in cardiac ultrasound. The results have been submitted to your general practitioner. Our advice is to make an appointment with your general practitioner to be referred to a cardiologist.

Diastolic dysfunction We have found an abnormal result in cardiac ultrasound. This finding, diastolic dysfunction, has been found at an early stage: it is not yet a disease and does not need to be treated yet. Your heart muscle is stiffer compared to others. Because the heart is stiffer, it has more difficulty to relax and to fill with blood. This stadium does not give complaints. If the heart becomes stiffer over time, it can lead to complaints of shortness of breath. In case of BMI <25 kg/m^2: To assess whether the heart muscle becomes stiffer, repeat the ultrasound in 3 years. In case of BMI ≥25 kg/m^2: Overweight is an important cause of stiffening of the heart. Therefore, reduce your weight to a BMI of 25 or lower.

BMI = body mass index

Table 2. Characteristics of participants with and without risk factors at cardiovascular risk assessment.

Characteristics		No risk factors in risk assessment n = 30		≥1 risk factors in risk assessment n = 117		p-value
Early-onset preeclampsia in history	n (%)	18	(60.0)	76	(65.0)	0.672
Age, years	mean ±SD	45.5	±4.6	45.6	±5.6	0.928
Post index pregnancy, years	mean ±SD	13.8	±2.4	14.0	±2.1	0.652
Caucasian	n (%)	28	(93.3)	100	(85.5)	0.365
Educational level, high	n (%)	16	(53.3)	48	(41.0)	0.293
BMI, kg/m^2	median [IQR]	22.1	[20.3–23.4]	26.3	[23.1–28.7]	<0.001
Exercise, hours/week	median [IQR]	5.0	[4.0–8.3]	4.0	[2.5–7.0]	0.052
Cigarettes, number/day	median [IQR]	−		10	[6–15]	−
Risk factors
Smoking	n (%)	−		27	(23.1)	−
Alcohol >2 units/day	n (%)	−		3	(2.6)	−
BMI >25 kg/m^2	n (%)	−		75	(64.1)	−
Waist circumference ≥88 cm	n (%)	−		28	(23.9)	−
Blood pressure ≥140/90 mmHg	n (%)	−		39	(33.3)	−
Abnormal result blood/urine	n (%)	−		68	(58.1)	−
Abnormal result echocardiography	n (%)	−		20	(17.1)	−
Diastolic dysfunction	n (%)	−		16	(13.7)	−

BMI: body mass index

Table 3. Intended healthy behavior before and after cardiovascular risk assessment.

Participants with and without risk factors per behavior		Intention before risk assessment		Intention after risk assessment		Mean difference	95% CI	p-value
Healthy diet
No risk factors	n = 26	2.96	±1.35	3.17	±1.10	0.21	(−0.65 − 1.06)	0.488
≥1 risk factors	n = 87	3.51	±1.17	3.83	±1.09	0.32	(−0.07 − 0.70)	0.057
Sufficient exercise
No risk factors	n = 26	2.96	±1.36	3.15	±1.02	0.19	(−0.65 − 1.04)	0.418
≥1 risk factors	n = 86	3.40	±1.17	3.44	±1.08	0.04	(−0.35 − 0.42)	0.784
Smoking cessation
No risk factors	−	−		−		−	−	−
≥1 risk factors	n = 17	3.08	±1.19	3.47	±0.91	0.39	(−0.40 − 1.18)	0.007

Intention was scored on a five-point Likert scale. CI: confidence interval