Association of Preterm Birth With Prevalent and Incident Hypertension, Early-Onset Hypertension, and Cardiovascular Disease in the Women's Health Initiative

Increasing evidence suggests preterm birth is a risk factor for hypertension and cardiovas-cular disease (CVD) in adulthood. Whether there is effect modification by hypertension on CVD risk is unknown. To investigate the associations between preterm birth, hyperten-sion, and incident CVD, we identified 2,303 women aged 50 to 79 years who self-reported being born preterm from the Women's Health Initiative. Using multivariable logistic regression, prevalent hypertension at enrollment, age at hypertension diagnosis, and anti-hypertensive medication use were compared by birth status (preterm, full-term). Risk of incident hypertension, coronary heart disease, and CVD were analyzed using multivari-able Cox proportional-hazard models. Both models adjusted for age, race/ethnicity, edu-cation, smoking, physical activity, body mass index, and diabetes mellitus. Significant associations were found between preterm birth and prevalent hypertension (37% vs 33.1%; adjusted odds ratio 1.26 [95% confidence interval (CI) 1.15 to 1.28] p = <0.0001), early-onset hypertension (<50 years) (14.7% vs 11.7%; adjusted odds ratio 1.31, 95% CI 1.15 to 1.48, p = <0.0001), and incident hypertension (53.2% vs 51%; ajusted hazard ratio 1.10, 95% CI 1.03 to 1.19, p = 0.008). Preterm-born women reported taking more antihy-pertensive medications (2.9% vs 2.6%, p = 0.04). Preterm birth had a nonsignificant asso-ciation with CVD risk, but when stratified by prevalent hypertension, women born preterm without hypertension had elevated CVD risk compared with women born full-term without prevalent hypertension. Women with prevalent hypertension, preterm and full-term, had similar magnitudes of elevations in CVD risk. In conclusion, preterm birth increases the risk of hypertension and coronary heart disease. With 10% of the population born preterm, birth history should be assessed as a CVD risk factor. (c) 2023 Elsevier Inc. All rights reserved. (Am J Cardiol 2023;192:132-138)

Automated summary

Increasing evidence suggests that preterm birth is a risk factor for hypertension and cardiovascular disease in adulthood. However, the effect of hypertension on cardiovascular disease risk in preterm-born individuals is unknown. This study investigated the associations between preterm birth, hypertension, and incident cardiovascular disease in a group of women aged 50 to 79 years.