Cardiovascular disease is the leading cause of death among women in the United States [1], and certain pregnancy complications are now recognized as important risk factors for the subsequent development of cardiovascular disease [2], [3], [4], [5], [6], [7], [8]. Specifically, hypertensive disorders of pregnancy (HDP), including gestational hypertension and preeclampsia, are strongly associated with cardiovascular disease later in life. Retrospective data show that a history of hypertensive disorders of pregnancy (HDP) is associated with significantly increased risks for death before age 50 from ischemic heart disease (aHR 7.91), stroke (aHR 5.64), and diabetes (aHR 9.53) [9].

Although the American Heart Association acknowledged a history of HDP as a risk factor for cardiovascular disease in their 2019 guideline for cardiovascular disease prevention [10], this has not yet translated to any specific recommendations for screening and intervention for this high-risk population. The nuMoM2b Heart Health Study, a large prospective US cohort currently underway to clarify the timeline of cardiovascular risk following complicated pregnancy, is approximately 10 years into data collection [11]. Thus far, this cohort has found that 36.5 % of women with HDP developed incident hypertension within 2 to 7 years after their affected pregnancy [12]. The timing and phenotype of coronary artery disease after HDP remains unclear.

We hypothesized that women with a history of HDP will have increased risks for early-onset cardiovascular disease [specifically coronary artery disease (CAD)] and cardiovascular events compared to women without pregnancy complications.