Hypertensive diseases of pregnancy are associated with a higher long-term risk of cardiovascular disease (CVD), that is not fully explained by concurrent other CVD risk factors. In a population-based cohort study of all women in Ontario, Canada, who were pregnant between 2002 and 2020 and followed for 9 years, the incidence of obstructive coronary artery disease (CAD) per 10 000 patient-years was 4.53 in the 422 525 women with pre-eclampsia compared with 0.97 in the 1 359 122 women without pre-eclampsia during pregnancy, corresponding to an adjusted HR of 2.07 (95% CI 1.77 to 2.43) (figure 1).1 The HR was even higher when pre-eclampsia was associated with preterm birth (HR 3.11, 95% CI 2.51 to 3.87) or stillbirth (HR 2.80, 95% CI 1.05 to 7.47). It remains unclear whether annual CVD risk factor evaluation and management in women who experienced pre-eclampsia, particularly when accompanied by preterm or stillbirth, will prevent subsequent CAD.

In the accompanying editorial, Acevedo and colleagues2 convincingly argue that women with a history of pre-eclampsia be treated with secondary (not primary) CVD prevention, including additional evaluation with coronary CT calcium scores in …