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(Hypertension. 2008;51:1499.)
© 2008 American Heart Association, Inc.

Original Articles

C-Reactive Protein Is Elevated 30 Years After Eclamptic Pregnancy

Carl A. Hubel; Robert W. Powers; Sunna Snaedal; Hilary S. Gammill; Roberta B. Ness; James M. Roberts; Reynir Arngrímsson

From the Magee-Womens Research Institute and Department of Obstetrics and Gynecology and Reproductive Sciences (C.A.H., R.W.P., H.S.G., R.B.N., J.M.R.), University of Pittsburgh School of Medicine, Pa; the Department of Renal Medicine (S.S.), Karolinska University Hospital at Huddinge, Stockholm, Sweden; the Department of Epidemiology (R.B.N, J.M.R.), University of Pittsburgh Graduate School of Public Health, Pa; and the Unit of Medical Genetics (R.A.), University of Iceland, Reykjavik.

Correspondence to Reynir Arngrímsson, University of Iceland, Laeknadeildarhus, Vatnsmyrarvegur 16, 101 Reykjavik, Iceland. E-mail reynira{at}REYKJALUNDUR.is

Women with a history of preeclampsia or eclampsia (seizure during preeclamptic pregnancy) are at increased risk for cardiovascular disease after pregnancy for reasons that remain unclear. Prospective studies during pregnancy suggest that inflammation, dyslipidemia, and insulin resistance are associated with increased risk of preeclampsia. Elevated serum C-reactive protein (CRP >3 mg/L) is an indicator of inflammation and cardiovascular risk. We hypothesized that Icelandic postmenopausal women with a history of eclampsia would manifest higher concentrations of serum CRP than Icelandic postmenopausal controls with a history of uncomplicated pregnancies. We also asked whether elevated CRP is associated with the dyslipidemia and insulin resistance previously identified in this cohort. CRP, measured by high-sensitivity enzyme-linked immunoassay, was higher in women with prior eclampsia (n=25) than controls (n=28) (median mg/L [interquartile range]: 9.0 [0.9 to 13.2] versus 2.0 [0.3 to 5.1]; P<0.03). This difference remained significant after adjustment for body mass index, smoking, hormone replacement, and current age. Women with prior eclampsia clustered into either high CRP (range 8.97 to 40.6 mg/L, n=13) or lower CRP (median 1.0, range 0.05 to 3.77, n=12) subsets. The prior eclampsia/high CRP subset displayed significantly elevated systolic blood pressures, lower high-density lipoprotein (HDL) cholesterol, higher apolipoprotein B, and higher fasting insulin and homeostasis model of insulin resistance (HOMA) values compared to controls, whereas the prior eclampsia/low CRP subset differed from controls only by marginally increased apolipoprotein B. The triad of inflammation, low HDL, and insulin resistance may elevate risk for both preeclampsia/eclampsia and cardiovascular disease in later life.

Key Words: preeclampsia • eclampsia • cardiovascular disease • C-reactive protein • insulin resistance • inflammation • HDL cholesterol