{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T16:42:42Z","timestamp":1793810562192,"version":"4.6.1"},"reference-count":26,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Cardiol"],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"\n Importance<\/jats:title>\n Cardiovascular disease (CVD) is the leading cause of death among women worldwide. Pregnancy serves as a natural cardiovascular stress test and universal clinical encounter, yet few approaches leverage its insights to inform long-term cardiovascular risk.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine whether clinical measures and biomarkers obtained during pregnancy may identify women at risk of long-term CVD.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This was a registry-linked, population-based cohort study of all pregnancies reaching at least 22 weeks between June 2010 and October 2013 in Southern Denmark. Primary analyses were performed in a nested prospective subcohort of Odense Child Cohort participants with available pregnancy biomarker data. Women with preexisting CVD were excluded (n\u2009=\u2009114). Follow-up was done through December 31, 2023. Among 38\u202f455 eligible women, 2056 had biomarker data at week 12 or week 29. Analytic subsets with complete data were used for prognostic modeling at week 12 (n\u2009=\u20091379) and week 29 (n\u2009=\u20091389).<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Clinical characteristics, obstetric outcomes, and pregnancy biomarkers including soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor, high-sensitivity cardiac troponin I (hs-cTnI), and N-terminal pro\u2013B-type natriuretic peptide.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Incident maternal CVD, evaluated using Cox proportional hazards models.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n In the biomarker cohort (median [IQR] age, 30.4 [27.4-33.8] years), 28 women (1.4%) developed CVD during a median (IQR) follow-up of 11.9 (11.2-12.5) years. Maternal age, hypertensive disorders of pregnancy (HDPs), and third-trimester concentrations of hs-cTnI and sFlt-1 were each independently associated with higher long-term CVD risk. A combined model including age and sFlt-1 measured at week 29 improved discrimination for CVD compared with a base model of age alone (\u0394AUC, 0.16; 95% CI, 0.02-0.30), whereas a clinical model consisting of age, systolic blood pressure, and non\u2013high-density lipoprotein cholesterol did not. Results were consistent in women without prior hypertension or HDPs and in nulliparous women. CVD incidence and the predictive value of the base model were comparable between the biomarker and the contemporaneous background cohorts (n\u2009=\u200936\u202f274).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n These findings support pregnancy as an opportunistic window for sex-specific cardiovascular risk assessment and prevention throughout a woman\u2019s life course. Further studies are warranted to validate these findings.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamacardio.2025.5595","type":"journal-article","created":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T16:30:35Z","timestamp":1771432235000},"page":"332","source":"Crossref","is-referenced-by-count":9,"title":["Clinical Factors and Biomarkers During Pregnancy and Risk of Cardiovascular Disease"],"prefix":"10.1001","volume":"11","author":[{"given":"Lucas","family":"Bacmeister","sequence":"first","affiliation":[{"name":"University Heart Center Freiburg - Bad Krozingen, Clinic for Cardiology and Angiology, Medical Center, University of Freiburg, Freiburg, Germany"},{"name":"Faculty of Medicine, University of Freiburg, Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorte","family":"Glintborg","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Odense University Hospital, University of Southern Denmark, Odense, Denmark"},{"name":"Institute for Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens-Jakob","family":"Kjer-M\u00f8ller","sequence":"additional","affiliation":[{"name":"Institute for Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hajir","family":"Al-Jorani","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Odense University Hospital, University of Southern Denmark, Odense, Denmark"},{"name":"Institute for Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrik Thybo","family":"Christesen","sequence":"additional","affiliation":[{"name":"Institute for Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark"},{"name":"Hans Christian Andersen Children\u2019s Hospital, Odense University Hospital, University of Southern Denmark, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tina Kold","family":"Jensen","sequence":"additional","affiliation":[{"name":"Institute for Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark"},{"name":"Department of Clinical Pharmacology, Pharmacy and Environmental Medication, Institute of Public Health, University of Southern Denmark, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan Stener","family":"J\u00f8rgensen","sequence":"additional","affiliation":[{"name":"Institute for Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark"},{"name":"Department of Obstetrics and Fetal Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annette","family":"Buellesbach","sequence":"additional","affiliation":[{"name":"University Heart Center Freiburg - Bad Krozingen, Clinic for Cardiology and Angiology, Medical Center, University of Freiburg, Freiburg, Germany"},{"name":"Faculty of Medicine, University of Freiburg, Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Heidenreich","sequence":"additional","affiliation":[{"name":"University Heart Center Freiburg - Bad Krozingen, Clinic for Cardiology and Angiology, Medical Center, University of Freiburg, Freiburg, Germany"},{"name":"Faculty of Medicine, University of Freiburg, Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanja","family":"Zeller","sequence":"additional","affiliation":[{"name":"Institute for Cardiogenetics, University of Luebeck, University Hospital Schleswig-Holstein, Germany"},{"name":"German Center for Cardiovascular Research, DZHK, partner site North, L\u00fcbeck, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf","family":"Dechend","sequence":"additional","affiliation":[{"name":"Experimental and Clinical Research Center, Cooperation Between the Max-Delbr\u00fcck-Center for Molecular Medicine in the Helmholtz Association and the Charit\u00e9, Universit\u00e4tsmedizin Berlin, Berlin, Germany"},{"name":"Department of Cardiology and Nephrology, Helios Clinic Berlin-Buch, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Westermann","sequence":"additional","affiliation":[{"name":"University Heart Center Freiburg - Bad Krozingen, Clinic for Cardiology and Angiology, Medical Center, University of Freiburg, Freiburg, Germany"},{"name":"Faculty of Medicine, University of Freiburg, Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianne","family":"Skovsager Andersen","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Odense University Hospital, University of Southern Denmark, Odense, Denmark"},{"name":"Institute for Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"7","key":"hoi250082r2","doi-asserted-by":"publisher","first-page":"592","DOI":"10.1161\/CIRCULATIONAHA.119.043429","article-title":"The use of sex-specific factors in the assessment of women\u2019s cardiovascular risk.","volume":"141","author":"Agarwala","year":"2020","journal-title":"Circulation"},{"issue":"2","key":"hoi250082r3","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.116.003497","article-title":"Preeclampsia and future cardiovascular health: a systematic review and meta-analysis.","volume":"10","author":"Wu","year":"2017","journal-title":"Circ Cardiovasc Qual Outcomes"},{"issue":"13","key":"hoi250082r4","doi-asserted-by":"publisher","first-page":"1050","DOI":"10.1161\/CIRCULATIONAHA.118.038080","article-title":"Preeclampsia and cardiovascular disease in a large UK pregnancy cohort of linked electronic health records: a CALIBER study.","volume":"140","author":"Leon","year":"2019","journal-title":"Circulation"},{"issue":"8","key":"hoi250082r5","doi-asserted-by":"publisher","first-page":"1069","DOI":"10.1161\/CIRCULATIONAHA.118.036748","article-title":"Cardiovascular disease-related morbidity and mortality in women with a history of pregnancy complications.","volume":"139","author":"Grandi","year":"2019","journal-title":"Circulation"},{"issue":"18","key":"hoi250082r6","doi-asserted-by":"publisher","first-page":"2323","DOI":"10.1016\/j.jacc.2020.03.028","article-title":"Incidence and long-term outcomes of hypertensive disorders of pregnancy.","volume":"75","author":"Garovic","year":"2020","journal-title":"J Am Coll Cardiol"},{"issue":"10","key":"hoi250082r7","doi-asserted-by":"publisher","first-page":"1003","DOI":"10.1007\/s10654-018-0429-1","article-title":"The value of pregnancy complication history for 10-year cardiovascular disease risk prediction in middle-aged women.","volume":"33","author":"Timpka","year":"2018","journal-title":"Eur J Epidemiol"},{"issue":"14","key":"hoi250082r8","doi-asserted-by":"publisher","first-page":"1113","DOI":"10.1093\/eurheartj\/ehy863","article-title":"Does pregnancy complication history improve cardiovascular disease risk prediction? findings from the HUNT study in Norway.","volume":"40","author":"Markovitz","year":"2019","journal-title":"Eur Heart J"},{"issue":"4","key":"hoi250082r9","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1136\/heartjnl-2018-313439","article-title":"Cardiovascular risk model performance in women with and without hypertensive disorders of pregnancy.","volume":"105","author":"Dam","year":"2019","journal-title":"Heart"},{"issue":"11","key":"hoi250082r10","doi-asserted-by":"publisher","first-page":"1252","DOI":"10.1016\/j.jacc.2018.05.077","article-title":"Hypertensive disorders of pregnancy and 10-year cardiovascular risk prediction.","volume":"72","author":"Stuart","year":"2018","journal-title":"J Am Coll Cardiol"},{"issue":"12","key":"hoi250082r11","doi-asserted-by":"publisher","first-page":"1273","DOI":"10.1177\/2047487319879791","article-title":"Risk prediction of maternal cardiovascular disease one year after hypertensive pregnancy complications or gestational diabetes mellitus.","volume":"27","author":"Moe","year":"2020","journal-title":"Eur J Prev Cardiol"},{"issue":"9","key":"hoi250082r12","doi-asserted-by":"publisher","first-page":"830","DOI":"10.1016\/S1701-2163(16)35381-6","article-title":"Ten-year, thirty-year, and lifetime cardiovascular disease risk estimates following a pregnancy complicated by preeclampsia.","volume":"34","author":"Smith","year":"2012","journal-title":"J Obstet Gynaecol Can"},{"issue":"3","key":"hoi250082r13","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1111\/ppe.12183","article-title":"The Odense Child Cohort: aims, design, and cohort profile.","volume":"29","author":"Kyhl","year":"2015","journal-title":"Paediatr Perinat Epidemiol"},{"issue":"11","key":"hoi250082r14","doi-asserted-by":"publisher","first-page":"1288","DOI":"10.1111\/aogs.13006","article-title":"Validation of hospital discharge diagnoses for hypertensive disorders of pregnancy.","volume":"95","author":"Luef","year":"2016","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"1","key":"hoi250082r15","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1056\/NEJMoa1414838","article-title":"Predictive value of the sFlt-1:PlGF ratio in women with suspected preeclampsia.","volume":"374","author":"Zeisler","year":"2016","journal-title":"N Engl J Med"},{"issue":"2","key":"hoi250082r16","doi-asserted-by":"publisher","first-page":"129","DOI":"10.3109\/10641955.2013.784780","article-title":"Endothelial function progressively deteriorates during normal pregnancy.","volume":"32","author":"Fujita","year":"2013","journal-title":"Hypertens Pregnancy"},{"issue":"6","key":"hoi250082r17","doi-asserted-by":"publisher","first-page":"1808","DOI":"10.1161\/HYPERTENSIONAHA.120.15830","article-title":"Angiogenic factors and long-term cardiovascular risk in women that developed preeclampsia during pregnancy.","volume":"76","author":"Garrido-Gimenez","year":"2020","journal-title":"Hypertension"},{"key":"hoi250082r18","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1016\/j.preghy.2022.04.004","article-title":"Prevalence of long term metabolic, cardiovascular, cerebrovascular and renal disease in patients with hypertensive disorders in pregnancy remote from pregnancy (POMCH).","volume":"28","author":"Schroers","year":"2022","journal-title":"Pregnancy Hypertens"},{"issue":"30","key":"hoi250082r19","doi-asserted-by":"publisher","first-page":"2428","DOI":"10.1093\/eurheartj\/ehw172","article-title":"Troponin I and cardiovascular risk prediction in the general population: the BiomarCaRE consortium.","volume":"37","author":"Blankenberg","year":"2016","journal-title":"Eur Heart J"},{"issue":"4","key":"hoi250082r20","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1001\/jamacardio.2022.5601","article-title":"High-sensitivity troponin T and I among pregnant women in the US\u2014the National Health and Nutrition Examination Survey, 1999-2004.","volume":"8","author":"Minhas","year":"2023","journal-title":"JAMA Cardiol"},{"issue":"2","key":"hoi250082r21","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1161\/CIRCULATIONAHA.123.066199","article-title":"High-sensitivity cardiac troponin I enhances preeclampsia prediction beyond maternal factors and the sFlt-1\/PlGF ratio.","volume":"149","author":"Bacmeister","year":"2024","journal-title":"Circulation"},{"issue":"4","key":"hoi250082r22","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacadv.2025.101671","article-title":"Third-trimester NT-proBNP for pre-eclampsia risk prediction: a comparison with sFlt-1\/PlGF in a population-based cohort.","volume":"4","author":"Bacmeister","year":"2025","journal-title":"JACC Adv"},{"issue":"3","key":"hoi250082r23","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1001\/jamacardio.2021.5617","article-title":"Association of N-terminal pro-brain natriuretic peptide concentration in early pregnancy with development of hypertensive disorders of pregnancy and future hypertension.","volume":"7","author":"Hauspurg","year":"2022","journal-title":"JAMA Cardiol"},{"issue":"5","key":"hoi250082r24","doi-asserted-by":"publisher","first-page":"514","DOI":"10.1001\/jamacardio.2025.0325","article-title":"Adverse pregnancy outcomes and N-terminal pro-brain natriuretic peptide levels 2 to 7 years after delivery: the nuMoM2b Heart Health Study.","volume":"10","author":"Freaney","year":"2025","journal-title":"JAMA Cardiol"},{"key":"hoi250082r25","doi-asserted-by":"publisher","first-page":"121","DOI":"10.2147\/CLEP.S441123","article-title":"Validation of obstetric diagnosis and procedure codes in the Danish National Patient Registry in 2017.","volume":"16","author":"Herskind","year":"2024","journal-title":"Clin Epidemiol"},{"issue":"2","key":"hoi250082r26","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1093\/aje\/kwm139","article-title":"Validity of preeclampsia-related diagnoses recorded in a national hospital registry and in a postpartum interview of the women.","volume":"166","author":"Klemmensen","year":"2007","journal-title":"Am J Epidemiol"},{"key":"hoi250082r1","unstructured":"Institute for Health Metrics and Evaluation. GBD results. Accessed March 9, 2025. https:\/\/vizhub.healthdata.org\/gbd-results"}],"container-title":["JAMA Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamacardiology\/articlepdf\/2845160\/jamacardiology_bacmeister_2026_oi_250082_1775567392.23078.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T15:00:46Z","timestamp":1775660446000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamacardiology\/fullarticle\/2845160"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,1]]},"references-count":26,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamacardio.2025.5595","relation":{},"ISSN":["2380-6583"],"issn-type":[{"value":"2380-6583","type":"print"}],"subject":[],"published":{"date-parts":[[2026,4,1]]}}}