(522) Combined Effect of Adverse Pregnancy Outcome and Steatotic Liver Disease on Future Cardiovascular Disease Risk

Objective:
Adverse pregnancy outcome (APO) is an emerging risk factor for cardiovascular disease (CVD) in women. Steatotic liver disease (SLD) is a metabolic disorder that independently increases CVD risk. However, the combined effect of APO and SLD remains unclear, despite their shared metabolic and inflammatory pathways. Evaluating their joint effect may provide important information for targeted prevention strategies.
The goal of this study was to evaluate the combined impact of APO and SLD on CVD risk.

Study Design:
This study utilized UK Biobank data, a large-scale prospective cohort. Participants aged 40-69 were recruited between 2006 and 2010 and remain under follow-up. Parous women without prior CVD were included. APO history was defined as any prior occurrence of preeclampsia, low birthweight, or gestational diabetes mellitus. SLD was defined according to the fatty liver index at enrollment (≥30). Participants were categorized into four groups based on APO history and SLD at enrollment: (1) APO(-), SLD(-) (reference), (2) APO(+), SLD(-), (3) APO(-), SLD(+), and (4) APO(+), SLD(+). The primary outcome was incident CVD after enrollment, which included conditions such as coronary artery disease, peripheral artery disease, ischemic stroke, heart failure, aortic stenosis, mitral regurgitation, atrial fibrillation, and venous thromboembolism. Adjusted hazard ratios (aHRs) for CVD risk were calculated using Cox models, adjusting for covariates.

Results:
Each factor—APO history or SLD at enrollment—was independently associated with an increased risk of CVD. Women with both risk factors showed the highest CVD incidence. The combined presence of these exposures suggests a greater overall impact on CVD risk than either factor alone (Figure).

Conclusion:
APO and SLD each confer increased long-term CVD risk, and their coexistence further amplifies risk in an additive manner. These findings support incorporating obstetric history and metabolic markers into postpartum cardiovascular risk assessment to identify high-risk women who may benefit from early intervention.