Heart disease, also called cardiovascular disease (CVD), is becoming more common in young women across the United States. Hypertensive disorders of pregnancy (HDP) is a group of conditions that include high blood pressure during pregnancy, such as preeclampsia and gestational hypertension. It is increasingly recognized as early warning signs of future heart and blood vessel problems. What has been less clear is whether HDP directly contributes to later heart disease or simply reflects underlying health risks that were already present before pregnancy.

To better understand this relationship, researchers studied a large, diverse group of women using real-world health data and confirmed their findings across multiple healthcare systems. This study used data from the All of Us Research Program, which includes more than 50 health systems across the U.S., and followed 17,357 women who were pregnant between 2007 and 2022.

Researchers examined whether women who experienced HDP were more likely to develop premature cardiovascular disease, meaning heart disease or stroke occurring at a relatively young age. Outcomes included heart attacks, heart failure, and strokes. To do this, they used a statistical method called multivariable Cox regression, which allows researchers to estimate risk over time while accounting for many factors at once, such as age and pre-pregnancy health conditions. The results are reported as hazard ratios, which describe how much more (or less) likely one group is to develop disease compared with another. For example, a hazard ratio of 2 means twice the risk of developing heart disease compared with someone without that exposure.

The researchers also looked at whether having health conditions before pregnancy—such as chronic high blood pressure, obesity, diabetes, high cholesterol, or kidney disease—changed this relationship. To strengthen their findings, the analyses were repeated in a second health system with a much larger sample of 56,549 women followed from 2016 to 2025.

The median age of participants was 30 years; 16% were Black or African American, and 42% were Hispanic or Latino. Over a median follow-up of 4.6 years, 701 women developed cardiovascular disease. Overall, women who experienced HDP had a higher risk of developing heart disease later in life, regardless of whether they had heart or metabolic health problems before pregnancy. Among women with no prior conditions, HDP was associated with nearly twice the risk of developing early heart disease compared with women who did not have HDP. Among those with preexisting conditions, the risk was still higher, about 30% greater.

This study did not separate different types of HDP, which may carry different long-term heart risks. Future research with more detailed pregnancy information could help clarify whether factors such as timing, severity, or type of HDP affect heart disease risk differently and allow for more personalized prevention strategies.

For young women, this study reinforces that pregnancy can offer important clues about future heart health. Developing high blood pressure during pregnancy is not just a temporary issue, it may signal an increased risk for heart disease years earlier than expected. Paying attention to heart health before, during, and after pregnancy and using tools like Beyond Pregnancy, designed for patients and providers to promote heart health in the 6 months to 2 years postpartum can help guide earlier screening, prevention, and long-term care.

Take Home Message: Hypertensive disorders of pregnancy increase the risk of early heart disease, even in women who had no heart or metabolic health problems before pregnancy. Supporting heart health before, during, and after pregnancy and including pregnancy complications in cardiovascular risk assessments may help reduce the growing rates of early-onset heart disease among women.

Citation: Theresa Boyer, Robert B. Barrett, Christelle Xiong, Fan Bu, Rebekah A. Bhansali, Amelia S. Wallace, Michael Fang, Arthur Jason Vaught, Elizabeth Selvin, Allison G. Hays, Erin D. Michos, Chiadi E. Ndumele & Anum S. Minhas (2025) Hypertensive Disorders of Pregnancy and Premature Cardiovascular Disease in a Diverse Cohort of Young US Women. Circulation. 10.1161/CIRCULATIONAHA.125.078057. Boyer, et al. Circulation Nov 2025. https://www.ahajournals.org/doi/10.1161 /CIRCULATIONAHA.125.078057.

Link: https://doi.org/10.1161/CIRCULATIONAHA.125.078057

About Research Roundup:

Each quarter, our team of science writers reviews the most current research studies related to hypertensive disorders of pregnancy and summarizes those studies of greatest interest and potential impact to our community, including research studies related to risk assessment, diagnosis, prevention, and treatment. Special thanks to our volunteer research team including Dr. Sig-Linda Jacobson, Dr. Jennifer Mitchell, Dr. Julie Reynolds, Amanda Yang, and Simren Gupta who make Research Roundup possible, and to our Patient Advisory Council, who reviews these materials from the patient perspective.