Heart disease and stroke are mainly consequences of atherosclerosis and high blood pressure (hypertension). Heart disease is sometimes included in the broader category of atherosclerotic and hypertensive diseases. Risk factors for heart disease and stroke have been well established for many years. Distinct from age, family history, and possible genetic determinants are modifiable risk factors that cause heart attacks and strokes, including high blood cholesterol, high blood pressure, smoking, and diabetes. Behaviors that contribute to development of risk factors for heart disease, partly by causing obesity, include adverse dietary patterns and physical inactivity.

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Social and environmental conditions that may determine such behavioral patterns, in turn, include education and income, cultural influences, family and personal habits, and opportunities to make favorable choices.For example, dietary patterns result from the influences of food production policies, marketing practices, product availability, cost, convenience, knowledge, choices that affect health, and preferences that are often based on early-life habits. Because many aspects of behavior are clearly beyond the control of the individual, the scope of heart disease and Stroke and stroke prevention, from the public health perspective, extends far beyond the individual or the patient. Thus, a comprehensive public health strategy for heart disease prevention must address the broader determinants of risk and disease burden as they affect both the population as a whole and particular groups of special concern, including those determinants that make healthier choices more likely for defeating heart disease.

NEW YORK -- Women who develop preeclampsia should be counseled about the risk in subsequent gestations and strategies to contain these risks, according to Baha M. Sibai, M.D.

In addition, more general implications about health in later life should be discussed with the patient, said Dr. Sibai, who is professor and chairman of obstetrics and gynecology at the University of Cincinnati.

He made his report at an obstetrics symposium sponsored by Columbia University and New York Presbyterian Hospital.

About 20%-30% of women who have had an episode of preeclampsia will develop the disorder in a subsequent pregnancy, which makes this history at least as significant a risk factor for future preeclampsia as chronic hypertension, renal disease, and pregestational diabetes.

The earlier in the first gestation preeclampsia developed, the higher the risk of recurrence in the next: the condition returned in more than half of women who had their first episode before week 27, compared with a 40% recurrence when the index episode was between week 27 and 30, and 20% at week 37 or after.

A severe episode of preeclampsia or eclampsia also is associated with a worse outcome in subsequent pregnancies, with an increased risk of intrauterine growth retardation, perinatal loss, and abruptio placentae. Here, too, the earlier the episode occurred in the first gestation, the greater the risk to the second, Dr. Sibai said.