Thilaganathan and Kalafat Cardiovascular System in Preeclampsia and Beyond 523 age of 60 years have an increased risk of preeclampsia. 18, 31 Previous preeclampsia is a risk factor for recurrence in a subsequent pregnancy, perhaps because of an inability of cardiovascular system to recover from preeclampsia as cardiovascular profiles in women with recurrent preeclampsia are poorer compared with those who have a normal pregnancy subsequently. Women with recurrent preeclampsia have increased carotid intima-media thickness and peak mitral filling early diastole/atrial contraction ratio, as well as lower cardiac output (CO) and left ventricular mass, compared with women with a normal follow-on pregnancy. 31–35 In a landmark study, Romundstad et al15 assessed in a large epidemiological study whether the predisposition of preeclamptic women to increased risk for cardiovascular disease later in life can be attributed to pregnancy factors or to prepregnancy risk factors that are shared by both disorders. Their results suggested that the positive association of preeclampsia postpartum cardiovascular risk is due largely to shared prepregnancy risk factors rather than reflecting a direct influence of preeclamptic pregnancy on the maternal cardiovascular system. That all of these risk factors are also known to be correlated with cardiovascular morbidity in nonpregnant adults (Table 1) is consistent with the hypothesis that poor cardiovascular reserve predisposes to the placentally mediated disorder of preeclampsia (Figure 1). 36–38