ABSTRACT Objectives Pre‐eclampsia (PE) is associated with both postpartum structural asymptomatic heart disease (i.e. heart failure Stage B (HF‐B)) and conventional cardiovascular (CV) risk factors. We aimed to evaluate the extent to which PE, adjusted for conventional CV risk factors, is associated independently with asymptomatic cardiac abnormalities postpartum. Methods In this cross‐sectional cohort study, 107 formerly pre‐eclamptic women and 41 women with uneventful previous pregnancy (controls) were invited for CV risk assessment 4–10 years postpartum. This included cardiac ultrasound, blood pressure (BP) measurement and evaluation of metabolic syndrome determinants. Asymptomatic structural and functional cardiac abnormalities were classified as HF‐B, according to the American Heart Association guidelines. Prehypertension was defined as systolic BP of 120–139 mmHg and/or diastolic BP of 80–89 mmHg. Univariate and multivariate regression analyses were performed to calculate associations of PE and conventional risk factors with HF‐B. Results The prevalence of asymptomatic HF‐B was approximately 3.5‐fold higher in the PE group compared with controls (25% vs 7%, P < 0.01); 67% of this group had concentric remodeling and 22% had mildly impaired ejection fraction. After adjustment for postpartum interval, hypertension and high‐density lipoprotein, PE was significantly associated with HF‐B (adjusted odds ratio, 4.4 (95% CI, 1.0–19.1)). Moreover, in the formerly pre‐eclamptic group, prehypertension was associated significantly with HF‐B (odds ratio, 4.3 (95% CI, 1.4–12.7)), while metabolic syndrome determinants were not. Conclusion PE is associated with a four‐fold increased female‐specific risk of asymptomatic cardiac abnormalities. Prehypertension apparently increases this risk significantly, while metabolic syndrome determinants do not. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. Linked Comment: Ultrasound Obstet Gynecol 2017; 49: 23–24