Female-Specific Risk Factors for CVD: The Impact of Adverse Pregnancy Outcomes on Subsequent Mental Health and CVD Risk

女性特定的 CVD 危险因素：不良妊娠结局对后续心理健康和 CVD 风险的影响

• 批准号: 10524644
• 负责人: Jennifer Jacqueline Stuart
• 金额: $ 14.32万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10524644
• 关键词: 37 weeks gestation; Acute; Address; Admission activity; Black race; Cardiovascular Diseases; Cardiovascular system; Cessation of life; Chronic; Clinical Data; Complex; Coronary heart disease; Cox Proportional Hazards Models; Data; Data Sources; Development; Diabetes Mellitus; Diagnosis; Electronic Health Record; Enrollment; Epidemiologist; Epidemiology; Event; Female; Fetal Growth; Foundations; Future; Goals; Health system; Hemorrhage; Hypertension; Interview; Joints; K-Series Research Career Programs; Life; Life Cycle Stages; Link; Literature; Machine Learning; Mediating; Mental Depression; Mental Health; Mentors; Mentorship; Methodology; National Heart, Lung, and Blood Institute; Neonatal Intensive Care Units; Non-Insulin-Dependent Diabetes Mellitus; Nurses' Health Study; Pathway interactions; Patient Recruitments; Patients; Population; Population Heterogeneity; Positioning Attribute; Post-Traumatic Stress Disorders; Postpartum Period; Pre-Eclampsia; Predictive Factor; Pregnancy; Pregnancy Complications; Premature Birth; Prospective cohort study; Psychiatric epidemiology; Qualitative Research; Questionnaires; Race; Recording of previous events; Research; Research Personnel; Risk; Risk Factors; Risk Marker; Role; Sampling; Science; Secondary to; Strategic vision; Stress Tests; Stroke; Structure; Techniques; Time; Training; Translating; Trauma; Woman; Women' s Health; adverse pregnancy outcome; barrier to care; cardiometabolism; cardiovascular disorder epidemiology; cardiovascular disorder prevention; cardiovascular disorder risk; cardiovascular health; cardiovascular risk factor; clinically relevant; cohort; epidemiology study; experience; follow-up; health care service utilization; healthy lifestyle; hypercholesterolemia; improved; infant outcome; insight; machine learning method; men; mental development; normotensive; novel; obstetrical complication; parous; predictive modeling; prepregnancy; prevent; prospective; racial and ethnic; reproductive; reproductive epidemiology; resilience; risk prediction model; risk sharing; screening; skills; traumatic event

PROJECT SUMMARY/ABSTRACT Female-specific and female-predominant risk factors provide opportunities to improve cardiovascular disease (CVD) prevention and screening in women. Pregnancy complications are risk markers for future CVD revealed through the cardiometabolic “stress test” of pregnancy, which can be leveraged for early CVD prevention before the onset of established risk factors (chronic hypertension, hypercholesterolemia, type 2 diabetes). Women with a history of preeclampsia (a condition involving high blood pressure during pregnancy) or preterm delivery (<37 weeks’ gestation) have twice the risk of future CVD. Mental health conditions, such as posttraumatic stress disorder (PTSD) and depression, are twice as common in women as in men and are also associated with increased CVD risk. Although existing studies and anecdotal evidence suggest that acute adverse pregnancy outcomes (APOs; preeclampsia and preterm delivery) can constitute a traumatic event for some women and precipitate the development of mental health conditions after pregnancy, rigorous epidemiologic studies are lacking. The extent to which APOs and mental health conditions may jointly contribute to CVD in women is also unknown. This project will draw on the strengths of complementary populations and methodologic approaches, including observational epidemiologic analyses within the Nurses’ Health Study 2 and 3 (NHS2/3) prospective cohort studies and leveraging electronic health records (EHR) from the Mass General Brigham health system for both quantitative prediction modeling using machine learning and to recruit patients with recent acute APOs to participate in qualitative interviews. This research will address the gaps in the literature by: 1) evaluating the extent to which the increased CVD risk observed among women with a history of APOs is accounted for by the development of mental health conditions after pregnancy using data from NHS2/3; 2) identifying clinically relevant risk and resilience factors from the EHR that influence the risk of developing mental health conditions after an acute APO; and 3) elucidating the relationship between APOs and subsequent PTSD secondary to APO-related trauma through semi-structured qualitative patient interviews. In addition to generating new insights into the accumulation of CVD risk across a woman’s life, this proposal will provide crucial training for my development into an independent investigator by cultivating new skills in: 1) machine learning using EHR data, 2) qualitative research, and 3) psychiatric epidemiology. Given my strong background in reproductive and cardiovascular epidemiology, my world-class mentoring team, and personalized training plan to advance my skillset, I am well equipped to accomplish the proposed research. The training, mentorship, and protected time provided by this Career Development Award will uniquely position me as a leading epidemiologist equipped to improve the cardiovascular health of women.

项目摘要/摘要 女性特异性和女性优势风险因素提供了改善心血管的机会 女性的疾病（CVD）预防和筛查。怀孕并发症是未来的风险标志 通过心脏代谢的“应力测试”揭示了CVD，可以将其用于早期CVD 在既定危险因素发作之前的预防（慢性高血压，高胆固醇血症，2型） 糖尿病）。具有先兆子痫病史的妇女（这种疾病涉及高血压 怀孕）或早产（妊娠<37周）的未来CVD风险是两倍。心理健康 妇女中的病变后应激障碍（PTSD）和抑郁症等疾病是抑郁症的两倍 就像男性一样，也与CVD风险增加有关。虽然现有研究和轶事 有证据表明，急性不良怀孕结局（APO；先兆子痫和早产）可以 构成某些妇女的创伤事件，并为心理健康状况的发展而珍贵 怀孕后，缺乏严格的流行病学研究。 APO和心理健康的程度 妇女中可能共同促进CVD的条件也未知。这个项目将借鉴优势 互补种群和方法论方法，包括观察性流行病学 护士健康研究2和3（NHS2/3）的分析前瞻性研究和利用 来自大规模杨海洋卫生系统的电子健康记录（EHR），用于两种定量 使用机器学习进行预测建模并招募最近急性APO的患者参与 定性访谈。这项研究将通过：1）评估文献中的差距 在具有APO史的女性中观察到的CVD风险增加的原因是 使用NHS2/3的数据在怀孕后心理健康状况的发展； 2）在临床上识别 EHR的相关风险和弹性因素影响发展心理健康的风险 急性Apo后的条件； 3）阐明APO与随后的PTSD之间的关系 通过半结构化定性患者访谈继发于APO相关的创伤。 除了对CVD风险在女性的生活中积累的新见解外，该提议 通过培养新技能，将为我的发展提供至关重要的培训： 1）使用EHR数据的机器学习，2）定性研究，3）精神病流行病学。给了我 生殖和心血管流行病学，我的世界一流的心理团队以及 个性化的培训计划以提高我的技能，我有能力完成拟议的研究。 该职业发展奖提供的培训，精通和受保护的时间将是唯一的 将我定位为能够改善女性心血管健康的领先流行病学家。