Hypertensive pregnancy disorders and future coronary artery disease

妊娠高血压疾病和未来冠状动脉疾病

• 批准号: 10188609
• 负责人: VESNA D GAROVIC
• 金额: $ 52.61万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10188609
• 关键词: Affect; Age; Age-Years; Aging; Atherosclerosis; Atrial Fibrillation; Back; Cardiac Surgery procedures; Cardiovascular system; Caring; Cause of Death; Cessation of life; Clinical; Code; Cohort Studies; Coronary Arteriosclerosis; Coronary Artery Bypass; County; Data; Death Rate; Diagnosis; Diagnostic; Disease; Early Diagnosis; Epidemiology; Event; Female; Future; Goals; Gold; Heart failure; Knowledge; Lead; Medical Record Linkage; Medical Records; Menopause; Methodology; Minnesota; Morbidity - disease rate; Myocardial Infarction; Nested Case-Control Study; Onset of illness; Outcome; Patient Self-Report; Postmenopause; Pre-Eclampsia; Pregnancy; Prevalence; Prevention; Proteinuria; Publishing; Recording of previous events; Records; Reporting; Research; Research Design; Resources; Risk; Risk Factors; Severities; Source; Stroke; System; Taxus; Testing; Time; Treatment Efficacy; United States; Woman; Women' s Role; base; cardiovascular health; cardiovascular risk factor; clinical care; clinical practice; cohort; disability; disorder risk; endothelial dysfunction; epidemiology study; experience; fetal; follow-up; hormone therapy; improved; longitudinal dataset; male; men; modifiable risk; mortality; next generation; normotensive; novel; parity; percutaneous coronary intervention; population based; pregnancy disorder; prospective; risk prediction; screening guidelines; sex; synergism; tool; treatment strategy

PROJECT SUMMARY Coronary artery disease (CAD) is the leading cause of death and disability among women in the United States. It became apparent in the 1980s that the decline of cardiovascular mortality in men was not accompanied by the same rate of decline in women. The reasons for these differences may relate to worsening of the overall CAD risk profile for aging in women compared to men, which may be further potentiated by sex-based disparities in cardiovascular care: women have been both under-evaluated for CAD and under-treated for modifiable risk factors. In addition, female sex-specific conditions, such as hypertensive pregnancy disorders (HPD), together with menopause and hormone therapy, may contribute to those differences. Approximately 6%-8% of pregnancies are affected by HPD, which remains a leading cause of both maternal and fetal morbidity and mortality worldwide. HPD cover a spectrum of conditions, most notably preeclampsia, a pregnancy-specific hypertensive disorder further characterized by systemic endothelial dysfunction and proteinuria. Our overarching hypothesis is that a history of HPD in general, and preeclampsia in particular, represents a unique risk factor that is independent of traditional risk factors for future coronary artery disease (CAD) events, including myocardial infarction, coronary artery bypass grafting and percutaneous coronary intervention (Aim 1); is associated with more severe atherosclerotic disease at CAD event (Aim 2); and is related to increasing cardiovascular morbidity and death among women with CAD (Aim 3). There are no studies to date of the association between a history of HPD/preeclampsia and CAD that confirm both exposure and outcome based on accepted clinical criteria, and that stratify the outcome based on the severity of exposure while controlling for known risk factors occurring before, during, and after the affected pregnancies. This proposal will cover current gaps in knowledge by testing these associations using the unique population-based records-linkage system of the Rochester Epidemiology Project (REP). We will include all female residents of Olmsted County, Minnesota who were identified through existing cohorts and REP-based sources, and who had an incident CAD event from 2002-2017, supplemented with cohorts of incident heart failure and atrial fibrillation that will be used to ascertain subsequent cardiovascular outcomes. We will perform extensive medical record reviews to confirm the diagnoses of HPD by using validated criteria for the retrospective diagnoses of HPD. The results of the proposed research may open new venues for early detection, prevention, diagnosis, and treatment of CAD in women.

项目概要 冠状动脉疾病（CAD）是美国女性死亡和残疾的主要原因。 20 世纪 80 年代，人们明显意识到，男性心血管死亡率的下降并没有伴随着 女性的下降速度相同。造成这些差异的原因可能与整体恶化有关 与男性相比，女性衰老的 CAD 风险状况可能因性别而进一步加剧 心血管护理方面的差异：女性在 CAD 方面的评估不足，在 CAD 方面的治疗也不足 可改变的风险因素。此外，女性特有的疾病，例如妊娠高血压疾病 (HPD)，加上更年期和激素治疗，可能会导致这些差异。大约 6%-8% 的妊娠受到 HPD 的影响，这仍然是母婴健康的主要原因 全世界的发病率和死亡率。 HPD 涵盖一系列病症，最显着的是先兆子痫， 妊娠特异性高血压疾病的进一步特征是全身内皮功能障碍和 蛋白尿。 我们的首要假设是 HPD 病史，特别是先兆子痫，代表了一种 独立于未来冠状动脉疾病 (CAD) 事件传统风险因素的独特风险因素， 包括心肌梗塞、冠状动脉搭桥术和经皮冠状动脉介入治疗（Aim 1）；与 CAD 事件时更严重的动脉粥样硬化疾病相关（目标 2）；并且与增加有关 患有 CAD 的女性的心血管发病率和死亡（目标 3）。 迄今为止，尚无研究证实 HPD/先兆子痫病史与 CAD 之间的关联 暴露和结果均基于公认的临床标准，并根据 暴露的严重程度，同时控制受影响之前、期间和之后发生的已知风险因素 怀孕。该提案将通过使用独特的方法测试这些关联来弥补当前的知识差距 罗切斯特流行病学项目（REP）基于人群的记录链接系统。我们将包括所有 明尼苏达州奥姆斯特德县的女性居民是通过现有队列和基于 REP 确定的 来源，以及 2002 年至 2017 年发生过 CAD 事件的人，并补充了事件心脏队列 衰竭和心房颤动将用于确定随后的心血管结局。我们将表演 广泛的医疗记录审查，通过使用经过验证的标准来确认 HPD 的诊断 HPD 的回顾性诊断。拟议研究的结果可能会为早期研究开辟新的场所 女性 CAD 的检测、预防、诊断和治疗。