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.

项目概要/摘要 女性特有的和女性主导的危险因素提供了改善心血管的机会 女性妊娠并发症的预防和筛查是未来的风险标志。 通过妊娠期心脏代谢“压力测试”揭示 CVD，可用于早期 CVD 在已确定的危险因素（慢性高血压、高胆固醇血症、2 型糖尿病）出现之前进行预防 有先兆子痫病史的女性（一种与高血压有关的疾病）。 妊娠）或早产（妊娠 <37 周）的未来发生 CVD 的风险是其两倍。 创伤后应激障碍 (PTSD) 和抑郁症等疾病在女性中的发病率是女性的两倍 与男性一样，也与 CVD 风险增加有关，尽管现有研究和轶事表明。 有证据表明，急性不良妊娠结局（APO；先兆子痫和早产）可以 对一些妇女来说构成创伤事件并加速心理健康状况的发展 怀孕后，缺乏严格的流行病学研究来了解 APO 与心理健康的关系。 条件可能共同促成女性CVD还未知。 互补人群和方法学方法，包括观察流行病学 护士健康研究 2 和 3 (NHS2/3) 前瞻性队列研究中的分析和利用 来自麻省总医院布里格姆卫生系统的电子健康记录 (EHR)，用于定量 使用机器学习进行预测建模，并招募近期患有急性 APO 的患者参与 本研究将通过以下方式解决文献中的空白：1）评估程度 在有 APO 病史的女性中观察到的 CVD 风险增加的原因是 使用 NHS2/3 的数据确定怀孕后心理健康状况的发展； EHR 中影响心理健康风险的相关风险和复原力因素 急性 APO 后的情况；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 相关创伤。 除了对女性一生中 CVD 风险积累产生新的见解外，该提案 将为我发展成为一名独立调查员提供重要的培训，培养以下方面的新技能： 1) 使用 EHR 数据进行机器学习，2) 定性研究，3) 精神病学流行病学。 强大的生殖和心血管流行病学背景，我的世界一流的指导团队，以及 个性化的培训计划可以提高我的技能，我有能力完成拟议的研究。 该职业发展奖提供的培训、指导和受保护的时间将是独一无二的 让我成为一名有能力改善女性心血管健康的领先流行病学家。