Per- and Polyfluoroalkyl substances mixtures and maternal cardiovascular disease risk across the reproductive life course

全氟烷基和多氟烷基物质混合物与整个生殖生命过程中孕产妇心血管疾病的风险

• 批准号: 10438890
• 负责人: Tamarra M James-Todd
• 金额: $ 61.95万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-22 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10438890
• 关键词: Address; Age; Blood Pressure; Body Weight Changes; Body mass index; Breast Feeding; Cardiovascular Diseases; Cause of Death; Central obesity; Chemical Exposure; Chemicals; Clinical; Conflict (Psychology); Data; Development; Diastolic blood pressure; Dyslipidemias; Economic Burden; Elderly; Endocrine Disruptors; Environment; Environmental Exposure; Environmental Impact; Environmental Pollutants; Environmental Risk Factor; Etiology; Evaluation; Exposure to; Fasting; Fibrinogen; First Pregnancy Trimester; Follow-Up Studies; Future; Genetic; Glucose; Glycosylated hemoglobin A; Health Expenditures; Hour; Hyperglycemia; Hypertension; Individual; Insulin; Knowledge; Life Cycle Stages; Life Style; Lipids; Longitudinal cohort study; Measures; Menopausal Status; Modification; Mothers; Non-Insulin-Dependent Diabetes Mellitus; OGTT; Obesity; Outcome; Participant; Phase; Plasma; Poly-fluoroalkyl substances; Population; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy Trimesters; Pregnant Women; Production; Prospective cohort study; Research; Research Design; Risk; Risk Factors; Risk Reduction; Signal Transduction; Stress Tests; Techniques; Testing; Time; United States; Weight Gain; Woman; cardiometabolism; cardiovascular disorder prevention; cardiovascular disorder risk; cardiovascular risk factor; cohort; course development; data access; disorder risk; environmental chemical; fasting glucose; follow-up; high body mass index; indexing; innovation; middle age; modifiable risk; next generation; pregnancy disorder; pregnancy hypertension; pregnant; reproductive; reproductive outcome; substance use

ABSTRACT Cardiovascular disease (CVD) is the leading cause of death among women living in the United States. Progress in identifying modifiable risk factors of CVD has been slow. Growing evidence supports the idea that pregnancy may be a stress test for future CVD risk and also a sensitive window of exposure for endocrine disrupting chemicals (EDCs) and women’s CVD risk. Our study will address the critical need to evaluate EDC exposures in pregnancy and midlife to determine whether these chemicals increase CVD risk across the reproductive life course—a key time period of CVD risk factor development. We will focus on exposure to per- and polyfluoroalkyl substances (PFAS), a class of ubiquitous, persistent chemicals. Our scientific premise is strong as prior studies and our preliminary data suggest that exposure to certain PFAS are associated with adverse cardiometabolic outcomes in both pregnant and non-pregnant women. However, previous studies have not prospectively evaluated CVD risk factor development between pregnancy and mid- life or examined replacement PFAS chemicals. The objective of this study is to determine whether exposures to legacy and replacement PFAS alter CVD risk in women across their reproductive lives. Our central hypothesis is that higher exposure to PFAS during pregnancy and through midlife alters the trajectory of CVD risk, first emerging in pregnancy as hypertension disorders of pregnancy (HDP), with subsequent emergence of CVD risk factors (i.e. obesity, hypertension, hyperglycemia, dyslipidemia) in midlife. This hypothesis will be tested through 3 aims using data from Project Viva, a longitudinal cohort study of 1,563 pregnant women with existing pregnancy PFAS data, of which 1198 are currently participating in a 20 year follow up study. In Aim 1, we will evaluate the association between legacy PFAS concentrations measured at 1st trimester of pregnancy with trajectories of systolic and diastolic blood pressure across pregnancy, and HDP (i.e. gestational hypertension and preeclampsia). In Aim 2, we will examine associations of legacy PFAS concentrations in pregnancy and the change in PFAS concentrations from pregnancy to midlife with CVD risk factors (e.g., body mass index, weight change since index pregnancy, central obesity, fasting glucose, insulin, hemoglobin A1c, hyperglycemia, blood pressure, hypertension, lipid levels, and dyslipidemia) during midlife (i.e.,20 years following pregnancy). In Aim 3, we will assess the association of legacy and replacement PFAS in mid-life with CVD risk factors in midlife. Across all aims, we will examine exposure to individual PFAS and their mixtures using advanced statistical techniques. The innovative aspects of our proposal include: evaluation of pregnancy as a susceptible window for EDCs and women’s CVD risk, examination of next-generation PFAS, and use of a large, well-characterized cohort that is undergoing 20 year follow up. Our findings will fill an important gap about the impact of environmental chemicals on an understudied time period—between pregnancy and midlife—with implications for CVD prevention and risk reduction.

摘要心血管疾病（CVD）是居住在联合的妇女中死亡的主要原因 国家在CVD的可识别风险因素中的进展一直很慢。 怀孕可能是对未来CVD风险的求婚测试的想法，也是敏感的暴露窗口 内分泌破坏化学物质（EDC）和妇女CVD风险。 评估EDC在怀孕和中年的暴露，以确定这些化学物质是否增加CVD风险 我们将重点介绍在生殖生活课程中 - CVD风险因素开发的关键时期。 暴露于每类使用的每类使用物质（PFAS），持续化学物质。 科学前提是横扫的强烈，我们的预后数据表明，某些PFA的暴露是 但是，与怀孕和非孕妇的不良心脏代谢结局有关。 前研究尚未预先评估怀孕与中期之间的CVD风险因素的发展 生命或替代PFAS化学物质的目的。 对遗产和替代的曝光PFA改变了我们的繁殖生活中的CVD风险。 中心假设是，在中年和虽然中年会改变轨迹，但较高的PFA暴露 CVD风险，首先在怀孕中作为怀孕的高血压疾病（HDP）出现，随后 中期生活中CVD危险因素的出现（即肥胖，高血压，高血糖，血脂异常）。 假设将使用来自项目Viva的数据进行测试，该数据是Viva的数据，这是一项1,563的纵向队列研究 现有怀孕PFA数据的孕妇，其中1198年目前在20年内颗粒 后续研究。 怀孕的第1个三个月，妊娠的预性和舒张压系统轨迹和HDP （即妊娠高血压和先兆子痫）。 怀孕的浓度以及PFA从怀孕到中年的变化，CVD风险 因素（例如，体重指数，体重变化以来，自指数妊娠，中心观察，禁食葡萄糖，胰岛素， 中年时期血红蛋白A1C，高血糖，血压，高血压，脂质水平和血脂异常） （即怀孕20年后）。 在所有目标中，在中年有CVD风险因素。 他们使用先进的统计学家的混合物，我们的提案的创新方面包括：评估 怀孕是EDCS和妇女CVD风险的易感窗口，检查下一代PFA， 并使用了20年的大型培训队列。 关于环境化学物质对安排时间段的影响的重要差距 - betweeen 怀孕和中年 - 对CVD预防和风险进行的影响。