Project Details
Description
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.
Status | Finished |
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Effective start/end date | 9/1/18 → 6/30/23 |
Funding
- National Heart, Lung, and Blood Institute: $478,709.00
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