Hypertensive pregnancy disorders and future coronary artery disease

项目总结 冠状动脉疾病(CAD)是美国女性死亡和残疾的主要原因。 在20世纪80年代，很明显，男性心血管死亡率的下降并不伴随着 女性的下降速度也是一样的。这些差异的原因可能与整体经济状况恶化有关。 与男性相比，女性衰老的冠心病风险概况，性别因素可能会进一步增强这一风险 心血管护理方面的差距：女性在冠心病和心脏病治疗方面都被低估了 可更改的风险因素。此外，女性特定性别的情况，如高血压妊娠障碍 (HPD)，加上更年期和激素治疗，可能会导致这些差异。大致 6%-8%的怀孕受到血栓性帕金森病的影响，这仍然是导致孕产妇和胎儿死亡的主要原因 世界范围内的发病率和死亡率。HPD涵盖了一系列情况，最明显的是先兆子痫， 妊娠期高血压疾病的进一步特征是全身内皮功能障碍和 蛋白尿。 我们最重要的假设是，HPD的一般病史，特别是先兆子痫，代表着 独立于未来冠状动脉疾病(CAD)事件的传统风险因素的独特风险因素， 包括心肌梗死、冠状动脉搭桥术和经皮冠状动脉介入治疗(目标 1)；在CAD事件中与更严重的动脉粥样硬化疾病相关(目标2)；并且与增加 女性冠心病患者的心血管发病率和死亡率(目标3)。 到目前为止，还没有关于HPD/先兆子痫病史与CAD之间关系的研究证实 基于公认的临床标准的暴露和结果，并根据 暴露的严重程度，同时控制发生在受影响之前、期间和之后的已知风险因素 怀孕。这项建议将通过使用唯一的 罗切斯特流行病学项目(REP)以人口为基础的记录链接系统。我们将包括所有 明尼苏达州奥姆斯特德县的女性居民，通过现有队列和基于代表的方式确定 资料来源，以及在2002-2017年间发生过事件CAD事件的人，并辅之以事件心脏队列 心力衰竭和房颤，将被用来确定随后的心血管结果。我们将表演 广泛的病历回顾，通过使用有效的标准来确认HPD的诊断 HPD的回顾性诊断。拟议的研究结果可能会为早期研究开辟新的场所 女性冠心病的检测、预防、诊断和治疗。

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.