Hypertensive pregnancy disorders and future coronary artery disease

项目摘要 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 女性也是同样的下降率。造成这些差异的原因可能与总体疾病恶化有关。 与男性相比，女性的CAD风险特征可能会因性别而进一步增强 心血管护理的差异：女性对CAD的评估不足， 可改变的风险因素。此外，女性性别特异性疾病，如妊娠期高血压疾病 (HPD)与绝经和激素治疗一起，可能有助于这些差异。约 6%-8%的妊娠受到HPD的影响，这仍然是孕产妇和胎儿死亡的主要原因。 发病率和死亡率。HPD涵盖一系列疾病，最明显的是先兆子痫， 妊娠特异性高血压疾病，其特征还在于全身性内皮功能障碍， 蛋白尿。 我们的总体假设是，一般而言，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， 包括心肌梗死、冠状动脉旁路移植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（目的2）;并且与增加 CAD女性患者的心血管发病率和死亡率（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 暴露和结局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 罗切斯特流行病学项目（REP）的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，通过现有队列和基于REP的 来源，以及2002-2017年发生CAD事件的患者，补充了心脏事件队列 失败和房颤，将用于确定随后的心血管结局。我们将执行 广泛的医疗记录审查，以确认HPD的诊断，通过使用有效的标准， HPD的回顾性诊断。拟议研究的结果可能会为早期开发新的场所， 检测、预防、诊断和治疗女性CAD。

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.