Postpartum low-dose aspirin to augment vascular recovery following a hypertensive disorder of pregnancy

项目摘要 心血管疾病（CVD）是全球女性死亡的主要原因，尽管所有死亡率都有所下降， 在其他年龄组中，育龄妇女因心血管疾病而死亡的比率正在上升。先兆子痫 是不同患者人群中CVD的公认风险因素，然而，目前没有 针对这一高危患者群体的循证干预措施。而控制血压是 作为产后管理的基石，新出现的证据表明， 并不能完全缓解先兆子痫后的CVD风险。这项研究的总体目标是开始 开发和测试用于先兆子痫后产后管理的新型药物干预， 这代表了除了血压控制之外还关注产后内皮恢复的范式转变。 本申请的目的是进行一项单点试验，以评估低- 剂量阿司匹林，以增加血管恢复后立即产后期先兆子痫后，通过两个 具体目的：初步测试进行产后低剂量的随机对照试验的可行性 阿司匹林与安慰剂，以及2）评估产后阿司匹林对内皮功能和血液流变学的影响。 压力我们的中心假设是子痫前期产后服用低剂量阿司匹林 将是可行的，改善内皮功能，并在产后6个月降低血压。该研究在 这种应用是创新性的，它是一种基于证据的策略，以改善血管功能 和产后血压在一个未充分研究的人群中具有显着的发病率在一个关键时期 期这一建议意义重大，因为它将提供一个机会，评估可行性和探讨 低剂量阿司匹林对血压及血管功能的影响采取有效措施，改善 产后高血压护理和降低长期心血管风险对改善 产妇发病率和减少护理方面的差距。我们的研究结果将提供一个有价值的框架， 随后的大规模随机试验低剂量阿司匹林在产后期先兆子痫。 成功完成这一系列研究将代表产后管理的转变， 妊娠期高血压疾病对妇女有直接影响，改善高血压， 心血管相关的孕产妇发病率和死亡率。

PROJECT ABSTRACT Cardiovascular disease (CVD) is the leading cause of death in women worldwide and despite declines in all other age groups, mortality rates attributed to CVD are increasing in women of childbearing age. Preeclampsia is a well-established risk factor for CVD across diverse patient populations, however, there are currently no evidence-based interventions targeting this at-risk patient population. While blood pressure control is the cornerstone of postpartum management, emerging evidence suggests that management of hypertension alone does not fully mitigate CVD risk after preeclampsia. The overall goal of this line of research is to begin to develop and test novel pharmacologic interventions for postpartum management following preeclampsia, representing a paradigm shift focused on endothelial recovery postpartum in addition to blood pressure control. In this application, the objective is to conduct a single-site pilot trial to assess the feasibility and effect of low- dose aspirin to augment vascular recovery in the immediate postpartum period after preeclampsia through two specific aims: to pilot test the feasibility of conducting a randomized controlled trial of postpartum low-dose aspirin vs. placebo, and 2) to assess the effect of postpartum aspirin on endothelial function and blood pressure. Our central hypothesis is that postpartum administration of low-dose aspirin following preeclampsia will be feasible, improve endothelial function, and lower BP at 6 months postpartum. The research proposed in this application is innovative in its novel adaptation of an evidence-based strategy to improve vascular function and postpartum blood pressure in an understudied population with significant morbidity during a critical time period. This proposal is significant as it will provide an opportunity to assess the feasibility and explore the effect of low-dose aspirin on vascular function in addition to blood pressure. Effective interventions to improve postpartum hypertension care and reduce long-term cardiovascular risk have broad implications for improving maternal morbidity and reducing disparities in care. Our findings will provide a valuable framework to inform a subsequent large-scale randomized trial of low-dose aspirin in the postpartum period following preeclampsia. Successful completion of this line of research would represent a transformation in postpartum management of women with hypertensive disorders of pregnancy and have a direct impact to improve hypertension and cardiovascular-related maternal morbidity and mortality.