Effect of reproductive history on longitudinal change in cardiac, vascular and lipid parameters

摘要 怀孕通常被描述为一种生理上的“压力测试”，可能会发现潜在的风险。 高血压、糖尿病和心血管疾病。即使在不复杂的怀孕中，女性也会经历快速 心脏代谢变化以支持胎儿发育。虽然许多这样的改编 分娩后不久恢复正常，一些变化持续存在，包括超声心动图的变化 心脏结构和较低的高密度脂蛋白胆固醇(HDL-C)。不管是这些 与怀孕有关的变化，或高密度脂蛋白颗粒结构或功能的变化，有助于 长期的心血管风险是未知的。平价，或活产婴儿总数，在后 更年期妇女患心血管疾病的风险也更高 高密度脂蛋白胆固醇水平、高密度脂蛋白结构和功能以及心脏和血管功能的改变。 然而，在将观察到的心血管变化联系起来方面存在着显著的研究差距。 怀孕与观察到的产次与绝经后心血管健康的关系。 我们将通过利用现有数据和来自NHLBI增长的样本来解决这一差距 健康研究(NGHS)并对350名参与者进行了新的面对面访问，年龄中值为46岁， 当女性处于绝经期前或围绝经期时。NGHS招收了871名女孩(50%是非洲人- 美国人和50%的白人)在1987年9或10岁时进行了长达17次的检查，直到27岁， 包括7个20-27岁的超声心动图，多个保存的样本和生殖 历史问卷。这项研究将进行详细的脂蛋白大小和功能 从存储的和新的样本中进行评估，并进行心血管成像和重复 超声心动图在中位年龄46岁至：1)确定特定的脂蛋白颗粒大小 从任职前到任职短期和长期的分布和职能变化 怀孕；2)确定与怀孕相关的心脏适应是否会导致长期的 心脏结构和功能的改变，从而增加妇女患心血管疾病的风险 40岁；以及3)检验是否与社会经济地位无关地平价会增加心血管风险 (SES)在非裔美国人和白人妇女中。随着我们目标的完成，我们将拥有 确定妊娠相关脂蛋白与心血管疾病之间的预期途径 40多岁女性绝经前心血管健康的变化。结果来自我们的 拟议的研究将填补我们对此类风险如何积累的理解上的一个关键空白。 在女性的生殖生活中，以及社会经济地位如何有助于平等- 相关风险长期存在。这项研究中的女性也暴露在肥胖症流行中， 为当代生殖发展提供更多的理解。

Abstract Pregnancy is often described as a physiologic “stress test” that may uncover latent risk for hypertension, diabetes and CVD. Even in uncomplicated pregnancies, women experience rapid cardiometabolic changes to support fetal development. While many of these adaptations normalize soon after delivery, some changes persist, including echocardiographic changes in cardiac structure and lower high-density lipoprotein cholesterol (HDL-C). Whether these pregnancy-related changes, or alterations in HDL particle structure or function, contribute to long-term cardiovascular risk is unknown. Parity, or the total number of live births, among post- menopausal women is also associated with greater risk of cardiovascular disease and alterations in HDL-C levels, HDL structure and function, and cardiac and vascular function. However, a significant research gap exists in linking observed cardiovascular changes across pregnancy to the observed associations of parity with cardiovascular health post-menopause. We will address this gap by leveraging existing data and samples from the NHLBI Growth and Health Study (NGHS) and conduct a new in-person visit in 350 participants at median age 46, when the women will be pre- or peri-menopausal. NGHS enrolled 871 girls (50% African- American and 50% white) in 1987 at age 9 or 10 and examined them up to 17 times, to age 27, including 7 echocardiograms between ages 20-27, multiple saved samples and reproductive history questionnaires. This study will conduct detailed lipoprotein sizing and functionality assessments from stored and new samples and conduct cardiovascular imaging and repeat echocardiograms at median age 46 to: 1) Determine the specific lipoprotein particle size distribution and function changes which occur from before to short- and long-term post pregnancy; 2) Determine whether pregnancy-related cardiac adaptations result in long-term alterations in cardiac structure and function, thereby increasing CVD risk for women in their forties; and 3) Test whether parity increases CV risk independently of socioeconomic status (SES) in African-American and white women. With the completion of our aims, we will have determined the prospective pathways between pregnancy-related lipoprotein and cardiovascular changes and pre-menopausal cardiovascular health for women in their forties. Results from our proposed studies will fill a critical gap in our understanding of how such risks may accumulate during a woman's reproductive life, as well as how socioeconomic status contributes to parity- related risk long-term. Women in this study have also been exposed to the obesity epidemic, lending greater understanding to contemporary reproductive development.