Trajectories of ovarian reserve and cardiovascular risk in Black and White women

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Abstract The reproductive lifecycle of a women can affect her long-term health including onset of cardiovascular disease. The menopausal transition affects the onset and timing of cardiovascular changes that can lead to long term health consequences. There is a link between the age at menopause and cardiovascular mortality and heart failure, as earlier onset of menopause is associated with higher rates of cardiovascular disease. The size of the ovarian follicle pool and cessation of ovarian hormone production is a key factor that influences the timing of menopause. Serum anti-mullerian hormone (AMH) has emerged as an important marker of the ovarian follicle pool. AMH has been shown to reflect the gradual decline in reproductive capacity with increasing age. Early decline in AMH and a more rapid trajectory of decline have been associated with increased risk for cardiovascular disease. This study supplement will test AMH values at multiple timepoints over the reproductive lifespan by utilizing stored samples and prospective samples from the NHLBI Growth and Health Study (NGHS). NGHS enrolled 871 girls (50% Black 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. The parent study for this supplement will be enrolling 350 NGHS participants in the late reproductive stage (average age 46) and collecting cardiovascular labs and imaging as well as update lifetime information on socioeconomic status and social determinants of health. This supplement will add assessment of ovarian reserve trajectory of time to: 1) Determine differences in the ovarian reserve and its trajectories between Black and White women and how the social determinants of health (SDOH) impact this difference; 2) Determine if the trajectory of ovarian reserve decline across the reproductive life-course affects cardiovascular disease risk or disease. In addition, this supplement aims to create a study participant advisory group to help optimize study recruitment and retention particularly in Black women. With completion of our aims, we will understand the effect of SDOH and race on ovarian reserve as well as determine if the rate of ovarian reserve decline can be a marker for future cardiovascular disease. This supplement is designed to enhance the parent grant by adding additional information about the reproductive system affecting cardiovascular disease as well as provide mechanisms to improve subject recruitment, retention, and satisfaction with the study.