Cardiovascular Risk after Preeclampsia - The CRISP study

项目总结/摘要 心血管疾病（CVD）每年导致全球860万女性死亡， 对非裔美国女性有很大影响。先兆子痫（PEC）影响所有妊娠的3-8%， 现在被美国心脏协会认为是心血管疾病的一个有效的独立危险因素。增加的 有PEC病史的女性的心血管（CV）风险被认为来自血管功能障碍， 这是这种疾病的标志性特征。 CVD的发展通常发生在暴露于PEC后20-30年。但有一个 缺乏研究调查暴露于PEC后十年内心脏危险因素的存在， 女性年轻时，PEC疾病发展和明显CVD之间的中间时期 （30-40岁），否则可能不会寻求护理。我们的首要目标是了解PEC的历史 改变女性的长期CV健康。实现这一目标的第一步是评估是否存在风险因素 在发生明显的CV事件之前，将既往暴露于PEC的女性确定为CVD高风险，以便 以早期干预和治疗战略为目标。我们建议的基本前提是， 有PEC病史的女性将有更高的CVD传统危险因素患病率， 与无PEC病史的女性相比，中间CV表型的患病率更高。 将对本研究中的女性进行长期随访，以将这些风险因素与未来的CV事件相关联。 我们在解决这一重要的临床问题方面具有独特的优势。我们有一群女性 （n=441）和无PEC（n=591），这些患者之前参加了在我们的 从2005年到2007年。该队列的一个特殊优势是对病例和对照进行了评价， 并且在专业产科医生登记时具有良好的表型，使我们能够有有限的偏倚 关于PEC的初步诊断以及控制大量元数据的能力， 在登记时收集。增加了这一群体的丰富性，这些妇女中有75%以上是 非洲裔美国人，提供了一个独特的机会，研究高风险，但通常研究不足的人口， 前者比后者更易患病，也更严重。该队列将作为研究人群 我们目前的提案。我们有一个由产科医生，心脏病专家，血管研究人员组成的多学科团队 和流行病学家，并准备好完成我们的专业知识和先前的合作研究。 总之，在一项针对150名女性的可行性研究中，我们证明了原始研究中57%的女性， 现在距离他们最初暴露于PEC 10（+/-1）年，可以联系，同意参与并出席 学习访问。这项研究的完成将解决有关该协会的知识的重大差距 PEC和CVD之间的关系。

PROJECT SUMMARY/ABSTRACT Cardiovascular disease (CVD) is responsible for the annual death of 8.6 million women worldwide and disproportionally affects African American women. Preeclampsia (PEC) affects 3-8% of all pregnancies and is now recognized by the American Heart Association as a potent independent risk factor for CVD. The increased cardiovascular (CV) risk in women with a remote history of PEC is posited to be from the vascular dysfunction that is the hallmark feature of the disease. The development of CVD typically occurs 20-30 years after the exposure to PEC. However, there is a paucity of research investigating the presence of cardiac risk factors in the decade after exposure to PEC – an intermediate time period between the development of PEC disease and overt CVD, when women are young (30-40's) and might not otherwise be seeking care. Our overarching goal is to understand how a history of PEC modifies a woman's long-term CV health. The first step in this goal is to evaluate whether there are risk factors that identify a woman previously exposed to PEC as high risk for CVD, prior to an overt CV event in order to target early intervention and therapeutic strategies. The fundamental premise of our proposal is that women with a history of PEC will have a higher prevalence of traditional risk factors for CVD and a higher prevalence of an intermediate CV phenotype compared to women without a history of PEC. Women from this study will be followed long-term in order to correlate these risk factors with future CV events. We are uniquely positioned to address this important clinical question. We have a group of women with (n=441) and without PEC (n=591) that were previously enrolled in a prospective study conducted at our institution from 2005-2007. An exceptional advantage to this cohort is that cases and controls were evaluated and well-phenotyped at the time of enrollment by specialized Obstetricians, allowing us to have limited bias regarding initial diagnosis of PEC as well as the ability to control for a large amount of metadata that was collected at the time of enrollment. Adding to the richness of this cohort, more than 75% of these women are African American, providing a unique opportunity to study a high risk yet typically understudied population, in whom PEC and CVD are both more prevalent and more severe. This cohort will serve as the study population for our current proposal. We have a multidisciplinary team of obstetricians, cardiologists, vascular researchers and epidemiologists and are well poised to complete the study given our expertise and prior collaboration. Together, in a feasibility study of 150 women, we demonstrated that 57% of women from the original study, now 10 (+/-1) years from their initial exposure to PEC, can be contacted, agree to participate and present for a study visit. Completion of this study will address significant gaps in knowledge regarding the association between PEC and CVD.