Fellowship in support of Priya Mehta - ACC/Merck Fellowship in Cardiovascular Disease and the Metabolic Syndrome

Cardiovascular disease (CVD) remains the leading cause of death among women in the United States, accounting for >400,000 deaths annually1. Despite significant declines in CVD mortality in the past 3 decades, premature onset of CVD and deaths attributable to CVD in women are now increasing, especially among black women1-3. Pregnancy acts as a “window,” to enable clinicians to predict future cardiovascular risk and is a critical period to assess a woman’s cardiovascular health (CVH). Identification of sex-specific CVD risk factors for women, such as adverse pregnancy outcomes (APO) is critical to inform primary prevention strategies and reduce existing sex-based disparities.4. Hypertensive disorders of pregnancy (pre-eclampsia and gestational hypertension), pre-term birth, and intrauterine growth restriction, are a common, inter-related group of vascular disorders that occur in pregnancy and are emerging as an important predictor of future CVD risk4. These related APOs occur in approximately 20% of all pregnancies, are disproportionately higher among black women, and are a leading cause of both maternal morbidity and mortality in the United States5. In addition, 25-45% of women with a hypertensive disorder of pregnancy develop hypertension within five years of delivery6. Because of this, the American College of Cardiology and American Heart Association (AHA) have recognized the importance of these disorders in comprehensive CV health promotion and CVD prevention in women7-9, and has encouraged collaboration between cardiologists and obstetrician/gynecologists to promote CVH in women10. However, clinical awareness of the link between APO and and CVD remains incomplete. While evidence supports that women with a history of APOs have a higher lifetime risk of CVD when compared to women with no history of APOs11-13, the pathways between the development of APOs and CVD are not well understood. Preliminary data suggest that APOs may be a marker of placental dysfunction, abnormalities in maternal vasculature, and a proinflammatory phenotype14. Women with APO’s may be more likely to have abnormal myocardial and vascular function, which is known to precede and predict CVD15. To explore this critical knowledge gap in women, I will leverage data from 1) The Coronary Artery Risk Development in Young Adults (CARDIA) Study, a longitudinal cohort study of 5,115 young adults (2787 women) recruited in 1985-1986 at 18 to 30 years of age and 2) Prospective participants recruited from the Northwestern Medicine Health System. CARDIA provides a unique opportunity to study the potential relationship between APO and cardiac mechanics in mid-life, given the young age at enrollment, biracial composition of the cohort, longitudinal follow-up at 9 in-person examinations over 30 years spanning the majority of a woman’s reproductive period with extensive and repeated phenotyping (including echocardiograms). Approximately 12,000 deliveries are performed annually at Northwestern, which provides the ideal resource to recruit women to prospectively investigate the association of APO and subclinical cardiovascular changes in the early post-partum period.