Hypertensive disorders of pregnancy (HDP) are a common and major risk factor for cardiovascular disease (CVD) that increase mortality by 13% compared to normotensive pregnancies. Although modifiable risk factors account for the majority of excess cardiovascular risk after HDP, these risk factors have only been studied in white women. Black women have a higher prevalence and severity of CVD and HDP; however, it is not known if they have similar risk patterns. Additionally, CVD and HDP have a substantial heritable genetic risk. However, it is unclear whether the genetic risk for CVD contributes to the development of HDP. Our main hypothesis asserts that race modulates cardiovascular risk factors after HDP and that CVD and HDP have at least some shared genetic risk. To test this hypothesis, we will leverage large de-identified databases of electronic health records (EHR) linked to genetic data. We propose the following specific aims: (1) To evaluate the impact of race on modifiable risk factors for CVD after HDP; (2) To quantify the effect of polygenic coronary artery risk (CAD) risk to the development of HDP. Aim 1 will use routinely recorded modifiable risk factors from EHRs. This will include BMI, blood pressure, and non-HDL cholesterol for black and white women with at least one HDP. We will test the association of each risk factor to CVD and if they are modulated by race. The results will identify candidate risk factors that can predict CVD and determine if they are different between blacks and whites. Aim 2 will measure genetic risk for CAD, a genetically well-characterized subtype of CVD, in white women with and without HDP. An individual's genome-wide CAD genetic risk will be measured using a polygenic risk score (PRS). We will test for an association between CAD PRS and HDP status. This will reveal if the genetic risk for CAD contributes to developing HDP. These analyses will demonstrate potential insights for cardiovascular risk stratification and underlying genetic mechanisms for CVD after HDP. This project directly advances the AHA's mission by furthering our understanding of how CVD risk emerges after HDP, promoting scientific inquiries into cardiovascular health, and informing the development of clinical risk stratification for CVD.
|Program type||Predoctoral Fellowship|
|Effective start/end date||01/01/2020 → 12/31/2021|