February 27, 2017
Novel insights into pregnancy might reveal a great deal about heart disease risks in women. By studying cardiovascular health and impairments during pregnancy, researchers can detect more than just birth complications; they can detect how cardiovascular disease affects women later in their lives.
Women who have had vascular problems during pregnancy, specifically microvascular or small vessel impairments, may be at higher risk for cardiovascular disease years later. “Microvascular disease is actually a more prevalent pathway to heart disease in women compared to men,” warns Dr. Janet Catov, primary investigator at Magee-Womens Research Institute (MWRI) and associate professor at the University of Pittsburgh’s School of Obstetrics, Gynecology and Reproductive Services. “The classic heart disease pathway is through large vessel blockages—[known as] atherosclerosis. Plaque accumulates in the vessels and occludes blood flow, ultimately leading to coronary disease. In microvascular disease, the large vessels may be clear, and yet women have heart attacks. It’s not the traditional pathway, but the thought is that those small vessel impairments also lead to heart disease.”
MWRI’s interest in studying microvascular disease is part scientific, part public health. By shedding light on the risks of cardiovascular disease for women through the lens of pregnancy, researchers hope to raise awareness about women’s cardiovascular health in general. The misconception that heart disease is not a woman’s disease is still, unfortunately, prevalent. Dr. Catov explains, “We’re studying these microvascular mechanisms that are really novel, untapped questions. This work, however, is built on twenty years of evidence, much of it done here at Magee, that pregnancy complications like preeclampsia, gestational diabetes, etc. mark excess heart disease risk for women.”
A 4-year, $3.7 million dollar grant from the American Heart Association awarded to Dr. Catov and her colleagues, Carl Hubel, PhD; Robert Powers, PhD; and Jim Roberts, MD, will allow MWRI to examine if and how pregnancy-related blood vessel changes can identify risks of cardiovascular disease in women and help identify new interventions. The study, “Women’s Cardiovascular Health and Microvascular Mechanisms: Novel Insights from Pregnancy”, looks at women earlier in their life course to examine this potential. MWRI is one of five centers funded by the American Heart Association that is studying heart disease in women, and the only one looking at women in pregnancy. By looking at the relationship between small vessel impairment during pregnancy and later cardiovascular health in women, researchers hope to identify high-risk groups of women and change the course of their cardiovascular health for the better.
Identifying CVD Before a Heart Attack
Heart disease in women doesn’t always present the same symptoms as it does in men or even in seniors. By identifying a woman’s risk in pregnancy, scientists can better understand causes and intervene before a heart attack happens. “Our notion is that if we could identify a risk [of cardiovascular disease] at pregnancy, many years before a first heart attack, we could potentially identify women very early in their lives where interventions could actually change the course of their long-term health,” Dr. Catov explains. Interventions for a high-risk population could be as simple as advising that group see their doctor more regularly or undergo more frequent blood pressure and/or lipid checks.
There’s evidence that sedentary time may also be important for women with an increased risk of cardiovascular disease. Dr. Catov adds, “We are asking women about activity—structured activity, how many hours a day do they sit on average, etc. We are planning to look at [that data]…to see if we can identify a high-risk group of women. We are also looking at data that suggests what might change that pathway—an activity or reduced sedentary time might actually be a particularly important kind of intervention for those high-risk women.”
Microvascular Impairments Later in Life
One immediate benefit of studying women’s cardiovascular health during pregnancy is the ability to understand more about pregnancy complications and how they may be tied to small vessel impairments after a woman has given birth. The epithelium, for instance, is one of these components being studied by Dr. Carl Hubel as a part of this grant. This single-cell layer that lines the blood vessels may play a key role in vascular health in women’s later lives.
Dr. Catov’s research takes a deeper look at small vessel impairments detected in the placenta and how those might mark women at a higher risk for small vessel disease years after pregnancy. Her hypothesis is relatively straightforward: women who exhibit these small vessel impairments in the placenta will go on to have a higher risk for microvascular dysfunction eight to ten years after pregnancy. “We’re using the [Magee Obstetric Maternal and Infant Database, or MOMI] registry—a registry of women who delivered their babies at Magee eight to ten years ago. We have lots of clinical information about the course of those pregnancies and we also very uniquely have a clinical evaluation of the placenta that includes a characterization of small vessel impairments,” Dr. Catov explains.
Eight years after the fact, a woman isn’t typically thinking about how her previous pregnancy is related to her current health. Dr. Catov says, “We’re interested in pregnancy itself as it is a pivotal launch of what Yoel Sadovsky, MD, Director of the Magee-Womens Research Institute, calls the 9-90 story.”
“There may well be important markers—for example in my project, the placenta—that are related not only to mom’s health but could actually be important for her child’s health,” Dr. Catov goes on to explain. “We’re hoping to leverage this line of inquiry in approaching other important health questions.”
Pregnancy: a Pivotal Time for Women’s Health
Pregnancy is unique for women not only in a biological sense, but also for being a key time for women to access healthcare. Increased access to health care means pregnancy is an ideal time to assess a woman’s risk of cardiovascular disease. “It’s also a time when women are really motivated to be healthy,” Dr. Catov says. She adds that, “Nearly all women access health care during pregnancy. And that access is not paralleled in her life course until she’s in older adulthood. It’s not only a key time but it may actually be the only time for ten, twenty years before someone’s really looking at her whole health story.”
A woman plays a key role in how her family accesses health care, so pregnancy is also a time that can set the stage for a woman’s long-term health and the health of her family. By disseminating the information that pregnancy reveals about heart-related health risks, this research study could trigger long-term awareness for many women.
Despite being identified in screening guidelines for women back in 2011, there’s still a disconnect between women linking a complicated pregnancy to a potential higher risk for heart disease.
As Dr. Catov talks about the team’s research, she invariably finds women in the audience who make the connection. She hears vocal discoveries of, “Oh my gosh, I had preeclampsia, my mom had preeclampsia, I didn’t know that this was attached to excess heart disease risk!”
“Pregnancy is a critical, life-changing event—biologic and beyond—in a woman’s life. That is an important part of this work, and what brings such passion to me. Women really pay attention to how their experience might be related to their health or their child’s health. It’s a very powerful experience in a woman’s life that I think we could really not only learn more about but would actually motivate women as well.”
Want to get involved? MWRI is currently identifying eligible women through the Pitt+Me community. If you are interested in determining your eligibility for the research study, visit Pitt+Me to learn more.