Project 1. Hypertensive Pregnancy Disorders: Future Cardiovascular Disease and Cognitive Functioning

Principal investigator: Vesna D. Garovic, M.D.; co-investigators: Michele M. Mielke, Ph.D., Slavica K. Katusic, M.D., and Walter A. Rocca, M.D.

The aim of this project is to test the hypothesis that a history of hypertensive pregnancy disorders, in general, and preeclampsia, in particular, are risk factors for all-cause and cardiovascular mortality, future cardiovascular disease, future cerebrovascular disease, and cognitive impairment using a population-based approach. The REP will be used to identify women who delivered babies in Olmsted County, Minn., between 1976 and 1982. Hypertensive pregnancy disorders will cover a spectrum of conditions including preeclampsia, eclampsia, preeclampsia superimposed on chronic hypertension, chronic hypertension and gestational hypertension.

Hard endpoints (adverse cardiovascular events and dementia) will be identified from the medical records. A subsample of women with a history of preeclampsia without a clinical event (suggestive of subclinical disease) will be matched by age and education to those without a history of preeclampsia and will be invited for cognitive testing and vascular and platelet studies. Thus, it will be possible to identify long-term consequences of the preeclamptic event with future cognitive health and to identify a potential mechanism mediating these consequences through changes in thrombotic characteristics of the blood and cerebrovascular dilatory capacity.

Although several studies have implicated hypertensive events of pregnancy with future adverse cardiovascular events, little attention has focused on the cerebral vasculature and cognitive health. Furthermore, although increased platelet activation is recognized in women with preeclampsia compared with those with normotensive pregnancy, platelet activation or thrombotic propensity of the blood has not been investigated in those women later in life.

Results of this study will provide essential information for the overarching theme of the SCOR by validating how the female sex-specific condition of preeclampsia affects cerebrovascular function and cognition in middle-aged women.