# Hypertensive Disorders of Pregnancy: Pathways to Future Cardiovascular Disease

> **NIH NIH K23** · THE CHRIST HOSPITAL · 2020 · $160,211

## Abstract

PROJECT ABSTRACT/SUMMARY
There are clear sex differences between women and men in the presentation, etiology, and outcomes of
cardiovascular disease (CVD). Among the most prominent sex-specific risk factors for women are those related
to pregnancy, including hypertensive disorders of pregnancy such as gestational hypertension and
preeclampsia. In fact, preeclampsia increases risk of coronary artery disease by 2-fold, heart failure (HF) by 4-
fold, and CV mortality by up to 8-fold in affected compared to unaffected women. Despite this substantial risk
burden, surprisingly little is known regarding the mechanisms that drive the development of pregnancy-related
hypertensive disorders or the subsequent CVD outcomes in these vulnerable women. Emerging but limited data
suggest that some, but not all, women with the presence of pre-conception clinical metabolic traits are
predisposed to hypertensive disorders of pregnancy. There is also heterogeneity in the extent to which some,
but not all, women with a history of preeclampsia have abnormalities in cardiovascular structure or function. We
hypothesize that: (i) the stress of pregnancy augments pre-existing metabolic and inflammatory derangements
in certain women, making them more susceptible to hypertensive disorders of pregnancy; (ii) in this setting, the
hypertensive disorder of pregnancy triggers a cascade of inflammation and oxidative stress that persists and
results in additional endothelial damage and coronary microvascular dysfunction (CMD), a previously
unrecognized driver of CVD risk; and, (iii) women affected by a hypertensive disorder of pregnancy, especially
in the setting of pre-existing metabolic and inflammatory risk and CMD, are more likely to experience accelerated
subclinical cardiac disease and progression to clinical CVD. To test our hypotheses and clarify the mechanisms
by which certain women are made vulnerable to hypertensive disorders of pregnancy and subsequent CVD, we
will comprehensively interrogate clinical, biochemical, and physiological determinants across the spectrum of
pregnancy-related CVD risk in both a community cohort enriched with metabolic traits and a clinical cohort that
is deeply phenotyped using advanced non-invasive CV diagnostics.
This K-23 award will support my goal of becoming a translational clinical investigator in women’s cardiovascular
health with expertise in epidemiology, population science, advanced cardiac imaging and hypertensive disorders
of pregnancy. The proposed project aligns with the National Institute of Health’s (NIH) mission and highlights the
need for “investigations of the many factors underlying the health of women (https://orwh.od.nih.gov).”

## Key facts

- **NIH application ID:** 10201985
- **Project number:** 7K23HL151867-02
- **Recipient organization:** THE CHRIST HOSPITAL
- **Principal Investigator:** Odayme Quesada
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $160,211
- **Award type:** 7
- **Project period:** 2020-05-04 → 2025-08-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10201985

## Citation

> US National Institutes of Health, RePORTER application 10201985, Hypertensive Disorders of Pregnancy: Pathways to Future Cardiovascular Disease (7K23HL151867-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10201985. Licensed CC0.

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