A Pound of Cure
Preterm childbirth correlates with later cardiovascular disease in women, providing an opportunity for prevention.
Chronic diseases grab on to the body and are hard to shake. Very few have cures.
“In medical school, they emphasized that an ounce of prevention is better than a pound of cure. And it is, especially for chronic conditions like heart disease that must be managed for many years,” says Dermot McGovern, MD, PhD, director of Cedars-Sinai Precision Health, and the Joshua L. and Lisa Z. Greer Chair in Inflammatory Bowel Disease Genetics.
Besides aiding the sick, precision medicine also can help healthy people stay well. One study at Cedars-Sinai applies its individualized tactics to investigate how adverse pregnancy outcomes can be used to identify women at risk for cardiovascular disease. Once identified, patients and physicians can initiate prevention strategies that may limit future heart disease risk.
“Preterm delivery is a marker of future heart disease, but many clinicians are unaware of the risk,” says Margo Minissian, ACNP, a nurse scientist and cardiology nurse practitioner at the Barbra Streisand Women’s Heart Center at the Cedars-Sinai Heart Institute.
In fact, preterm delivery (at 37 weeks or less) doubles a woman’s risk for cardiovascular disease. Combine that with other adverse pregnancy outcomes such as preeclampsia, a condition marked by high blood pressure, and a woman is up to eight times more likely to have heart disease later in life.
Minissian is investigating the problem in a National Institutes of Health-funded project. When a new mom delivers early, Minissian heads down to the Labor and Delivery Unit within 72 hours to conduct vascular testing and oversee a blood draw in women who consent to participate in the study. More tests are conducted six months later. Minissian is leading the study with maternal-fetal expert Sarah Kilpatrick, MD, PhD, and they are collaborating with proteomics specialist Jennifer Van Eyk, PhD.
“We are looking at inflammatory markers as well as blood pressure and cholesterol numbers that might be risk factors in creating a perfect storm of impaired vascular function,” Minissian says.
“In medical school, they emphasized that an ounce of prevention is better than a pound of cure. And it is, especially for chronic conditions like heart disease that must be managed for many years.”
— Dermot McGovern, MD, PhD
To hunt for the biochemical markers, Minissian and her collaborators employ cutting-edge technology that is 1,000 times more sensitive than that used to assess a patient with an active, obvious condition like a heart attack. The study also uses equipment that noninvasively assesses blood-vessel health with extreme accuracy. The data will help create a heart disease risk-stratification system for women of childbearing age.
“Women who give birth have put themselves through a nine-month physiological stress test called ‘pregnancy,’” Minissian says. “We are identifying women who have an adverse response to pregnancy and asking why.”
Many women are not assessed for cardiovascular problems until they already have symptoms, so clinicians like Minissian end up managing heart attacks and strokes instead of preventing them.
“If we can identify these women during their childbearing years, manage their blood pressure and cholesterol, and educate them about nutrition, exercise, and other heart-healthy behaviors, we can deviate them from the track to heart disease,” she says.