Reducing the research gap for cardiovascular risk in women

Dr Clare Arnott, cardiologist at the RPA

Dr Clare Arnott is a cardiologist at the Royal Prince Alfred Hospital with a special interest in women’s cardiovascular disease, specifically following high-risk pregnancies.

She has been awarded a Churchill Fellowship to pursue clinical and translational research questions including the pathophysiology linking preeclampsia and CVD and how to attenuate risk in the postpartum period.

Can you describe the aim of your research in 10 words?

To improve cardiovascular outcomes for women and address the gender research gap.

What have you discovered in this area so far?

That women following preeclampsia exhibit elevated fasting lipid profiles, significantly elevated high sensitivity CRP (a marker of future cardiovascular events) and impaired endothelial function (reduced brachial flow mediated dilatation).

Beyond this, we have discovered that the current paradigm of clinical care does not offer women with preeclampsia adequate education/information and cardiovascular follow-up.

Moreover, primary care physicians report that they are poorly educated regarding the cardiovascular ramifications of hypertensive disorders of pregnancy and are not given appropriate evidence-based tools to accurately risk stratify these women.

What aspect of this research excites you the most?

The prospect of not only understanding the pathophysiological links between preeclampsia and cardiovascular disease but to be able to attenuate that risk in the medium to long term.

Currently when I see women and their families in the post-partum setting, I explain that preeclampsia is a vascular condition and that it may have long term ramifications for their health.

I would love to be able to tell them that, beyond addressing other modifiable risk factors, I could reduce that risk to them through a safe intervention.

You’ll be travelling to the Mayo and Stanford in the US as part of the Fellowship. What are the opportunities there?

Both of these clinics have more than 10 years of experience in women’s cardiovascular disease.

Their multi-disciplinary teams employ evidence-based and gender specific methods to engage women and institute positive lifestyle modification and primary/secondary prevention.

I hope to learn these methods and bring them back to our clinic at the Charles Perkins Centre (RPA/USYD).

Moreover, we aim to create strong international research collaborations focused on elucidating the mechanistic links between preeclampsia and cardiovascular disease and interventions to reduce this risk.

Given that the majority of cardiovascular studies are based on men, we hope our research will help to close this gender research gap and improve outcomes for women.

 What is your Holy Grail – the one thing you’d like to achieve through your research?

Identify a safe treatment that not only improves endothelial function and inflammatory profiles in the short term but also reduces rates of recurrent preeclampsia in subsequent pregnancies, and ultimately attenuates long-term cardiovascular risk.

How far is your work from impacting patient care?

From a primary care and education perspective we are already impacting on clinical care.

Every woman who presents to our institution with preeclampsia is offered a cardiovascular review, thorough assessment of risk factors and lifestyle/risk factor interventions as appropriate.

Until now, women in our health district (and more widely) were not offered this care. Furthermore, we are educating women and their families regarding their long-term risk and empowering them to actively monitor and address other modifiable risk factors.

We are then taking this message to GPs through education sessions.

In regards to understanding the pathophysiological links between preeclampsia and cardiovascular disease, we are currently enrolling women in a randomised clinical trial non-invasively assessing their endothelial function, inflammatory profile and vascular resistance.

Our next step is to determine whether our structured lifestyle modifications and aspirin therapy can reduce their risk. This work is still several years away from impacting on clinical care.

What is your biggest research hurdle?

For decades people have thought of cardiovascular disease as a man’s disease. Not only is cardiovascular disease the leading cause of death in women in Australia, but women are more likely to present later than men, have more complications and are more likely to die.

Moreover, cardiologists and other physicians have not considered that conditions during pregnancy are relevant to long-term health.

Convincing them of the importance and relevance of preeclampsia and other hypertensive or metabolic disorders of pregnancy to a woman’s cardiovascular health is so difficult.

Who has inspired you?

I am surrounded by so many brilliant and inspiring clinicians and scientists it’s hard to choose one!

Professors David Celermajer and Jon Hyett have both been, and continue to be, incredible mentors to me.

They both have such an amazing commitment to their patients and their colleagues and a single-minded determination to challenge/question in order to learn. I owe so much to them.

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