7. ABSTRACT Cardiovascular disease (CVD) remains the leading cause of mortality globally. About three quarters of CVD deaths occur in the low- and middle-income settings. Although CVD related deaths have progressively declined in high income settings, mortality among adults below 55 years especially women have stagnated, most likely due to female specific risk factors. One such factor, new onset hypertensive disorders of pregnancy (HDP) is associated with 2-fold or greater risk for future metabolic syndrome, chronic low-grade inflammation and heart failure. However, majority of studies on long-term heart failure risk after HDP have mostly focused on end-stage disease and not the progression of asymptomatic cardiac dysfunction. Previous studies have shown that even the asymptomatic patients with myocardial dysfunction have compromised prognosis with an increased risk of developing symptomatic heart failure in the future. Therefore, early identification of at-risk population of women is critical and would allow implementation of intervention strategies to delay the progression or to prevent the onset of heart failure. Few studies in high income settings and none in SSA have evaluated the risk and correlates of subclinical cardiac dysfunction after HDP using speckle tracking echocardiography (STE) which accurately quantifies myocardial mechanics, including global longitudinal strain (GLS), a prognostic marker of adverse CVD outcomes. Using STE, we aim to understand and describe the presence and progression of asymptomatic cardiac dysfunction after pregnancies complicated with HDP (Aim 1) and evaluate the contribution of inflammation at 3 years postpartum by comparing women with and without new onset of new hypertensive disorders of pregnancy (Aims 2 and 3). The study findings will inform the development of novel and scalable screening and monitoring strategies to manage CVD risk after HDP and therefore reduce CVD and CVD- mortality in sub-Saharan Africa and globally.

8. Project Narrative For this R21 award, the proposed clinical research will allow the applicant to evaluate the prevalence and correlates of subclinical cardiac dysfunction after hypertensive disorders in pregnancy, specifically preeclampsia and gestational hypertension. In addition, the proposed project will evaluate the association between inflammatory biomarkers and subclinical cardiac dysfunction at 3 years after delivery. The research findings will inform screening, monitoring and prevention interventions to reduce cardiovascular disease burden among women in this setting. ! !