The Society for Vascular Surgery (SVS) Foundation has awarded its Vascular Care for the Underserved (VC4U) Project Grant to a study examining the link between reproductive history and peripheral artery disease (PAD). The project, titled “Linking Reproductive History to Vascular Health: Understanding Peripheral Artery Disease Risk After Adverse Pregnancy Outcomes,” is led by Katherine M. Reitz, MD, and Natalie Domenick Sridharan, MD.
The VC4U grants fund initiatives to close gaps in vascular care delivery across the United States. This year, the SVS Foundation partnered with the SVS Women’s Section to prioritize research on women’s vascular health — an area historically underrepresented in clinical studies.
“The SVS Foundation is proud to support trailblazing research that ensures women are included in vascular studies,” said Catherine Lampi, SVS Foundation director. “This award was made possible through the generosity of our donors, and we look forward to continuing to partner with the SVS Women’s Section to fund projects like this that advance equity and improve outcomes for all patients.”
PAD affects more than 200 million people worldwide and up to 10% of adults in the United States, according to the 2019 Global Disease Burden Collaborators. Prevalence is higher in women than men, but women remain underrepresented in PAD research and clinical trials. This lack of inclusion has contributed to the absence of sex-specific guidelines for reducing limb loss and cardiovascular mortality, both doctors explained in their project.
“The award is a generous seed funding that allows us to get additional preparation for research and will help us continue to grow in our research interests and in exploring women’s health, as it synergizes with PAD. This will help us continue to apply to more funding sources and continue to increase the amount of information we can put behind these efforts,” said Reitz.
Recent evidence links adverse pregnancy outcomes (APOs) — including hypertensive disorders, preterm delivery, gestational diabetes, placental abruption and pregnancy loss — to increased short- and long-term risk of atherosclerotic cardiovascular disease. The American Heart Association (AHA) recognizes APOs as predictors of cardiovascular morbidity and mortality and calls for early postpartum interventions. APOs affect one in five pregnancies, with rates rising in the United States.
Despite this evidence, the relationship between APOs and PAD remains unexplored. Obstetric history is rarely included in vascular evaluations, limiting clinicians’ ability to identify sex-specific risk factors. Understanding this connection could enable earlier diagnosis and targeted interventions to reduce complications in high-risk women.
The study will focus on Western Pennsylvania, where tobacco use, hypertension and diabetes disproportionately affect low-income neighborhoods and racially and ethnically minoritized populations. Both rural Appalachian and urban Pittsburgh communities face heightened risk for APOs and PAD. Magee-Women’s Hospital, which handles more than 10,000 deliveries annually, serves these vulnerable populations.
“More than anything, knowledge is power and knowing that these pregnancy outcomes are associated with adverse events, we can screen patients. We can continue to study it. We can continue to improve patient outcomes and try to get the outcomes for women, at least approaching those for men,” said Reitz.
Using electronic health records and the Magee Obstetric Maternal & Infant (MOMI) Database, investigators hypothesize that APOs are associated with early PAD development and adverse outcomes following lower extremity revascularization. The study has two aims:
- Aim 1: Identify APOs linked to early PAD onset and long-term major adverse limb events and cardiovascular events among women undergoing PAD treatment. Researchers will integrate data from 8,104 female PAD patients treated between 2016 and 2024 with APO data from more than 300,000 live births recorded from 1985 to 2019.
- Aim 2: Explore barriers and facilitators to implementing a structured obstetric history tool in electronic health records. Guided by the Consolidated Framework for Implementation Research, the team will interview clinicians, EHR developers and patients to design a sustainable process for integrating sex-specific history into vascular care.
Sridharan said the team will be working with the Clinical and Translational Science Institute at the University of Pittsburgh, where the grant funds will help them begin, asking the women questions and documenting their history.
“We’ll be having a summit with multiple stakeholders who are involved in women’s health and patient care and possibly even some patients themselves to see how we can integrate this history intake tool and the process of asking these important women’s health history questions to patients in a way that is acceptable and sustainable,” she said. “We’re going to do it in a very structured way to make sure that it fits into the clinic flow so that it’s not disruptive, it’s acceptable to patients, it’s integrated into our EMR so that we can collect this data hopefully for many years to come and identify the risk factors that are relevant to our patients so that we can intervene on them earlier in life.”
The team is based at a high-volume academic medical center anchored by UPMC Magee-Women’s Hospital, one of the largest women’s hospitals in the country. The system performs nearly 1,000 lower extremity revascularizations annually, 40% of which involve female patients, and about 1,200 carotid interventions, more than half of which include women.
Reitz and Sridharan also lead a vascular screening clinic for underserved patients. Seed funding from the Eastern Vascular Society (EVS) enabled a bi-monthly clinic serving unhoused and uninsured individuals in Pittsburgh, providing diagnostic and preventive services.
By investigating the link between APOs and PAD and creating a framework for integrating obstetric history into vascular care, the project aims to inform sex-specific risk factors and improve outcomes for women. Findings could lead to scalable strategies for early diagnosis and intervention, ultimately reducing disparities in vascular health.
“We see this as something that can potentially be rolled out to other providers, whether that is gynecologists, women’s health providers or cardiologists. We’re hopeful that this knowledge and the tools that we create from the studies that come from this grant are something that can be used to help inform other providers and provide screening tools for them, as well to help capture these patients earlier, possibly get them vascular referrals earlier or possibly get them on medications for prevention of vascular disease and adverse outcomes,” said Sridharan.
