AtorvaStatin Postpartum and Reduction of Cardiovascular risK

Individuals will be followed for up to 1 year to address the following specific aims: Specific Aim 1: To determine if among individuals diagnosed with hypertensive disorders of pregnancy (HDP), the use of atorvastatin 10 mg daily initiated in the postpartum period following cessation of breastfeeding and continued for 3 months, lowers cardiovascular risk, as measured by the Framingham Risk Score for Cardiovascular Disease (30 year risk, primary outcome) and cardiovascular risk prediction model (PREVENT, secondary outcome) compared with placebo; and if the benefit will persist for at least 3-6 months following discontinuation of atorvastatin treatment. Specific Aim 2: To determine if among individuals diagnosed with HDP the use of atorvastatin 10 mg daily initiated in the postpartum period following cessation of breastfeeding and continued for 3 months lowers the frequency of metabolic syndrome, improves lipid levels, and reduces inflammatory markers compared with placebo; and if this benefit will persist for at least 3-6 months following discontinuation of atorvastatin treatment. Specific Aim 3: Determine if circulating extracellular vesicles (EVs) from patients with HDP mediate increased CV risk factors and the potential of EV-based therapeutics to dampen these risk factors. We will isolate plasma-derived EVs from individuals with HDP using retrospective samples and perform in vivo and in vitro functional and metabolic assays. We will also analyze the molecular cargo of EVs isolated from individuals in Aim 1 to identify specific pathways that can be targeted via engineered EVs to attenuate the increased CV risk after HDP.