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Chen T, Wu J, Pan Q, Dong M. The association of female reproductive factors with history of cardiovascular disease: a large cross-sectional study. BMC Public Health 2024; 24:1616. [PMID: 38886693 PMCID: PMC11181605 DOI: 10.1186/s12889-024-19130-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 06/13/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND This study aimed to explore the association of female reproductive factors (age at first birth (AFB), age at last birth (ALB), number of pregnancies, and live births) with history of cardiovascular disease (CVD). METHODS A total of 15,715 women aged 20 years or over from the National Health and Nutrition Examination Surveys from 1999 to 2018 were included in our analysis. Weighted multivariable logistic regression analysis and restricted cubic spline (RCS) model were used to evaluate the association of AFB and ALB with history of CVD in women. Additionally, the relationship between the number of pregnancies, and live births and history of CVD was also explored. RESULTS After adjusting for potential confounding factors, the RCS plot showed a U-curve relationship between AFB, ALB and history of CVD. Among them, AFB was associated with congestive heart failure (CHF), heart attack, and stroke in a U-shaped curve. Additionally, this U-shaped correlation also exists between ALB and CHF and stroke. However, the number of pregnancies and live births was liner positive associated with history of CVD, including coronary heart disease, CHF, angina pectoris, heart attack, and stroke. CONCLUSIONS Women with younger or later AFB and ALB have higher odds of CVD in later life. Further study is warranted to verify the underlying mechanisms of this association.
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Affiliation(s)
- Tiehan Chen
- Department of Internal Medicine, Lianyungang Maternal and Child Health Hospital, Lianyungang, Jiangsu, 222000, China.
| | - Jingwen Wu
- Department of Cardiology, Lianyungang First People's Hospital, Lianyungang, Jiangsu, 222000, China
| | - Qinyuan Pan
- Department of Intensive Care Unit, Lianyungang First People's Hospital, Lianyungang, Jiangsu, 222000, China
| | - Mingmei Dong
- Department of Internal Medicine, Lianyungang Maternal and Child Health Hospital, Lianyungang, Jiangsu, 222000, China
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2
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Feng Y, Lau S, Barrett C, Chamley LW. Can placental extracellular vesicles provide long-term protection against cardiovascular disease: a reply. Am J Obstet Gynecol 2024; 230:e126. [PMID: 38408619 DOI: 10.1016/j.ajog.2024.02.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 02/15/2024] [Indexed: 02/28/2024]
Affiliation(s)
- Yourong Feng
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand
| | - Sandy Lau
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand
| | - Carolyn Barrett
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Lawrence W Chamley
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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3
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Birhanu MM, Zengin A, Joshi R, Evans RG, Kalyanram K, Kartik K, Riddell MA, Suresh O, Srikanth VK, Arabshahi S, Thomas N, Thrift AG. Risk factors for incident cardiovascular events and their population attributable fractions in rural India: The Rishi Valley Prospective Cohort Study. Trop Med Int Health 2024; 29:377-389. [PMID: 38403844 DOI: 10.1111/tmi.13981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
OBJECTIVE We prospectively determined incident cardiovascular events and their association with risk factors in rural India. METHODS We followed up with 7935 adults from the Rishi Valley Prospective Cohort Study to identify incident cardiovascular events. Using Cox proportional hazards regression, we estimated hazard ratios (HRs) with 95% confidence intervals (95% CI) for associations between potential risk factors and cardiovascular events. Population attributable fractions (PAFs) for risk factors were estimated using R ('averisk' package). RESULTS Of the 4809 participants without prior cardiovascular disease, 57.7% were women and baseline mean age was 45.3 years. At follow-up (median of 4.9 years, 23,180 person-years [PYs]), 202 participants developed cardiovascular events, equating to an incidence of 8.7 cardiovascular events/1000 PYs. Incidence was greater in those with hypertension (hazard ratio [HR] [95% CI] 1.73 [1.21-2.49], adjusted PAF 18%), diabetes (1.96 [1.15-3.36], 4%) or central obesity (1.77 [1.23, 2.54], 9%) which together accounted for 31% of the PAF. Non-traditional risk factors such as night sleeping hours and number of children accounted for 16% of the PAF. CONCLUSIONS Both traditional and non-traditional cardiovascular risk factors are important contributors to incident cardiovascular events in rural India. Interventions targeted to these factors could assist in reducing the incidence of cardiovascular events.
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Affiliation(s)
- Mulugeta Molla Birhanu
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Ayse Zengin
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Rohina Joshi
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- George Institute for Global Health, New Delhi, India
| | - Roger G Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, Australia
- Pre-clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Kartik Kalyanram
- Rishi Valley Rural Health Centre, Chittoor, Andhra Pradesh, India
| | - Kamakshi Kartik
- Rishi Valley Rural Health Centre, Chittoor, Andhra Pradesh, India
| | - Michaela A Riddell
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Oduru Suresh
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
- Rishi Valley Rural Health Centre, Chittoor, Andhra Pradesh, India
| | - Velandai K Srikanth
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- National Centre for Healthy Ageing, Melbourne, Victoria, Australia
| | - Simin Arabshahi
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Nihal Thomas
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
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Guo J, Zhong L, Ding S, Xiao G, Huang M, Zhang L, Chen Q. Number of Pregnancies and Risk of Atherosclerotic Cardiovascular Disease in Postmenopausal Women: A Cross-Sectional Study of NHANES from 1999 to 2018. J Womens Health (Larchmt) 2024. [PMID: 38607374 DOI: 10.1089/jwh.2023.0859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Abstract
Background: Atherosclerotic cardiovascular disease (ASCVD) remains the most common cause of death in women. Pregnancy is an exposure unique to women leading to significant changes in maternal cardiovascular function. However, studies of the relationship between the number of pregnancies and ASCVD are rare. We aimed to clarify the association between the number of pregnancies and ASCVD. Methods: In this cross-sectional study, we used publicly available data from the National Health and Nutrition Examination Survey from 1999 to 2018. The number of pregnancies was divided into 0 (reference), 1, 2-3, 4-5, or ≥6, to create more stable estimates. A multiple logistic regression approach was used to examine the correlation between pregnancy and ASCVD in women aged 45 years or older who reported no menstruation in the past 12 months due to menopause, as well as in those aged 55 years or older, encompassing various age groups. We also separately estimated the association between the exposure of pregnancy and individual components of ASCVD. Results: In this study, age-adjusted data showed that women with six or more pregnancies had a doubled risk (odds ratio [OR]: 2.07) of ASCVD. The risk remained elevated at 1.69 times in women with four to five pregnancies and further increased to 1.90 times in women with six or more pregnancies, after adjusting for social factors. Similar patterns were observed when considering reproductive health and cardiovascular risk factors. Across the full population, every model that accounted for these variables consistently indicated that with an increasing number of pregnancies, we observed higher ORs for ASCVD risk (all p values <0.05). Conclusions: A higher number of pregnancies was associated with a higher risk of ASCVD after menopause, especially among women aged 45-64 years. Moreover, this association is particularly significant in the risk of stroke, cardiovascular heart disease, and heart attack.
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Affiliation(s)
- Jie Guo
- Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Lingli Zhong
- Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Shan Ding
- Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Guitao Xiao
- Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Minhong Huang
- Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Li Zhang
- Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Qionghua Chen
- Department of Clinical Medicine, Fujian Medical University, Fuzhou, China
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5
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Roberts Davis M, Hiatt SO, Gupta N, Dieckmann NF, Hansen L, Denfeld QE. Incorporating reproductive system history data into cardiovascular nursing research to advance women's health. Eur J Cardiovasc Nurs 2024; 23:206-211. [PMID: 38195931 PMCID: PMC10932536 DOI: 10.1093/eurjcn/zvad125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 01/11/2024]
Abstract
The lack of sex-specific variables, such as reproductive system history (RSH), in cardiovascular research studies is a missed opportunity to address the cardiovascular disease (CVD) burden, especially among women who face sex-specific risks of developing CVD. Collecting RSH data from women enrolled in research studies is an important step towards improving women's cardiovascular health. In this paper, we describe two approaches to collecting RSH in CVD research: extracting RSH from the medical record and participant self-report of RSH. We provide specific examples from our own research and address common data management and statistical analysis problems when dealing with RSH data in research.
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Affiliation(s)
- Mary Roberts Davis
- School of Nursing, Oregon Health & Science University, 3455 S.W. U.S. Veterans Hospital Road, Portland, OR 97239, USA
| | - Shirin O Hiatt
- School of Nursing, Oregon Health & Science University, 3455 S.W. U.S. Veterans Hospital Road, Portland, OR 97239, USA
| | - Nandita Gupta
- Knight Cardiovascular Institute, Oregon Health & Science University, 3303 S. Bond Avenue, Building 1, Portland, OR 97239, USA
| | - Nathan F Dieckmann
- School of Nursing, Oregon Health & Science University, 3455 S.W. U.S. Veterans Hospital Road, Portland, OR 97239, USA
| | - Lissi Hansen
- School of Nursing, Oregon Health & Science University, 3455 S.W. U.S. Veterans Hospital Road, Portland, OR 97239, USA
| | - Quin E Denfeld
- School of Nursing, Oregon Health & Science University, 3455 S.W. U.S. Veterans Hospital Road, Portland, OR 97239, USA
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Chakraborty R, Kobayashi LC, Jock J, Wing C, Chen X, Phillips M, Berkman L, Kahn K, Kabudula CW, Rosenberg M. Child support grant expansion and cognitive function among women in rural South Africa: Findings from a natural experiment in the HAALSI cohort. PLoS One 2024; 19:e0297673. [PMID: 38446751 PMCID: PMC10917272 DOI: 10.1371/journal.pone.0297673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 01/11/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Cash transfers are a promising but understudied intervention that may protect cognitive function in adults. Although South Africa has a rapidly ageing population, little is known about the nature of association between cash transfers and cognitive function in this setting. OBJECTIVES We leveraged age-eligibility expansions to South Africa's Child Support Grant (CSG) to investigate the association between duration of CSG eligibility and cognitive function of biological mothers of child beneficiaries in South Africa. METHODS We analysed 2014/2015 baseline data from 944 women, aged 40-59 years with at least one CSG-eligible child, enrolled in the population-representative HAALSI cohort in Agincourt, South Africa. Duration of CSG eligibility for each mother was calculated based on the birth dates of all their children and the CSG age-eligibility expansion years (2003-2012). Cognitive function was measured using a cognitive battery administered at the HAALSI baseline interview. Linear regression was used to estimate the association between duration of CSG eligibility, dichotomized as low (≤10 years) and high (>10 years) eligibility, and cognitive function z-scores of the mothers. RESULTS High vs. low duration of CSG eligibility, was associated with higher cognitive function z-scores in the full sample [β: 0.15 SD units; 95% CI: 0.04, 0.26; p-value = 0.01]. In mothers with one to four lifetime children, but not five or more, high vs. low duration of CSG eligibility, was associated with higher cognitive function z-scores [β: 0.19 SD units; 95% CI: 0.05, 0.34, p-value = 0.02]. CONCLUSION Government cash transfers given to support raising children may confer substantial protective effects on the subsequent cognitive function of mothers. Further studies are needed to understand how parity may influence this relationship. Our findings bring evidence to policymakers for designing income supplementation programmes to promote healthy cognitive ageing in low-income settings.
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Affiliation(s)
- Rishika Chakraborty
- Department of Environmental and Occupational Health, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, United States of America
| | - Lindsay C. Kobayashi
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
| | - Janet Jock
- O’Neill School of Public and Environmental Affairs, Indiana University-Bloomington, Bloomington, Indiana, United States of America
| | - Coady Wing
- O’Neill School of Public and Environmental Affairs, Indiana University-Bloomington, Bloomington, Indiana, United States of America
| | - Xiwei Chen
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, United States of America
| | - Meredith Phillips
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, United States of America
| | - Lisa Berkman
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts, United States of America
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Chodziwadziwa Whiteson Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Molly Rosenberg
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, United States of America
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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7
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Björkman S, Lilliecreutz C, Bladh M, Strömberg T, Östgren CJ, Mahmoud A, Kafashian A, Bergstrand S, Sederholm Lawesson S. Microvascular dysfunction in women with a history of hypertensive disorders of pregnancy: A population-based retrospective cohort study. BJOG 2024; 131:433-443. [PMID: 37732494 DOI: 10.1111/1471-0528.17665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/04/2023] [Accepted: 08/31/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE To evaluate microvascular function in women with previous hypertensive disorders of pregnancy (HDP). DESIGN Retrospective population-based cohort study. SETTING Linköping, Sweden. POPULATION Women aged 50-65 years, participating in the Swedish CArdioPulmonary bioImage Study (SCAPIS) at one site (Linköping) 2016-18, who underwent microcirculatory assessment (N = 1222). METHODS Forearm skin comprehensive microcirculatory assessment was performed with a PeriFlux PF6000 EPOS (Enhanced Perfusion and Oxygen Saturation) system measuring oxygen saturation and total speed resolved perfusion. Obstetric records were reviewed to identify women with previous HDP. Data on cardiovascular risk factors, comorbidities, medication, lifestyle, anthropometric data, and biochemical analyses were obtained from SCAPIS. The microcirculatory data were compared between women with and without previous HDP. MAIN OUTCOME MEASURES Skin microcirculatory oxygen saturation and total speed resolved perfusion at baseline and post-ischaemic peak. RESULTS Women with previous pre-eclampsia displayed impaired post-ischaemic peak oxygen saturation compared with women with normotensive pregnancies (88%, interquartile range [IQR] 84-89% vs 91%, IQR 87-94%, p = 0.001) 6-30 years after pregnancy. The difference remained after multivariable adjustment (β -2.69, 95% CI -4.93 to -0.45). CONCLUSIONS The findings reveal microvascular dysfunction at long-term follow up in women with previous pre-eclampsia and strengthen the possible role of endothelial dysfunction as a link to the increased risk of cardiovascular disease in women with HDP.
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Affiliation(s)
- Stina Björkman
- Department of Obstetrics and Gynaecology in Norrköping, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Caroline Lilliecreutz
- Department of Obstetrics and Gynaecology in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Marie Bladh
- Department of Obstetrics and Gynaecology in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Tomas Strömberg
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Carl Johan Östgren
- Department of Health, Medicine and Caring Sciences, and CMIV Centre of Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | | | | | - Sara Bergstrand
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Sofia Sederholm Lawesson
- Department of Cardiology, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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8
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Pan R, Guo M, Chen Y, Lin G, Tian P, Wang L, Zhao J, Chen W, Wang G. Dynamics of the Gut Microbiota and Faecal and Serum Metabolomes during Pregnancy-A Longitudinal Study. Nutrients 2024; 16:483. [PMID: 38398806 PMCID: PMC10892471 DOI: 10.3390/nu16040483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Normal pregnancy involves numerous physiological changes, including changes in hormone levels, immune responses, and metabolism. Although several studies have shown that the gut microbiota may have an important role in the progression of pregnancy, these findings have been inconsistent, and the relationship between the gut microbiota and metabolites that change dynamically during and after pregnancy remains to be clarified. In this longitudinal study, we comprehensively profiled the temporal dynamics of the gut microbiota, Bifidobacterium communities, and serum and faecal metabolomes of 31 women during their pregnancies and postpartum periods. The microbial composition changed as gestation progressed, with the pregnancy and postpartum periods exhibiting distinct bacterial community characteristics, including significant alterations in the genera of the Lachnospiraceae or Ruminococcaceae families, especially the Lachnospiraceae FCS020 group and Ruminococcaceae UCG-003. Metabolic dynamics, characterised by changes in nutrients important for fetal growth (e.g., docosatrienoic acid), anti-inflammatory metabolites (e.g., trans-3-indoleacrylic acid), and steroid hormones (e.g., progesterone), were observed in both serum and faecal samples during pregnancy. Moreover, a complex correlation was identified between the pregnancy-related microbiota and metabolites, with Ruminococcus1 and Ruminococcaceae UCG-013 making important contributions to changes in faecal and serum metabolites, respectively. Overall, a highly coordinated microbiota-metabolite regulatory network may underlie the pregnancy process. These findings provide a foundation for enhancing our understanding of the molecular processes occurring during the progression of pregnancy, thereby contributing to nutrition and health management during this period.
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Affiliation(s)
- Ruili Pan
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi 214122, China; (R.P.); (M.G.); (Y.C.); (G.L.); (P.T.); (J.Z.); (W.C.); (G.W.)
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Min Guo
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi 214122, China; (R.P.); (M.G.); (Y.C.); (G.L.); (P.T.); (J.Z.); (W.C.); (G.W.)
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Ying Chen
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi 214122, China; (R.P.); (M.G.); (Y.C.); (G.L.); (P.T.); (J.Z.); (W.C.); (G.W.)
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Guopeng Lin
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi 214122, China; (R.P.); (M.G.); (Y.C.); (G.L.); (P.T.); (J.Z.); (W.C.); (G.W.)
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Peijun Tian
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi 214122, China; (R.P.); (M.G.); (Y.C.); (G.L.); (P.T.); (J.Z.); (W.C.); (G.W.)
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi 214122, China
| | - Linlin Wang
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi 214122, China; (R.P.); (M.G.); (Y.C.); (G.L.); (P.T.); (J.Z.); (W.C.); (G.W.)
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi 214122, China
| | - Jianxin Zhao
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi 214122, China; (R.P.); (M.G.); (Y.C.); (G.L.); (P.T.); (J.Z.); (W.C.); (G.W.)
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi 214122, China
- (Yangzhou) Institute of Food Biotechnology, Jiangnan University, Yangzhou 225004, China
| | - Wei Chen
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi 214122, China; (R.P.); (M.G.); (Y.C.); (G.L.); (P.T.); (J.Z.); (W.C.); (G.W.)
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi 214122, China
| | - Gang Wang
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi 214122, China; (R.P.); (M.G.); (Y.C.); (G.L.); (P.T.); (J.Z.); (W.C.); (G.W.)
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi 214122, China
- (Yangzhou) Institute of Food Biotechnology, Jiangnan University, Yangzhou 225004, China
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9
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Théberge ET, Vikulova DN, Pimstone SN, Brunham LR, Humphries KH, Sedlak TL. The Importance of Nontraditional and Sex-Specific Risk Factors in Young Women With Vasomotor Nonobstructive vs Obstructive Coronary Syndromes. CJC Open 2024; 6:279-291. [PMID: 38487074 PMCID: PMC10935675 DOI: 10.1016/j.cjco.2023.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/26/2023] [Indexed: 03/17/2024] Open
Abstract
Background Heart disease is the leading cause of premature death for women in Canada. Ischemic heart disease is categorized as myocardial infarction (MI) with no obstructive coronary artery disease (MINOCA), ischemia with no obstructive coronary arteries (INOCA), and atherosclerotic obstructive coronary artery disease (CAD) with MI (MI-CAD) or without MI (non-MI-CAD). This study aims to study the prevalence of traditional and nontraditional ischemic heart disease risk factors and their relationships with (M)INOCA, compared to MI-CAD and non-MI-CAD in young women. Methods This study investigated women who presented with premature (at age ≤ 55 years) vasomotor entities of (M)INOCA or obstructive CAD confirmed by coronary angiography, who are currently enrolled in either the Leslie Diamond Women's Heart Health Clinic Registry (WHC) or the Study to Avoid Cardiovascular Events in British Columbia (SAVEBC). Univariable and multivariable regression models were applied to investigate associations of risk factors with odds of (M)INOCA, MI-CAD, and non-MI-CAD. Results A total of 254 women enrolled between 2015 and 2022 were analyzed, as follows: 77 with INOCA and 37 with MINOCA from the registry, and 66 with non-MI-CAD and 74 with MI-CAD from the study. Regression analyses demonstrated that migraines and preeclampsia or gestational hypertension were the most significant risk factors, with a higher likelihood of being associated with premature (M)INOCA, relative to obstructive CAD. Conversely, the presence of diabetes and a current or previous smoking history had the highest likelihood of being associated with premature CAD. Conclusions The risk factor profiles of patients with premature (M)INOCA, compared to obstructive CAD, have significant differences.
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Affiliation(s)
| | - Diana N. Vikulova
- University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Heart Lung Innovation, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Simon N. Pimstone
- University of British Columbia, Vancouver, British Columbia, Canada
- University of British Columbia Hospital, Vancouver, British Columbia, Canada
| | - Liam R. Brunham
- University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Heart Lung Innovation, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | | | - Tara L. Sedlak
- University of British Columbia, Vancouver, British Columbia, Canada
- Division of Cardiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
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10
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Søndergaard SH, Kamper-Jørgensen M. Pregnancy, cardiovascular health, and microchimerism. Curr Opin Lipidol 2024; 35:7-13. [PMID: 37982290 DOI: 10.1097/mol.0000000000000914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
PURPOSE OF REVIEW To provide an updated review of scientific literature concerning associations between pregnancy and cardiovascular health among women, and to discuss a possible impact of microchimerism on the association. RECENT FINDINGS In most studies, pregnancy and childbirth is associated with increased risk of cardiovascular disease in women. Some ascribe the association mainly to lifestyle, whereas others suggest that pregnancy itself negatively affects women's cardiovascular health. Pregnancy is a natural source of microchimerism, which in turn markedly affects female health. The only study published in the area surprisingly shows that among middle-aged women, male-origin microchimerism (MOM) is associated with half the risk of developing ischemic heart disease (IHD). No similar association is found between MOM and ischemic stroke. SUMMARY The sparse evidence published suggests reduced risk of developing IHD among MOM-positive women. Despite the association being biologically plausible, replication of the findings is warranted to support that this is not a chance finding.
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Affiliation(s)
- Sara Hallum Søndergaard
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen K, Denmark
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11
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d'Errico A, Fontana D, Sacerdote C, Ardito C. Child rearing or childbearing? Risk of cardiovascular diseases associated to parity and number of children. BMC Public Health 2024; 24:272. [PMID: 38263016 PMCID: PMC10804732 DOI: 10.1186/s12889-023-17119-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/31/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND An increased risk of cardiovascular diseases (CVD) has been associated with women's parity, but whether or not this association reflects a direct pregnancy effect, or exposure to factors related to childrearing, still appears unclear. We assessed the CVD risk associated with number of children separately by gender and tested effect modification by socioeconomic position (SEP) and employment status, in order to elucidate the possible mechanisms underlying this association. METHODS The study population was composed of 20,904 men and 25,246 women who were interviewed in one of two National Health Surveys conducted in 2000 and 2005 in Italy. These subjects were followed for CVD incidence up to 2014 through record-linkage with national archives of mortality and hospitalisations. CVD risk was estimated by Cox regression models that were adjusted for socio-demographics, perceived health, lifestyles, biological CVD risk factors and for other potential confounders. RESULTS CVD incidence was significantly increased among men with 3 or more children (HR = 1.26, 95% CI: 1.02-1.56) and among women with 2 and with 3 or more children (HR = 1.42, 95% CI: 1.10-1.83; and HR = 1.39, 95% CI: 1.03-1.87, respectively) compared to subjects without children and no significant gender differences were observed. Subjects with lower SEP displayed stronger associations with parity and a higher number of children for both genders; by contrast, no modifying effect of employment status was observed. CONCLUSIONS Taken together, the significant association between higher parity and CVD risk in both genders, and the higher risk of CVD associated with higher parity among lower SEP parents, suggests that childrearing has a potential effect on the development of CVD that is more pronounced among disadvantaged families, although a concurrent effect of childbearing cannot be completely excluded.
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Affiliation(s)
- Angelo d'Errico
- Epidemiology Unit Piedmont Region ASL TO3, Grugliasco (TO), Italy
| | - Dario Fontana
- Epidemiology Unit Piedmont Region ASL TO3, Grugliasco (TO), Italy
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, University of Turin, Turin, Italy
- Centre for Cancer Epidemiology and Prevention (CPO Piemonte), Turin, Italy
| | - Chiara Ardito
- Competence Centre On Microeconomic Evaluation (CC-ME), European Commission, Joint Research Centre (JRC), Ispra, Italy.
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12
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Nichols AR, Rifas-Shiman SL, Switkowski KM, Zhang M, Young JG, Hivert MF, Chavarro JE, Oken E. History of Infertility and Midlife Cardiovascular Health in Female Individuals. JAMA Netw Open 2024; 7:e2350424. [PMID: 38180761 PMCID: PMC10770770 DOI: 10.1001/jamanetworkopen.2023.50424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/16/2023] [Indexed: 01/06/2024] Open
Abstract
Importance Fertility status is a marker for future health, and infertility has been associated with risk for later cancer and diabetes, but associations with midlife cardiovascular health (CVH) in female individuals remain understudied. Objective To evaluate the association of infertility history with CVH at midlife (approximately age 50 years) among parous individuals. Design, Setting, and Participants Project Viva is a prospective cohort study of pregnant participants enrolled between 1999 and 2002 who delivered a singleton live birth in the greater Boston, Massachusetts, area. Infertility history was collected at a midlife visit between 2017 and 2021, approximately 18 years after enrollment. Data analysis was performed from January to June 2023. Exposures The primary exposure was any lifetime history of infertility identified by self-report, medical record, diagnosis, or claims for infertility treatment. Main Outcomes and Measures The American Heart Association's Life's Essential 8 (LE8) is a construct for ranking CVH that includes scores from 0 to 100 (higher scores denote better health status) in 4 behavioral (diet, physical activity, sleep, and smoking status) and 4 biomedical (body mass index, blood pressure, blood lipids, and glycemia) domains to form an overall assessment of CVH. Associations of a history of infertility (yes or no) with mean LE8 total, behavioral, biomedical, and blood biomarker (lipids and glycemia) scores were examined, adjusting for age at outcome (midlife visit), race and ethnicity, education, household income, age at menarche, and perceived body size at age 10 years. Results Of 468 included participants (mean [SD] age at the midlife visit, 50.6 [5.3] years) with exposure and outcome data, 160 (34.2%) experienced any infertility. Mean (SD) LE8 scores were 76.3 (12.2) overall, 76.5 (13.4) for the behavioral domain, 76.0 (17.5) for the biomedical domain, and 78.9 (19.2) for the blood biomarkers subdomain. In adjusted models, the estimated overall LE8 score at midlife was 2.94 points lower (95% CI, -5.13 to -0.74 points), the biomedical score was 4.07 points lower (95% CI, -7.33 to -0.78 points), and the blood subdomain score was 5.98 points lower (95% CI, -9.71 to -2.26 points) among those with vs without history of infertility. The point estimate also was lower for the behavioral domain score (β = -1.81; 95% CI, -4.28 to 0.66), although the result was not statistically significant. Conclusions and Relevance This cohort study of parous individuals found evidence for an association between a history of infertility and lower overall and biomedical CVH scores. Future study of enhanced cardiovascular preventive strategies among those who experience infertility is warranted.
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Affiliation(s)
- Amy R. Nichols
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Sheryl L. Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Karen M. Switkowski
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Mingyu Zhang
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Jessica G. Young
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Marie-France Hivert
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Diabetes Unit, Massachusetts General Hospital, Boston
| | - Jorge E. Chavarro
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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13
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Zhang S, Yang H, Li Z, Zhang S, Wu Y. A study of the effect of number of children on depression among rural older women: empirical evidence from China. J Biosoc Sci 2024; 56:182-206. [PMID: 37718633 DOI: 10.1017/s0021932023000172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
The association between early reproductive events and health status in later life has always been of interest across disciplines. The purpose of this study was to investigate whether there was an association between the number of children born in the early years of elderly women and their depression in later life based on a sample of older women aged 65 years and above with at least one child in rural China. Data from the Chinese Longitudinal Healthy Longevity Survey in 2018, this study used the ordinary least square method to conduct empirical research. This study has found a significant correlation between an increase in the number of children and depression in older rural women. When considering the sex of the child, the number of daughters had a greater and more significant impact on depression. Number of children may exacerbate depression of older women through declining self-rated health and reduced social activity, while increased inter-generational support alleviated depression. The association between number of children born and depression also existed in urban older women, though not significant. Therefore, it is suggested to accelerate the improvement of supporting policies related to childbirth, developing a healthy and scientific fertility culture, and improving rural maternal and child health services. Women should be assisted in balancing their roles in the family and in society, and in particular in sharing the burden of caring for children. Targeted efforts to increase old-age protection for older people.
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Affiliation(s)
- Shuo Zhang
- School of Sociology and Population Studies, Renmin University of China, Beijing, China
| | - Hualei Yang
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China
| | - Zhiyun Li
- School of Politics and Public Administration, Qingdao University, Qingdao, China
| | - Siqing Zhang
- School of Government, Nanjing University, Nanjing, China
| | - Yuanyang Wu
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
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14
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Feng Y, Lau S, Chen Q, Oyston C, Groom K, Barrett CJ, Chamley LW. Normotensive placental extracellular vesicles provide long-term protection against hypertension and cardiovascular disease. Am J Obstet Gynecol 2023:S0002-9378(23)02189-0. [PMID: 38158074 DOI: 10.1016/j.ajog.2023.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Women with normotensive pregnancy are at a reduced risk of developing cardiovascular disease postpartum compared with those who experience hypertensive conditions during pregnancy. However, the underlying mechanisms remain poorly understood. During normotensive pregnancy, vast numbers of placental extracellular vesicles are released into the maternal circulation, which protect endothelial cells from activation and alter maternal vascular tone. We hypothesized that placental extracellular vesicles play a mechanistic role in lowering the risk of cardiovascular disease following normotensive pregnancy. OBJECTIVE This study aimed to investigate the long-term effects of placental extracellular vesicles derived from normotensive term placentae on the cardiovascular system and explore the mechanisms underlying their biological effects. STUDY DESIGN Spontaneously hypertensive rats were injected with placental extracellular vesicles from normotensive term pregnancies (2 mg/kg each time, n=8) or vehicle control (n=9) at 3 months of age. Blood pressure and cardiac function were regularly monitored from 3 months to 15 months of age. The response of mesenteric resistance arteries to vasoactive substances was investigated to evaluate vascular function. Cardiac remodeling, small artery remodeling, and renal function were investigated to comprehensively assess the impact of placental extracellular vesicles on cardiovascular and renal health. RESULTS Compared with vehicle-treated control animals, rats treated with normotensive placental extracellular vesicles exhibited a significantly lower increase in blood pressure and improved cardiac function. Furthermore, the vasodilator response to the endothelium-dependent agonist acetylcholine was significantly enhanced in the normotensive placental extracellular vesicle-treated spontaneously hypertensive rats compared with the control. Moreover, treatment with placental extracellular vesicles reduced wall thickening of small renal vessels and attenuated renal fibrosis. CONCLUSION Placental extracellular vesicles from normotensive term pregnancies have long-lasting protective effects reducing hypertension and mitigating cardiovascular damage in vivo.
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Affiliation(s)
- Yourong Feng
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
| | - Sandy Lau
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Qi Chen
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Charlotte Oyston
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Katie Groom
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Carolyn J Barrett
- Department of Physiology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Lawrence W Chamley
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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15
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Mussa J, Rahme E, Dahhou M, Nakhla M, Dasgupta K. Considering gestational diabetes and gestational hypertension history across two pregnancies in relationship to cardiovascular disease development: A retrospective cohort study. Diabetes Res Clin Pract 2023; 206:110998. [PMID: 37951478 DOI: 10.1016/j.diabres.2023.110998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/17/2023] [Accepted: 11/08/2023] [Indexed: 11/14/2023]
Abstract
AIMS Gestational diabetes (GDM) and hypertension (GHTN) occurrences signal elevated cardiovascular disease (CVD) risk. There is little study of occurrence and recurrence of these conditions in relationship to CVD. Among women with two singleton pregnancies, we aimed to quantify CVD risk in relationship to the number of GDM/GHTN occurrences. METHODS In this Quebec-based retrospective cohort study (n = 431,980), we ascertained the number of GDM/GHTN occurrences over two pregnancies and assessed for CVD over a median of 16.4 years (cohort inception 1990-2012, outcomes 1990-2019). We defined CVD as a composite of myocardial infarction, stroke, and angina, requiring hospitalization and/or causing death. We adjusted Cox proportional hazards models for offspring size, preterm/term birth status, maternal age group, time between deliveries, ethnicity, deprivation level, and co-morbid conditions. RESULTS Compared to absence of GDM/GHTN in either pregnancy, one GDM/GHTN occurrence increased CVD hazards by 47% (hazard ratio [HR] = 1.47, 95% confidence interval [CI] 1.35-1.61), two occurrences nearly doubled hazards (HR = 1.91, 95% CI 1.68-2.17), and three or more approximately tripled CVD hazards (HR = 2.93, 95% CI 2.20-3.90). Individual components of the composite demonstrated similar findings. CONCLUSIONS Health care providers and mothers should consider a complete history of GDM/GHTN occurrences to ascertain the importance and urgency of preventive action.
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Affiliation(s)
- Joseph Mussa
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Quebec, Canada
| | - Elham Rahme
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Quebec, Canada
| | - Mourad Dahhou
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Quebec, Canada
| | - Meranda Nakhla
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Quebec, Canada; Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Kaberi Dasgupta
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Quebec, Canada.
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16
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Vorobeľová L, Falbová D, Candráková Čerňanová V. The importance of female reproductive history on self-reported sleep quality, mood, and urogenital symptoms in midlife. Menopause 2023; 30:1157-1166. [PMID: 37889612 DOI: 10.1097/gme.0000000000002277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
OBJECTIVE This study investigated the importance of reproductive history on somatic and psychological symptoms in midlife women. METHODS A total of 503 women from 39 to 65 years of age were recruited from different localities in Slovakia. These were interviewed about their reproductive and menstrual history, sociodemographic background, and lifestyle and health status after submitting pretested questionnaires. All variables were measured by self-reporting, and multivariable logistic and ordinal regression analyses tested the associations. RESULTS Women who experienced miscarriage had a greater likelihood of waking early and then sleeping poorly, and they also felt unattractive in midlife. Moreover, women with two or more miscarriages were four times more likely to experience this sleep symptom than those without miscarriage (odds ratio [OR], 4.2; 95% confidence interval [CI], 1.70-10.38; P = 0.002). In addition, women with one or two children suffered significantly less often with severe depressed mood and lack of enjoyment than women with three and more children (lack of enjoyment: with one child, the OR was 0.39 [95% CI, 0.16-0.96; P = 0.041]; with two children, the OR was 0.47 [95% CI, 0.23-0.97; P = 0.040]; depressed mood: with one child, the OR was 0.32 [95% CI, 0.12-0.84; P = 0.021]). Finally, the premenopausal and perimenopausal women were less likely to experience severe vaginal dryness than those in postmenopause. CONCLUSIONS This cross-sectional pilot study suggests that women's reproductive history, as determined by parity and miscarriage, may be relevant to their midlife health and well-being. Future research is warranted.
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Affiliation(s)
- Lenka Vorobeľová
- From the Department of Anthropology, Faculty of Natural Sciences, Comenius University in Bratislava, Bratislava, Slovakia
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17
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DiBiase RM, Gottesman RF, Tom SE, Walker KA, Mosley T, Lutsey PL, Miller EC. Parity and Risk of Dementia in Women: The Atherosclerosis Risk in Communities Study. J Womens Health (Larchmt) 2023; 32:1031-1040. [PMID: 37615600 PMCID: PMC10541925 DOI: 10.1089/jwh.2023.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
Objective: Reproductive factors, including parity, may contribute to dementia risk, due to hormonal, physiological, social, and demographic factors. We hypothesized that higher parity would be associated with increased dementia risk. Materials and Methods: We utilized data from the Atherosclerosis Risk in Communities (ARIC) community-based cohort study. Participants were recruited in 1987-1989 and followed through 2017. Participants, all born between 1921 and 1945, were from four U.S. communities in Forsyth County, NC; Jackson, MS; Minneapolis, MN; and Washington County, MD. We included all female participants seen at ARIC visit three or five for whom parity and dementia outcomes were available (N = 7,921). The primary exposure was self-reported number of live births. Our primary outcome was dementia, diagnosed via neurocognitive assessments, informant interviews, and expert adjudication. We created Cox proportional hazards models to evaluate the association between parity and incident dementia, adjusting for demographic factors, education level, apolipoprotein E allele status, and vascular risk factors. We tested for interactions by race and birth cohort. Results: The adjusted hazard ratio was 0.82 (95% confidence intervals [CI] 0.69-0.99) for dementia in women with 0-1 births and 0.85 (95% CI 0.72-0.99) for women with 5+ births, compared to women with 2 births (reference group). This association was present in women born from 1924 to 1934, but not in women born in 1935 or later (p-interaction <0.001). Conclusion: We found an inverted U-shaped association of parity with dementia risk. This effect was modified by birth cohort, suggesting that the association may depend on demographic and sociocultural factors.
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Affiliation(s)
- Rebecca M. DiBiase
- Department of Neurology, McGaw Medical Center of Northwestern University, Chicago, Illinois, USA
| | - Rebecca F. Gottesman
- Stroke Branch, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Maryland, USA
| | - Sarah E. Tom
- Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - Keenan A. Walker
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, Maryland, USA
| | - Thomas Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Eliza C. Miller
- Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
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18
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Quesada O. Reproductive risk factors for cardiovascular disease in women. Menopause 2023; 30:1058-1060. [PMID: 37738036 DOI: 10.1097/gme.0000000000002264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Cardiovascular disease (CVD) remains the leading cause of death for women. Adverse pregnancy outcomes, including hypertensive disorders of pregnancy, gestational diabetes mellitus, preterm delivery, and low birth weight-affecting up to 30% of pregnant women-increase the risk of CVD. Early menarche and polycystic ovary syndrome are implicated. Premature and early menopause and significant vasomotor symptoms are all associated. Including reproductive risk assessment is critical when determining CVD risk and implementing evidence-based prevention strategies.
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19
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Huttler A, Murugappan G, Stentz NC, Cedars MI. Reproduction as a window to future health in women. Fertil Steril 2023; 120:421-428. [PMID: 36641001 DOI: 10.1016/j.fertnstert.2023.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/16/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023]
Abstract
Cultivating awareness for reproduction as a window to future health presents an opportunity for early identification and modification of risk factors that can affect both individual and population-level morbidity and mortality. Infertility could serve as both a window into future health as well as a pathway to future pathology. The underlying mechanisms of infertility may share common pathways with long-term risk for health and well-being. Making this identification early in the disease process may improve opportunities for intervention, and deepen our understanding of long-term risk. Additionally, fertility treatments may increase individual risk. Only by making these associations and designing studies to understand how disease and treatment risk impact health can we truly fulfill our goal of building healthy families. The aim of this review is to discuss the short-term impact of fertility challenges and treatment, long-term associations of infertility with morbidity and mortality, and the role of parity in modifying these risk associations.
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20
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Brown CE, Casey H, Dominiczak AF, Kerr S, Campbell A, Delles C. Impact of preeclampsia on cardiovascular events: An analysis of the Generation Scotland: Scottish family health study. J Hum Hypertens 2023; 37:735-741. [PMID: 36973315 PMCID: PMC10403345 DOI: 10.1038/s41371-023-00812-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 09/14/2022] [Accepted: 02/03/2023] [Indexed: 03/29/2023]
Abstract
Preeclampsia is a recognised cause of an increased risk of major adverse cardiovascular events when compared to the background risk in women who did not have hypertensive disorders during pregnancy. The Generation Scotland: Scottish Family Health Study (GS:SFHS) is a population cohort of more than 20,000 members of the Scottish population. Using the Scottish Morbidity Records, we linked the women in the GS:SFHS cohort to validated maternity and inpatient admission data. This allowed us to robustly identify cardiovascular outcomes in the form of inpatient admission for cardiovascular events, We also aimed to explore the risk of pregnancy on future cardiovascular events, using data from nulliparous and parous women.In total, 9732 women were selected. 3693 women were nulliparous, and after study exclusion, 5253 women with 9583 pregnancies remained. Pregnancies from 1980 until the end of the study period of 1st of July 2013 were included. Cardiovascular events occurred in 9.0% of nulliparous women, 4.2% of women with pregnancies and in 7.6% of women with a history of preeclampsia. A total of 218 parous women experienced cardiovascular events, 25 in the preeclampsia group and 193 in the normotensive group.Survival analysis was undertaken, with index pregnancy taken as first pregnancy in normotensive controls and first preeclampsia pregnancy in cases. Endpoint of interest was admission to hospital with first cardiovascular event. After further exclusions a total of 169 cardiovascular events occurred in the normotensive pregnancy group and 20 in the preeclampsia group. Women with a history of preeclampsia were more likely to have cardiovascular events later in life than women with normotensive deliveries., This was statistically significantly different on Kaplan Meier survival analysis, (log rank Mantel-Cox p-value < 0.001). The women in our study were middle-aged, within 33 years of pregnancy, with a mean age of 53 years in the preeclampsia cardiovascular events group.Our study supports the urgent need for uniform guidelines and implementation to improve the health in women with this medical history. Increased awareness among the public of the cardiovascular risk associated with PE is vital to aid uptake of cardiovascular prevention programmes.
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Affiliation(s)
- Catriona E Brown
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, UK
| | - Helen Casey
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, UK.
| | - Anna F Dominiczak
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, UK
| | - Shona Kerr
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, Scotland, UK
| | - Archie Campbell
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, Scotland, UK
| | - Christian Delles
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, UK.
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21
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Sato W, Nomura K, Satoh M, Hara A, Tsubota-Utsugi M, Murakami T, Asayama K, Tatsumi Y, Kobayashi Y, Hirose T, Inoue R, Totsune T, Kikuya M, Hozawa A, Metoki H, Imai Y, Watanabe H, Ohkubo T. Female Reproductive Events and Subclinical Atherosclerosis of the Brain and Carotid Arteriopathy: the Ohasama Study. J Atheroscler Thromb 2023; 30:956-978. [PMID: 36198521 PMCID: PMC10406647 DOI: 10.5551/jat.63592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 08/26/2022] [Indexed: 08/04/2023] Open
Abstract
AIMS Few studies have investigated the subclinical atherosclerotic changes in the brain and carotid artery, and in East Asian populations. We sought to investigate whether gravidity, delivery, the age at menarche and menopause and estrogen exposure period are associated with subclinical atherosclerosis of the brain and carotid arteriopathy. METHODS This cross-sectional study formed part of a cohort study of Ohasama residents initiated in 1986. Brain atherosclerosis and carotid arteriopathy were diagnosed as white matter hyperintensity (WMH) and lacunae evident on brain magnetic resonance imaging (MRI) and carotid intimal media thickness (IMT) or plaque revealed by ultrasound, respectively. The effect of the reproductive events on brain atherosclerosis and carotid arteriopathy was investigated using logistic regression and general linear regression models after adjusting for covariates. RESULTS Among 966 women aged ≥ 55 years in 1998, we identified 622 and 711 women (mean age: 69.2 and 69.7 years, respectively) who underwent either MRI or carotid ultrasound between 1992-2008 or 1993-2018, respectively. The highest quartile of gravidity (≥ 5 vs. 3) and delivery (≥ 4 vs. 2), and the highest and second highest (3 vs. 2) quartiles of delivery were associated with an increased risk of WMH and carotid artery plaque, respectively. Neither of age at menarche, menopause, and estrogen exposure period estimated by subtracting age at menarche from age at menopause was associated with atherosclerotic changes of brain and carotid arteries. CONCLUSIONS Higher gravidity and delivery are associated with subclinical atherosclerosis of the brain and carotid plaque.
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Affiliation(s)
- Wakana Sato
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Kyoko Nomura
- Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, Akita, Japan
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Michihiro Satoh
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Azusa Hara
- Division of Drug Development and Regulatory Science, Faculty of Pharmacy, Keio University, Tokyo, Japan
| | - Megumi Tsubota-Utsugi
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Takahisa Murakami
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Division of Aging and Geriatric Dentistry, Department of RehabilitationDentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Yukako Tatsumi
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Yuki Kobayashi
- Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, Akita, Japan
| | - Takuo Hirose
- Department of Endocrinology and Applied Medical Science, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryusuke Inoue
- Department of Medical Information Technology Center, Tohoku University Hospital, Sendai, Japan
| | - Tomoko Totsune
- Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Masahiro Kikuya
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Atsushi Hozawa
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Hirohito Metoki
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Yutaka Imai
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Hiroyuki Watanabe
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
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22
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Phillips AK, Keller MF, McClung JP, Steele N, Witkop CT, Wu TJ. Physical Health and Well-being: Updates and the Way Ahead. Mil Med 2023; 188:9-18. [PMID: 37490559 DOI: 10.1093/milmed/usac370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 02/24/2022] [Accepted: 11/14/2022] [Indexed: 07/27/2023] Open
Abstract
INTRODUCTION The Women in Combat Summit 2021 "Forging the Future: How Women Enhance the Fighting Force" took place during February 9-11, 2021, via a virtual conference platform. The third and final day of the Summit regarded the physical health and well-being of military women and included the topics of urogenital health, nutrition and iron-deficiency anemia, unintended pregnancy and contraception, and traumatic brain injury. MATERIALS AND METHODS After presentations on the topics earlier, interested conference attendees were invited to participate in focus groups to discuss and review policy recommendations for physical health and well-being in military women. Discussions centered around the topics discussed during the presentations, and suggestions for future Women in Combat Summits were noted. Specifics of the methods of the Summit are presented elsewhere in this supplement. RESULTS We formulated research and policy recommendations for urogenital health, nutrition and iron-deficiency anemia, contraception and unintended pregnancy, and traumatic brain injury. CONCLUSIONS In order to continue to develop the future health of military women, health care providers, researchers, and policymakers should consider the recommendations made in this supplement as they continue to build on the state of the science and forge the future.
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Affiliation(s)
- Angela K Phillips
- Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, MD 20762, USA
| | - Margaux F Keller
- Henry Jackson Foundation at the Daniel K. Inouye Graduate School of Nursing, Uniformed Services University, Bethesda, MD 20814, USA
| | - James P McClung
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
| | - Nancy Steele
- School of Nursing, University of North Florida, Jacksonville, FL 32224, USA
| | - Catherine T Witkop
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD 20814, USA
- Department of Gynecologic Surgery and Obstetrics, Uniformed Services University, Bethesda, MD 20814, USA
| | - T John Wu
- Department of Gynecologic Surgery and Obstetrics, Uniformed Services University, Bethesda, MD 20814, USA
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Kazzi B, Shankar B, Elder-Odame P, Tokgözoğlu LS, Sierra-Galan LM, Michos ED. A Woman's Heart: Improving Uptake and Awareness of Cardiovascular Screening for Middle-Aged Populations. Int J Womens Health 2023; 15:1171-1183. [PMID: 37520181 PMCID: PMC10377626 DOI: 10.2147/ijwh.s328441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/11/2023] [Indexed: 08/01/2023] Open
Abstract
Mid-life, the years leading up to and following the menopause transition, in women is accompanied by a change in cardiometabolic risk factors, including increases in body weight, changes in body composition, a more insulin-resistant state, and a shift towards a more atherogenic dyslipidemia pattern. Cardiovascular disease (CVD) risk assessment should be performed continually throughout the lifespan, as risk is not stagnant and can change throughout the life course. However, mid-life is a particularly important time for a woman to be evaluated for CVD risk so that appropriate preventive strategies can be implemented. Along with assessing traditional risk factors, ascertainment of a reproductive history is an integral part of a comprehensive CVD risk assessment to recognize unique female-specific or female-predominant factors that modify a woman's risk. When there is uncertainty about CVD risk and the net benefit of preventive pharmacotherapy interventions (such as statins), measuring a coronary artery calcium score can help further refine risk and guide shared decision-making. Additionally, there should be heightened sensitivity around identifying signs and symptoms of ischemic heart disease in women, as these may present differently than in men. Ischemia from coronary microvascular disease and/or vasospasm may be present even without obstructive coronary artery disease and is associated with a heightened risk for major cardiovascular events and reduced quality of life. Therefore, correctly identifying CVD in women and implementing preventive and treatment therapies is paramount. Unfortunately, women are underrepresented in cardiovascular clinical trials, and more data are needed about how to best incorporate novel and emerging risk factors into CVD risk assessment. This review outlines an approach to CVD screening and risk assessment in women using several methods, focusing on the middle-aged population.
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Affiliation(s)
- Brigitte Kazzi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bairavi Shankar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Petal Elder-Odame
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lale S Tokgözoğlu
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Lilia M Sierra-Galan
- Cardiology Department of the Cardiovascular Division, American British Cowdray Medical Center, Mexico City, Mexico
| | - Erin D Michos
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Kim HL, Kim HJ, Kim M, Park SM, Yoon HJ, Byun YS, Park SM, Shin MS, Hong KS, Kim MA. Association between the number of pregnancies and cardiac target organ damages: a cross-sectional analysis of data from the Korean women's chest pain registry (KoROSE). BMC Womens Health 2023; 23:377. [PMID: 37461008 DOI: 10.1186/s12905-023-02514-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 06/27/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Pregnancy increases long-term cardiovascular risk after childbirth, but the mechanisms are unclear. This study was performed to investigate the association between the number of pregnancies and several cardiac target organ damage (TOD) in middle-aged and elderly women. METHODS Using the database of the nation-wide registry, a total of 1,137 women (mean age 63.0 ± 10.9 years) with stable chest pain undergoing invasive coronary angiography (CAG) were analyzed. Information on the number of pregnancies was obtained through a questionnaire. Obstructive coronary artery disease (CAD), left ventricular (LV) mass index (LVMI) and LV septal annular (e') velocity were assessed as indicators of cardiac TOD. RESULTS Women with higher number of pregnancies (≥ 3) were older (66.3 ± 9.6 vs. 57.4 ± 10.7 years; P < 0.001), had more cardiovascular risk factors, and took more cardiovascular medications than those with lower number of pregnancies (< 3). In multivariable analyses, higher number of pregnancies (≥ 3) was associated with obstructive CAD (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.21-2.17; P = 0.001), a higher LVMI (> 95 g/m2) (OR, 1.46; 95% CI, 1.08-1.98; P = 0.013) and a lower septal e' velocity (< 7 cm/s) (OR, 1.55; 95% CI, 1.12-2.14; P = 0.007) even after controlling for potential confounders. As the number of pregnancies increased, the prevalence of CAD and LVMI increased, and the septal e' velocity gradually decreased (P < 0.001 for each). CONCLUSIONS In women with chest pain undergoing invasive CAG, higher number of pregnancies was associated with multiple cardiac TOD. Parity information should be checked when assessing a woman's cardiovascular risk.
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Affiliation(s)
- Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Boramae Medical Center, Seoul, 07061, Republic of Korea
| | - Hyun-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Mina Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Sang Min Park
- Division of Cardiology, Department of Internal Medicine, Eulji University School of Medicine, Nowon Eulji Medical Center, Seoul, Republic of Korea
| | - Hyun Ju Yoon
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Young Sup Byun
- Division of Cardiology, Department of Internal Medicine, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
| | - Seong-Mi Park
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Mi-Seung Shin
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Gil Medical Center, Gyeonggi-do, Republic of Korea
| | - Kyung-Soon Hong
- Division of Cardiology, Department of Internal Medicine, Hallym University Medical Center, Chuncheon, Republic of Korea
| | - Myung-A Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Boramae Medical Center, Seoul, 07061, Republic of Korea.
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Zareei S, Behrasi F, Naghizadeh MM, Talebzadeh F, Kharmandar A, Farjam M, Homayounfar R. The relationship between pregnancy count and duration of breast-feeding with metabolic syndrome (Fasa Persian cohort study). BMC Womens Health 2023; 23:371. [PMID: 37443023 PMCID: PMC10339557 DOI: 10.1186/s12905-023-02528-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Changes that occur during pregnancy and after that during breastfeeding induce some symptoms similar to metabolic syndrome (MetS) risk factors. This study aims to determine the relationship between pregnancy, as well as the duration of breastfeeding and MetS controlling the effect of other risk factors like hypertension, glucose intolerance, triglyceride, central obesity, and reduction of high-density lipoprotein in women of Fasa Persian Cohort Study. MATERIALS AND METHODS In this cross-sectional study, 5015 women aged 35-70 years were investigated in the Sheshdeh region from 2016 to 2021, and the information related to the disease symptoms was collected through questionnaires, examinations, and laboratory tests. MetS was calculated based on two guidelines according to adult treatment panel III (ATP III) and international diabetes federation (IDF) methods. For reporting the data, the odds ratio with its 95% confidence interval was used. In order to eliminate the effect of confounders, logistic regression was used. RESULTS Prevalence of MetS showed a descending trend in women with up to two pregnancies and it reached 22.6% and 22.4% using ATPIII and IDF methods respectively, while with an increase in the number of pregnancies of more than two, MetS prevalence was ascending. The prevalence of MetS did not have any specific trend across various breastfeeding duration groups. Multivariate analysis approved that the odds ratio of developing MetS in comparison with women who had two pregnancies was significantly increasing trend when the pregnancy counts increased. CONCLUSION The chance of developing MetS based on both IDF and ATP III methods after adjustment for confounding effects would grow with an increase in the number of pregnancies to more than two and breast-feeding of more than seven years. It is recommended that women with more than two pregnancies or the long duration of breast-feeding women undergo a specialized examination to investigate and control MetS problems so that future diseases could be prevented.
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Affiliation(s)
- Saeideh Zareei
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Fatemeh Behrasi
- Department Of Nutrition, School Of Medicine, Zahedan University Of Medical Sciences, Zahedan, Iran
| | | | - Fatemeh Talebzadeh
- Student's research committee, Fasa University of medical sciences, Fasa, Iran
| | - Ali Kharmandar
- Student's research committee, Fasa University of medical sciences, Fasa, Iran
| | - Mojtaba Farjam
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Reza Homayounfar
- Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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26
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Bonner AN, Jayawickreme S, Malek AM, Vladutiu CJ, Oliver-Williams C, Cortés YI, Tanaka H, Meyer ML. Number of prior live births is associated with higher arterial stiffness but not its change in older women: the atherosclerosis risk in communities study. Front Cardiovasc Med 2023; 10:1172828. [PMID: 37288258 PMCID: PMC10242178 DOI: 10.3389/fcvm.2023.1172828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/27/2023] [Indexed: 06/09/2023] Open
Abstract
Introduction Although studies have demonstrated a J-shaped association between parity and cardiovascular disease (CVD), the association with arterial stiffness is not fully understood. Methods We examined the association between parity and carotid-femoral pulse wave velocity (cfPWV), a measure of central arterial stiffness. We conducted a longitudinal analysis of 1220 women (mean age 73.7 years) who attended the Atherosclerosis Risk in Communities Study visit 5 (2011-2013). At visit 2 (1990-1992), women self-reported parity (number of prior live births), which we categorized as: 0 (never pregnant or pregnant with no live births); 1-2 (referent); 3-4; and 5+ live births. Technicians measured cfPWV at visit 5 (2011-2013) and visit 6 or 7 (2016-2019). Multivariable linear regression modeled the associations of parity with visit 5 cfPWV and cfPWV change between visit 5 and 6/7 adjusted for demographics and potential confounding factors. Results Participants reported 0 (7.7%), 1-2 (38.7%), 3-4 (40.0%), or 5+ (13.6%) prior live births. In adjusted analyses, women with 5+ live births had a higher visit 5 cfPWV (β=50.6 cm/s, 95% confidence interval: 3.6, 97.7 cm/s) than those with 1-2 live births. No statistically significant associations were observed for other parity groups with visit 5 cfPWV or with cfPWV change. Discussion In later life, women with 5+ live births had higher arterial stiffness than those with 1-2 live births, but cfPWV change did not differ by parity, suggesting women with 5+ live births should be targeted for early primary prevention of CVD given their higher arterial stiffness at later-life.
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Affiliation(s)
- Alison N. Bonner
- Medical Doctorate Program, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Shantal Jayawickreme
- Medical Doctorate Program, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Angela M. Malek
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Catherine J. Vladutiu
- Department of Obstetrics & Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Clare Oliver-Williams
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
- Central Bedfordshire Council, Chicksands, Bedfordshire, United Kingdom
| | - Yamnia I. Cortés
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Hirofumi Tanaka
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, United States
| | - Michelle L. Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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27
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Alkhatib B, Salimi S, Jabari M, Padmanabhan V, Vyas AK. Impact of Adverse Gestational Milieu on Maternal Cardiovascular Health. Endocrinology 2023; 164:bqad060. [PMID: 37042476 PMCID: PMC10164662 DOI: 10.1210/endocr/bqad060] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/27/2023] [Accepted: 04/10/2023] [Indexed: 04/13/2023]
Abstract
Cardiovascular disease affects 1% to 4% of the nearly 4 million pregnancies in the United States each year and is the primary cause of pregnancy-related mortality. Adverse pregnancy outcomes are associated with cardiovascular complications during pregnancy persisting into the postpartum period. Recently, investigations have identified an altered sex hormone milieu, such as in the case of hyperandrogenism, as a causative factor in the development of gestational cardiovascular dysfunction. The mechanisms involved in the development of cardiovascular disease in postpartum women are largely unknown. Animal studies have attempted to recapitulate adverse pregnancy outcomes to investigate causal relationships and molecular underpinnings of adverse gestational cardiac events and progression to the development of cardiovascular disease postpartum. This review will focus on summarizing clinical and animal studies detailing the impact of adverse pregnancy outcomes, including preeclampsia, gestational diabetes mellitus, and maternal obesity, on gestational cardiometabolic dysfunction and postpartum cardiovascular disease. Specifically, we will highlight the adverse impact of gestational hyperandrogenism and its potential to serve as a biomarker for maternal gestational and postpartum cardiovascular dysfunctions.
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Affiliation(s)
- Bashar Alkhatib
- Department of Pediatrics, Washington University, St. Louis, MO 63110, USA
| | - Shadi Salimi
- College of Human Medicine, California Northstate University, Elk Grove, CA 95757, USA
| | - Mary Jabari
- College of Human Medicine, California Northstate University, Elk Grove, CA 95757, USA
| | | | - Arpita Kalla Vyas
- Department of Pediatrics, Washington University, St. Louis, MO 63110, USA
- College of Human Medicine, California Northstate University, Elk Grove, CA 95757, USA
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28
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Farland LV, Wang Y, Gaskins AJ, Rich‐Edwards JW, Wang S, Magnus MC, Chavarro JE, Rexrode KM, Missmer SA. Infertility and Risk of Cardiovascular Disease: A Prospective Cohort Study. J Am Heart Assoc 2023; 12:e027755. [PMID: 36847044 PMCID: PMC10111453 DOI: 10.1161/jaha.122.027755] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/17/2023] [Indexed: 03/01/2023]
Abstract
Background Certain symptoms associated with infertility are associated with cardiovascular disease, including menstrual cycle irregularity, early menopause, and obesity; however, few studies have investigated the association between infertility and cardiovascular disease risk. Methods and Results Participants in the NHSII (Nurses' Health Study II) who reported infertility (12 months of trying to conceive without success, including women who subsequently conceived) or who were gravid, with no infertility were followed from 1989 until 2017 for development of incident, physician-diagnosed coronary heart disease (CHD) (myocardial infarction, coronary artery bypass grafting, angioplasty, stent) and stroke. Time-varying Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% CIs and were adjusted a priori for potential confounding variables. Among 103 729 participants, 27.6% reported having ever experienced infertility. Compared with gravid women who had not reported infertility, women with a history of infertility had greater risk of CHD (HR, 1.13 [95% CI, 1.01-1.26]) but not stroke (HR, 0.91 [95% CI, 0.77-1.07]). The association between history of infertility and CHD was strongest among women who reported infertility at an earlier age (HR for infertility first reported at ≤25 years, 1.26 [95% CI, 1.09-1.46]; HR at 26-30 years, 1.08 [95% CI, 0.93-1.25]; HR at >30 years, 0.91 [95% CI, 0.70-1.19]). When we investigated specific infertility diagnoses, elevated risk of CHD was observed among women whose infertility was attributed to an ovulatory disorder (HR, 1.28 [95% CI, 1.05-1.55]) or endometriosis (HR, 1.42 [95% CI, 1.09-1.85]). Conclusions Women with infertility may be at an increased risk of CHD. Risk differed by age at first infertility diagnosis and was restricted to ovulatory- and endometriosis-related infertility.
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Affiliation(s)
- Leslie V. Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public HealthUniversity of ArizonaTucsonAZ
- Department of Obstetrics and Gynecology, College of Medicine‐TucsonUniversity of ArizonaTucsonAZ
| | - Yi‐Xin Wang
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMA
| | - Audrey J. Gaskins
- Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaGA
| | - Janet W. Rich‐Edwards
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMA
- Division of Women’s Health, Department of Medicine, Brigham and Women’s HospitalHarvard Medical SchoolBostonMA
| | - Siwen Wang
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMA
| | | | - Jorge E. Chavarro
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMA
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s HospitalHarvard Medical SchoolBostonMA
| | - Kathryn M. Rexrode
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMA
- Division of Women’s Health, Department of Medicine, Brigham and Women’s HospitalHarvard Medical SchoolBostonMA
| | - Stacey A. Missmer
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMA
- Department of Obstetrics and Gynecology and Reproductive Biology, College of Human MedicineMichigan State UniversityGrand RapidsMI
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29
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Barha CK, Best JR, Rosano C, Yaffe K, Catov JM, Liu-Ambrose T. Walking for Cognitive Health: Previous Parity Moderates the Relationship Between Self-Reported Walking and Cognition. J Gerontol A Biol Sci Med Sci 2023; 78:486-493. [PMID: 35670837 PMCID: PMC9977231 DOI: 10.1093/gerona/glac123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Older females show greater cognitive gains from physical activity (PA) than males, which may be related to long-term consequences of female-specific reproductive events (eg, pregnancy) on cognitive health. METHODS To determine whether previous parity could moderate the relationship between PA and cognitive decline in older women, we conducted secondary analyses of data from the Health, Aging, and Body Composition Study. We tested whether the association between average PA over 10 years and cognition (Modified Mini-Mental State Examination [3MS]) and executive functioning (digit symbol substitution test [DSST]) over 10 years varied by previous parity (nulliparity, low parity, medium parity, and grand multiparity). An analysis of covariance was performed with cognition (average and change over 10 years) as the dependent variables, parity as a categorical predictor, average PA as a continuous predictor, and a set of relevant covariates. RESULTS Significant interactions were found between PA and parity group for all 4 comparisons: average 3MS (p = .014), average DSST (p = .032), change in 3MS (p = .016), and change in DSST (p = .017). Simple slope analyses indicated the positive relationship between PA and average 3MS and DSST was only significant in the nulliparity and grand multiparity groups, and the positive relationship between PA and change in 3MS and DSST was only significant in the grand multiparity group. CONCLUSION The findings suggest the relationship between self-reported walking and cognitive performance was strongest in the groups at risk for cognitive decline and dementia, the nulliparous and grand multiparous groups.
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Affiliation(s)
- Cindy K Barha
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - John R Best
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Caterina Rosano
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kristine Yaffe
- Department of Epidemiology and Biostatistics, University of California, California, San Francisco, USA
- Departments of Psychiatry and Neurology, University of California, San Francisco, California,USA
| | - Janet M Catov
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Teresa Liu-Ambrose
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
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30
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Blom JN, Velez MP, McClintock C, Shellenberger J, Pudwell J, Brogly SB, Bougie O. Endometriosis and cardiovascular disease: a population-based cohort study. CMAJ Open 2023; 11:E227-E236. [PMID: 36882211 PMCID: PMC10000901 DOI: 10.9778/cmajo.20220144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Endometriosis, a prevalent condition among females of reproductive age, may be associated with increased risk of cardiovascular disease (CVD) through chronic inflammation and early menopause. The objective of this study was to estimate the association between endometriosis and subsequent risk of CVD. METHODS We conducted a population-based cohort study using administrative health data from Ontario residents from 1993 to 2015. We compared the incidence of CVD and cardiovascular health outcomes between females with endometriosis and 2 age-matched females without endometriosis. The primary outcome was hospital admission for CVD. Secondary outcomes included in-hospital CVD events of interest and emergency department visits for CVD. We used Cox proportional hazards models to estimate adjusted hazard ratios (HRs) between endometriosis and CVD events. RESULTS We identified 166 835 eligible patients with endometriosis and matched 333 706 patients without endometriosis. The mean age of those with endometriosis was 36.4 years. Patients with endometriosis had a higher incidence of hospital admission for CVD (195 admissions/100 000 person-years) compared with those without endometriosis (163 admissions/100 000 person-years). Similarly, the incidence of secondary CVD events was slightly higher among patients with endometriosis (292 cases/100 000 person-years) than among those without endometriosis (224 cases/100 000 person-years). Females with endometriosis had an increased risk of hospital admission (adjusted HR 1.14, 95% confidence interval [CI] 1.10-1.19) and secondary CVD events (adjusted HR 1.26, 95% CI 1.23-1.30). INTERPRETATION In this large, population-based study, endometriosis was associated with a small increased risk of CVD events. Future studies need to investigate potential etiological mechanisms and strategies to decrease long-term CVD risk in patients with endometriosis.
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Affiliation(s)
- Jessica N Blom
- Department of Obstetrics and Gynaecology (Blom, Velez, Pudwell, Bougie), Queen's University, Kingston Health Sciences Centre; ICES Queen's (Velez, McClintock, Shellenberger, Brogly); Department of Surgery (Brogly), Queen's University, Kingston, Ont
| | - Maria P Velez
- Department of Obstetrics and Gynaecology (Blom, Velez, Pudwell, Bougie), Queen's University, Kingston Health Sciences Centre; ICES Queen's (Velez, McClintock, Shellenberger, Brogly); Department of Surgery (Brogly), Queen's University, Kingston, Ont
| | - Chad McClintock
- Department of Obstetrics and Gynaecology (Blom, Velez, Pudwell, Bougie), Queen's University, Kingston Health Sciences Centre; ICES Queen's (Velez, McClintock, Shellenberger, Brogly); Department of Surgery (Brogly), Queen's University, Kingston, Ont
| | - Jonas Shellenberger
- Department of Obstetrics and Gynaecology (Blom, Velez, Pudwell, Bougie), Queen's University, Kingston Health Sciences Centre; ICES Queen's (Velez, McClintock, Shellenberger, Brogly); Department of Surgery (Brogly), Queen's University, Kingston, Ont
| | - Jessica Pudwell
- Department of Obstetrics and Gynaecology (Blom, Velez, Pudwell, Bougie), Queen's University, Kingston Health Sciences Centre; ICES Queen's (Velez, McClintock, Shellenberger, Brogly); Department of Surgery (Brogly), Queen's University, Kingston, Ont
| | - Susan B Brogly
- Department of Obstetrics and Gynaecology (Blom, Velez, Pudwell, Bougie), Queen's University, Kingston Health Sciences Centre; ICES Queen's (Velez, McClintock, Shellenberger, Brogly); Department of Surgery (Brogly), Queen's University, Kingston, Ont
| | - Olga Bougie
- Department of Obstetrics and Gynaecology (Blom, Velez, Pudwell, Bougie), Queen's University, Kingston Health Sciences Centre; ICES Queen's (Velez, McClintock, Shellenberger, Brogly); Department of Surgery (Brogly), Queen's University, Kingston, Ont.
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31
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Chakraborty R, Kobayashi LC, Jock J, Wing C, Chen X, Phillips M, Berkman L, Kahn K, Kabudula CW, Rosenberg M. Child Support Grant expansion and cognitive function among women in rural South Africa: findings from a natural experiment in HAALSI cohort. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.18.23286130. [PMID: 36824712 PMCID: PMC9949209 DOI: 10.1101/2023.02.18.23286130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Cash transfers are a promising but understudied intervention that may protect cognitive function in adults by promoting their cognitive reserve. South Africa has a rapidly ageing population, however, less is known about the nature of association between cash transfers and cognitive function in this setting. We leveraged natural experiments from Child Support Grant (CSG) age-eligibility expansions to investigate the association between duration of CSG eligibility and cognitive function among biological mothers of child beneficiaries in South Africa. We analysed 2014/2015 baseline data from 944 women, aged 40 - 59 years with at least one CSG-eligible child, enrolled in the HAALSI cohort in Agincourt, South Africa. Duration of CSG eligibility for each mother was calculated based on the birth dates of all their children and the CSG age eligibility expansion years. Cognitive function was measured using a cognitive battery administered to the mothers at baseline interview. Linear regression was used to estimate the association between duration of CSG eligibility, dichotomized as low (≤10 years) and high (>10 years) eligibility, and cognitive function z-scores of the mothers. Our study finds that high duration of CSG eligibility, compared to low, was associated with higher cognitive function z-scores in the full sample [β: 0.15 SD; 95% CI: 0.04, 0.26; p-value = 0.01]. In mothers with one to four lifetime children, but not five or more, high duration of CSG eligibility, compared to low, was associated with higher cognitive function z-scores [β: 0.19 SD; 95% CI: 0.05, 0.34, p-value = 0.02]. Government cash transfers given to support raising children may confer substantial protective effect on cognitive function of mothers in their mid-life. Further studies are needed to understand how parity may influence this relationship. Our findings bring evidence to policymakers for designing income supplementation programmes to promote healthy cognitive ageing in low-income settings.
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Affiliation(s)
- Rishika Chakraborty
- Department of Environmental and Occupational Health, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, United States of America
| | - Lindsay C. Kobayashi
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
| | - Janet Jock
- O’Neill School of Public and Environmental Affairs, Indiana University-Bloomington, Bloomington, Indiana, United States of America
| | - Coady Wing
- O’Neill School of Public and Environmental Affairs, Indiana University-Bloomington, Bloomington, Indiana, United States of America
| | - Xiwei Chen
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, United States of America
| | - Meredith Phillips
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, United States of America
| | - Lisa Berkman
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts, United States of America
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
| | - Chodziwadziwa Whiteson Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Molly Rosenberg
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, United States of America
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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32
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Chen M, Guo J, Lin Y, Xu J, Hu Y, Yang L, Xu X, Zhu L, Zhou J, Zhang Z, Li H, Lin S, Wu S. Life-course fertility and multimorbidity among middle-aged and elderly women in China: Evidence from China health and retirement longitudinal study. Front Public Health 2023; 11:1090549. [PMID: 36891346 PMCID: PMC9986627 DOI: 10.3389/fpubh.2023.1090549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 01/30/2023] [Indexed: 02/22/2023] Open
Abstract
Background Multimorbidity has become an important public health problem in China, especially among middle-aged and elderly women. Few studies have been reported on the association between multimorbidity and female fertility, which is an important stage in the life course. This study aimed to explore the association between multimorbidity and fertility history among middle-aged and elderly women in China. Methods Data from 10,182 middle-aged and elderly female participants in the China Health and Retirement Longitudinal Study (CHARLS) in 2018 were used in this study. Multimorbidity was defined as the presence of at least two or more chronic conditions. Logistic regression analysis, negative binomial regression analysis, and restrictive cubic splines (RCSs) were used to analyze the relationship between female fertility history and multimorbidity or the number of chronic conditions. Multivariable linear regression was used to analyze the relationship between female fertility history and multimorbidity pattern factor scores. Results The results of this study showed that high parity and early childbearing were significantly associated with an increased risk of multimorbidity and an increased number of chronic conditions among middle-aged and elderly women in China. Late childbearing was significantly associated with reduced risk of multimorbidity and lessened diseases. Parity and age of first childbirth were significantly correlated with the odds of multimorbidity. The association between fertility history and multimorbidity was found to be influenced by age and urban-rural dual structure. Women with high parity tend to have higher factor scores of cardiac-metabolic, visceral-arthritic, and respiratory-psychiatric patterns. Women with early childbearing tended to have higher factor scores of the visceral-arthritic pattern and those with late childbearing tended to have lower factor scores of the cardiac-metabolic pattern. Conclusion Fertility history has a significant effect on multimorbidity in the middle and later lives of Chinese women. This study is of great importance for reducing the prevalence of multimorbidity among Chinese women through their life course and promoting health during their middle and later lives.
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Affiliation(s)
- Mingjun Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Jianhui Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Yawen Lin
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Jialiang Xu
- School of Public Health, Fujian Medical University, Fuzhou, China
| | - Yuduan Hu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Le Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Xingyan Xu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Li Zhu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Jungu Zhou
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Zhiyu Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Huangyuan Li
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Shaowei Lin
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Siying Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
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33
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Cnattingius S, Källén K, Sandström A, Rydberg H, Månsson H, Stephansson O, Frisell T, Ludvigsson JF. The Swedish medical birth register during five decades: documentation of the content and quality of the register. Eur J Epidemiol 2023; 38:109-120. [PMID: 36595114 PMCID: PMC9867659 DOI: 10.1007/s10654-022-00947-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/15/2022] [Indexed: 01/04/2023]
Abstract
Pregnancy-related factors are important for short- and long-term health in mothers and offspring. The nationwide population-based Swedish Medical Birth Register (MBR) was established in 1973. The present study describes the content and quality of the MBR, using original MBR data, Swedish-language and international publications based on the MBR.The MBR includes around 98% of all births in Sweden. From 1982 onwards, the MBR is based on prospectively recorded information in standardized antenatal, obstetric, and neonatal records. When the mother and infant are discharged from hospital, this information is forwarded to the MBR, which is updated annually. Maternal data include information from first antenatal visit on self-reported obstetric history, infertility, diseases, medication use, cohabitation status, smoking and snuff use, self-reported height and measured weight, allowing calculation of body mass index. Birth and neonatal data include date and time of birth, mode of delivery, singleton or multiple birth, gestational age, stillbirth, birth weight, birth length, head circumference, infant sex, Apgar scores, and maternal and infant diagnoses/procedures, including neonatal care. The overall quality of the MBR is very high, owing to the semi-automated data extraction from the standardized regional electronic health records, Sweden's universal access to antenatal care, and the possibility to compare mothers and offspring to the Total Population Register in order to identify missing records. Through the unique personal identity numbers of mothers and live-born offspring, the MBR can be linked to other health registers. The Swedish MBR contains high-quality pregnancy-related information on more than 5 million births during five decades.
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Affiliation(s)
- Sven Cnattingius
- grid.465198.7Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - Karin Källén
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences, Centre of Reproduction Epidemiology, Tornblad Institute, Lund University, Lund, Sweden
| | - Anna Sandström
- grid.465198.7Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Solna, Sweden ,grid.24381.3c0000 0000 9241 5705Department of Women’s Health, Division of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
| | - Henny Rydberg
- grid.416537.20000 0004 0511 9852Statistics Unit 1, Department of Registers and Statistics, National Board of Health and Welfare, Stockholm, Sweden
| | - Helena Månsson
- grid.416537.20000 0004 0511 9852Statistics Unit 1, Department of Registers and Statistics, National Board of Health and Welfare, Stockholm, Sweden
| | - Olof Stephansson
- grid.465198.7Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Solna, Sweden ,grid.24381.3c0000 0000 9241 5705Department of Women’s Health, Division of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
| | - Thomas Frisell
- grid.465198.7Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - Jonas F. Ludvigsson
- grid.4714.60000 0004 1937 0626Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177 Stockholm, Sweden ,grid.412367.50000 0001 0123 6208Department of Pediatrics, Örebro University Hospital, Örebro, Sweden ,grid.21729.3f0000000419368729Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY USA
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34
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Kazzi B, Ogunmoroti O, Rodriguez CP, Zhao D, Minhas AS, Osibogun O, Subramanya V, Allison MA, Ouyang P, Michos ED. Parity History and Later Life Sex Hormone Levels in the Multi-Ethnic Study of Atherosclerosis (MESA). Can J Cardiol 2022; 38:1893-1900. [PMID: 36087657 DOI: 10.1016/j.cjca.2022.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/14/2022] [Accepted: 09/01/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Multiparity is a risk factor for cardiovascular disease (CVD). A more androgenic sex hormone profile, with a higher testosterone (T)/estradiol (E2) ratio, is associated with worse CVD outcomes in women and might be one mechanism linking multiparity to increased CVD risk. We investigated the relationship between parity and sex hormones at mid-to-older age. METHODS We performed a cross-sectional analysis of 2979 women with data on parity and endogenous sex hormone levels from the Multi-Ethnic Study of Atherosclerosis (MESA), a community-based cohort. Parity and gravidity (our exposures) were categorized as 0 (reference), 1-2, 3-4, or ≥ 5. Our outcome measures were T, E2, sex hormone binding globulin, dehydroepiandrosterone, and T/E2 ratio. Progressively adjusted linear regression was used to evaluate the association of parity/gravidity with sex hormones. RESULTS In multivariable adjusted models, there were no significant associations of parity with E2, dehydroepiandrosterone, and sex hormone binding globulin. Compared with nulliparity, after adjustment for CVD risk factors, women with 1-2 and 3-4 live births had higher T, but this was not significant for grand multiparity (≥ 5 live births). However, grand multigravidity (≥ 5 pregnancies) was associated with 10% (95% confidence interval [CI], 1%-20%) higher T and 14% (95% CI, 1%-29%) higher T/E2, compared with null gravidity. Grand multiparity was associated with an 18% (95% CI, 4%-34%) higher T/E2 ratio compared with nulliparity, after adjustment for CVD risk factors. CONCLUSIONS In this multiethnic cohort, women with grand multigravidity and grand multiparity had higher T/E2 levels, reflecting a more androgenic sex hormone profile. Longitudinal studies on sex hormones' influence on the relationship between multiparity and CVD are warranted.
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Affiliation(s)
- Brigitte Kazzi
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Oluseye Ogunmoroti
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Carla P Rodriguez
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Di Zhao
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anum S Minhas
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Vinita Subramanya
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Matthew A Allison
- Department of Family Medicine, University of California San Diego, San Diego, California, USA
| | - Pamela Ouyang
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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35
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Kaur G, Lau E. Sex differences in heart failure with preserved ejection fraction: From traditional risk factors to sex-specific risk factors. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221140209. [PMID: 36448661 PMCID: PMC9720805 DOI: 10.1177/17455057221140209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Heart failure with preserved ejection fraction has a higher prevalence in women versus men. There are several proposed mechanisms to explain this sex discrepancy including differences in cardiovascular adaptation to comorbidities and potential underlying etiologic mechanisms. In this review, we summarize sex differences in traditional risk factors, such as obesity, diabetes, hypertension, and coronary artery disease, which contribute to the development of heart failure with preserved ejection fraction in women. Furthermore, we explore female-specific risk factors, such as sex hormones, adverse pregnancy outcomes, and other reproductive factors, which may explain the predominance of heart failure with preserved ejection fraction in women. Beyond sex differences in risk factors, there are also significant sex differences in outcomes with women reporting lower quality of life but overall better survival versus men. Finally, while treatment options for patients with heart failure with preserved ejection fraction are still limited, sex differences have also been reported for the available therapies, with suggestion of preferential benefit of specific heart failure with preserved ejection fraction therapies in women. Further work is required to better understand sex differences in heart failure with preserved ejection fraction, including deeper understanding of pathophysiological mechanisms, derivation of more accurate risk stratification models, and increased representation of women in clinical trials.
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Affiliation(s)
- Gurleen Kaur
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Emily Lau
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA,Emily Lau, Division of Cardiology, Massachusetts General Hospital, 185 Cambridge Street, CPZN #3206, Boston, MA 02114, USA.
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36
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Association of Number of Live Births With Electrocardiographic and Cardiac Structural Changes. J Am Heart Assoc 2022; 11:e025805. [DOI: 10.1161/jaha.122.025805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background
Pregnancy is a major life event unique to women and leads to significant hemodynamic, hormonal, and metabolic changes. The purpose of this study was to use the DHS (Dallas Heart Study), a multiethnic population‐based cohort study of Dallas county adults, to evaluate the association between number of live births and cardiac magnetic resonance imaging and ECG parameters later in life.
Methods and Results
Women were included if they had data on self‐reported live births and ECG or cardiac magnetic resonance imaging measurements. The 3014 women were stratified by number of live births: 0, 1, 2, 3, 4, and ≥5. Higher number of live births was associated with larger left ventricular (LV) end‐diastolic volume (β, 1.31±0.41;
P
<0.01), LV end‐systolic volume (β, 0.83±0.24;
P
<0.01), and LV mass (β, 1.13±0.49;
P
=0.02) and lower LV ejection fraction (β, −0.004±0.0014;
P
<0.01). Increasing parity was associated with longer PR intervals (β, 1.07±0.38;
P
<0.01). Subgroup analysis by race demonstrated that the association between number of live births and magnetic resonance imaging parameters (LV end‐diastolic volume, LV end‐systolic volume, and LV ejection fraction) only remained significant in Black women (
P
value for interaction <0.05).
Conclusions
Increasing number of live births was associated with electrocardiographic and cardiac structural changes in a multiethnic population. When stratified by race and ethnicity, magnetic resonance imaging structural changes only remained significant in Black participants. Whether these changes are pathologic and increase the risk of heart failure or arrhythmias in multiparous women warrants further investigation.
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37
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Xue K, Nie Y, Wang Y, Hu Z. Number of Births and Later-Life Depression in Older Adults: Evidence from China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11780. [PMID: 36142053 PMCID: PMC9517263 DOI: 10.3390/ijerph191811780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/14/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
Previous studies on the number of births and the health of the elderly have been highly focused on physical health and used samples from developed countries. Therefore, this study aimed to explore the effect of the lifetime number of births on depression in Chinese older adults. We used panel data for men and women aged 50 and over from the 2013-2018 China Health and Retirement Longitudinal Study. Depressive symptoms were assessed through a short form of the Center for Epidemiologic Studies Depression Scale. We found that depression levels in women were significantly higher than in men, with a mean difference of 2.44 (p < 0.001). The model estimation results indicated that the number of births affected depression in older adults, and its increase could exacerbate depression in older adults. The number of births significantly impacted depression among the elderly aged 50-69. Furthermore, there was a negative relationship between the proportion of sons and older adults' depression, which was significant in older males; the number of abortions may exacerbate depression in older adults, especially in females.
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Affiliation(s)
- Kaiyun Xue
- College of Economics and Management, Northwest A&F University, Yangling, Xianyang 712100, China
| | - Yafeng Nie
- School of Economics, Jinan University, Guangzhou 510632, China
| | - Yue Wang
- College of Economics and Management, Northwest A&F University, Yangling, Xianyang 712100, China
| | - Zhen Hu
- College of Economics and Management, Northwest A&F University, Yangling, Xianyang 712100, China
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38
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Ezeigwe A, Ogunmoroti O, Minhas AS, Rodriguez CP, Kazzi B, Fashanu OE, Osibogun O, Kovell LC, Harrington CM, Michos ED. Association between parity and markers of inflammation: The multi-ethnic study of atherosclerosis. Front Cardiovasc Med 2022; 9:922367. [PMID: 36186982 PMCID: PMC9515387 DOI: 10.3389/fcvm.2022.922367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 08/12/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Multiparity has been associated with increased risk of cardiovascular disease (CVD). Inflammation may be a mechanism linking parity to CVD. We investigated the association between parity and later-life markers of inflammation. Methods We studied 3,454 female MESA participants aged 45-84, free of CVD, who had data on parity and inflammatory markers. Parity was categorized as 0 (reference), 1-2, 3-4, or ≥5. Linear regression was used to evaluate the association between parity and natural log-transformed levels of fibrinogen, D-dimer, GlycA, high sensitivity C-reactive protein (hsCRP), and interleukin-6 (IL-6). Results Mean age was 62 ± 10 years. The proportion of women with nulliparity, 1-2, 3-4, and ≥5 live births were 18, 39, 29, and 14%, respectively. There was no association between parity and fibrinogen. Women with grand multiparity (≥5 live births) had 28, 10, and 18% higher levels of hsCRP, IL-6 and D-dimer, respectively, compared to nulliparous women, after adjustment for demographic factors. After additional adjustment for CVD risk factors, women with 1-2 and 3-4 live births had higher hsCRP and women with 1-2 live births had higher GlycA. Conclusion In this diverse cohort of middle-to-older aged women, we found that higher parity was associated with some inflammatory markers; however, these associations were largely attenuated after adjustment for CVD risk factors. There was no clear dose-response relationship between parity and these inflammatory markers. Future studies are needed to evaluate how inflammation may influence the link between parity and CVD and whether healthy lifestyle/pharmacotherapies targeting inflammation can reduce CVD risk among multiparous women. Clinical trial registration The MESA cohort design is registered at clinicaltrials.gov as follows: https://clinicaltrials.gov/ct2/show/NCT00005487.
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Affiliation(s)
- Angelica Ezeigwe
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Oluseye Ogunmoroti
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Anum S. Minhas
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Carla P. Rodriguez
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Brigitte Kazzi
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Oluwaseun E. Fashanu
- Division of Cardiology, Sands Constellation Heart Institute, Rochester Regional Health, Rochester, NY, United States
| | - Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, United States
| | - Lara C. Kovell
- Division of Cardiology, University of Massachusetts Chan School of Medicine, Worchester, MA, United States
| | - Colleen M. Harrington
- Corrigan's Women's Heart Health Program, Massachusetts General Hospital, Boston, MA, United States
| | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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39
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Wu Y, Pang J, Wang J, Wu J, Zhang S, Zhang S, Yao Y, Cheng S, Tao Y, Shen Z, Li ZY, Xie L, Yang H. Fertility Histories and Heart Disease in Later Life in China. Front Public Health 2022; 10:819196. [PMID: 35719619 PMCID: PMC9201049 DOI: 10.3389/fpubh.2022.819196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 04/11/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose Based on life course theories, health among older people is driven by a continuous and cumulative process that develops over the life course. To better understand the aging process, it is important to assess associations between parity and heart disease in older people of China. Method The associations between heart disease prevalence and number of births, number of boys or girls ever born were evaluated among 5,990 samples (mean age 64.1 years) using the Probit regression model based on the data from China Health and Retirement Longitudinal Study (CHARLS) conducted in 2013 and 2018. The model was adjusted only for rural or urban residents, and multivariate regression models were run separately by gender. Results Our results showed that more than three children or more than two boys ever born were associated with a higher risk of heart disease. However, the number of girls ever born had no significant effect on heart disease in the elderly. We further analyzed the group difference between urban and rural residents using the regression model. More than three children or more than two boys ever born were associated with a high risk of heart disease in rural areas. Compared to urban residents, rural residents were more likely to be suffering from heart disease due to high parity. When considering the digender difference the paper found that more than three children ever born were associated with a high risk of heart disease in the female group. Late age at the time of giving birth for the first time was associated with a poorer risk level of heart disease in the rural residents, because the phenomenon of early childbearing was serious in the rural residents. But after considering the impact on the physical health of using chronic diseases, the first birth and the last birth both increased the risk of heart disease. Conclusions Some policy implications were being put forward. Firstly, parents who were ready to give birth should be aware of the possible health loss of high parity. Postpartum nutrition supplements and chronic disease prevention were suggested to prevent heart disease in later life. Secondly, the elderly in rural areas should pay more attention to heart diseases. Participating in more daily exercise and physical examinations was a good choice to reduce the risk of heart disease. Thirdly, women who give birth prematurely have a higher risk of CVD. Based on our results, age at entry to parenthood was closely related to the risk of heart disease in later life.
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Affiliation(s)
- Yuanyang Wu
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China
| | - Jiahui Pang
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China
| | - Jiahao Wang
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China
| | - Jing Wu
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China
| | - Shuo Zhang
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China
| | - Siqing Zhang
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China
| | - Yidan Yao
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China
| | - Simeng Cheng
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China
| | - Yiwen Tao
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China
| | - Zheng Shen
- School of Economics and Management, Zhejiang Agriculture and Forestry University, Zhejiang, China
| | - Zhi-Yun Li
- College of Politics and Public Administration, Qingdao University, Qingdao, China
| | - Lin Xie
- Chinese Academy of Social Sciences (CASS), Beijing, China
| | - Hualei Yang
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China
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Xing Z, Alman AC, Kirby RS. Parity and Risk of Cardiovascular Disease in Women over 45 Years in the United States: National Health and Nutrition Examination Survey 2007-2018. J Womens Health (Larchmt) 2022; 31:1459-1466. [PMID: 35727098 DOI: 10.1089/jwh.2021.0650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective: Current research results on the association between parity and cardiovascular disease (CVD) risk are inconclusive. The purpose of this study was to examine the relationship between parity and risk of CVD in women over 45 years of age. Materials and Methods: Data were from the National Health and Nutrition Examination Survey for 2007-2018. A total of 8,882 women ≥45 years of age were included. The exposure of parity referred to the number of live births, and the outcome variable was the occurrence of CVD events, including stroke, heart attack, coronary heart disease (CHD), heart failure, and angina. We performed logistic regression to calculate the unadjusted and adjusted odds ratios (ORs; 95% confidence intervals [CIs]) controlling for confounding factors. Results: Among 8,882 women, the mean age was 62.4 ± 10.8 years, with a range of 45 to 80 years. The weighted prevalence of CVD, stroke, heart attack, CHD, heart failure, and angina in parous women were significantly higher than those of nulliparous women (p < 0.05). After adjusting for demographic factors, CVD risk factors, reproductive factors, the ORs of CVD with parity 1-2, 3-4, and 5+ were 1.85 (95% CI: 1.29-2.64), 1.70 (95% CI: 1.15-2.50), and 1.92 (95% CI: 1.28-2.88), respectively. The odds of stroke and heart attack were also significantly positively related to increasing parity compared with nulliparity. However, compared with nulliparity, parity of 3 was associated with a slightly lower risk of CVD. Conclusions: Our findings indicated that parity was significantly positively associated with CVD, giving birth to three children associated with a slightly lower risk compared with nulliparity. Further cohort studies are warranted to confirm the findings.
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Affiliation(s)
- Zailing Xing
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Amy C Alman
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Russell S Kirby
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, Florida, USA.,Birth Defects Surveillance Program, Chiles Center, College of Public Health, University of South Florida, Tampa, Florida, USA
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Vision for Improving Pregnancy Health: Innovation and the Future of Pregnancy Research. Reprod Sci 2022; 29:2908-2920. [PMID: 35534766 PMCID: PMC9537127 DOI: 10.1007/s43032-022-00951-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/15/2022] [Indexed: 10/25/2022]
Abstract
Understanding, predicting, and preventing pregnancy disorders have been a major research target. Nonetheless, the lack of progress is illustrated by research results related to preeclampsia and other hypertensive pregnancy disorders. These remain a major cause of maternal and infant mortality worldwide. There is a general consensus that the rate of progress toward understanding pregnancy disorders lags behind progress in other aspects of human health. In this presentation, we advance an explanation for this failure and suggest solutions. We propose that progress has been impeded by narrowly focused research training and limited imagination and innovation, resulting in the failure to think beyond conventional research approaches and analytical strategies. Investigations have been largely limited to hypothesis-generating approaches constrained by attempts to force poorly defined complex disorders into a single "unifying" hypothesis. Future progress could be accelerated by rethinking this approach. We advise taking advantage of innovative approaches that will generate new research strategies for investigating pregnancy abnormalities. Studies should begin before conception, assessing pregnancy longitudinally, before, during, and after pregnancy. Pregnancy disorders should be defined by pathophysiology rather than phenotype, and state of the art agnostic assessment of data should be adopted to generate new ideas. Taking advantage of new approaches mandates emphasizing innovation, inclusion of large datasets, and use of state of the art experimental and analytical techniques. A revolution in understanding pregnancy-associated disorders will depend on networks of scientists who are driven by an intense biological curiosity, a team spirit, and the tools to make new discoveries.
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Neshteruk CD, Norman K, Armstrong SC, Cholera R, D'Agostino E, Skinner AC. Association between parenthood and cardiovascular disease risk: Analysis from NHANES 2011-2016. Prev Med Rep 2022; 27:101820. [PMID: 35656211 PMCID: PMC9152778 DOI: 10.1016/j.pmedr.2022.101820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/31/2022] [Accepted: 04/30/2022] [Indexed: 01/14/2023] Open
Abstract
The objective of this study was to examine the association between parenthood and cardiovascular disease (CVD) risk factors among a nationally representative sample of United States adults. A cross sectional analysis was conducted with adults aged 20-59 years from the National Health and Nutrition Examination Survey 2011-2016. Adults were classified as parents and non-parents based on the presence of children birth-17 years in the home. CVD risk factors assessed included: physical inactivity, obesity, blood pressure, HDL cholesterol, glycohemoglobin, and smoking status. Multivariable logistic regression models stratified by sex were used to examine the association between parenthood and each risk factor. 10,908 adults (5,329 [49%] male, weighted mean age 39.6 years) were included. In adjusted analyses, fathers had greater odds of obesity (OR: 1.22; 95% CI: 1.04-1.42) and lower odds of being a current smoker (OR: 0.82; 95% CI: 0.68-0.98) compared to non-fathers. Mothers had greater odds of physical inactivity (OR: 1.27; 95% CI: 1.03-1.56) and low HDL cholesterol (OR: 1.24; 95% CI: 1.06-1.45), and lower odds of being a current smoker (OR: 0.78; 95% CI: 0.63-0.96) compared to non-mothers. Parents with younger children in the household tended to have greater odds of CVD risk factors compared to non-parents. No clear patterns emerged in CVD factor risk based on the number of children in the household. Parents are at greater risk for several modifiable CVD risk factors. This illustrates the importance of including parental health promotion in settings that serve children and implementing policies that support parental health and wellbeing.
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Affiliation(s)
- Cody D. Neshteruk
- Department of Population Health Sciences, Duke University Medical School, Durham, NC, United States,Corresponding author at: 215 Morris Street, Suite 210, Durham, NC 27701, United States.
| | - Katherine Norman
- Department of Population Health Sciences, Duke University Medical School, Durham, NC, United States
| | - Sarah C. Armstrong
- Department of Population Health Sciences, Duke University Medical School, Durham, NC, United States,Duke Clinical Research Institute, Duke University, Durham, NC, United States,Department of Pediatrics, Duke University Medical School, Durham, NC, United States
| | - Rushina Cholera
- Department of Pediatrics, Duke University Medical School, Durham, NC, United States,National Clinician Scholars Program, United States,Duke Margolis Center for Health Policy, Duke University, Durham, NC, United States
| | - Emily D'Agostino
- Department of Population Health Sciences, Duke University Medical School, Durham, NC, United States,Department of Orthopaedic Surgery, Duke University Medical School, Durham, NC, United States
| | - Asheley C. Skinner
- Department of Population Health Sciences, Duke University Medical School, Durham, NC, United States,Duke Clinical Research Institute, Duke University, Durham, NC, United States
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Rodriguez CP, Ogunmoroti O, Quispe R, Osibogun O, Ndumele CE, Echouffo Tcheugui J, Minhas AS, Bertoni AG, Allison MA, Michos ED. The Association Between Multiparity and Adipokine Levels: The Multi-Ethnic Study of Atherosclerosis. J Womens Health (Larchmt) 2022; 31:741-749. [PMID: 34747649 PMCID: PMC9133972 DOI: 10.1089/jwh.2021.0091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Background: Multiparity is a risk factor for cardiovascular disease (CVD). However, the mechanisms of this relationship are unknown. Adipokines may predispose multiparous women to certain cardiometabolic complications that can increase their risk of future CVD. Materials and Methods: We studied 973 female participants of the Multi-Ethnic Study of Atherosclerosis free of CVD, who had complete data on parity and adipokines measured at Examination 2 or 3 (randomly assigned). Parity was categorized as nulliparity, 1-2, 3-4, and ≥5 live births. Multivariable linear regression was used to evaluate the association of parity with leptin, resistin, and adiponectin levels. Results: The women had mean age of 65 ± 9 years. After adjustment for age, race/ethnicity, study site, education, menopause status, smoking, physical activity, use of hormone therapy, and waist circumference, a history of grand multiparity (≥5 live births) was associated with 11% higher resistin levels (95% confidence interval [CI] 0-23) and 3-4 live births was associated with 23% higher leptin levels (95% CI 7-42), compared with nulliparity. After adjustment for computed tomography-measured visceral fat, the association of 3-4 live births with leptin remained significant. There were no significant associations of parity with adipokines after further adjustment for additional CVD risk factors. Multigravidity (but not parity) was inversely associated with adiponectin levels. Conclusions: In a multiethnic cohort of women, greater parity was associated with resistin and leptin; however, this association was attenuated after accounting for CVD risk factors. Dysregulation of adipokines could contribute to the excess CVD risk associated with multiparity. Further studies are needed to determine whether adipokines independently mediate the relationship between multiparity and CVD. Clinical trials registration: The MESA cohort is registered at NCT00005487.
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Affiliation(s)
- Carla P. Rodriguez
- Division of Cardiology, The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Oluseye Ogunmoroti
- Division of Cardiology, The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Renato Quispe
- Division of Cardiology, The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, Florida, USA
| | - Chiadi E. Ndumele
- Division of Cardiology, The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Justin Echouffo Tcheugui
- Division of Cardiology, The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anum S. Minhas
- Division of Cardiology, The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alain G. Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Matthew A. Allison
- Department of Family Medicine, University of California San Diego, San Diego, California, USA
| | - Erin D. Michos
- Division of Cardiology, The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Farland LV, Liu CL, Diop H, Cabral HJ, Missmer SA, Coddington CC, Hwang SS, Stern JE. Hospitalizations up to 8 years following delivery in assisted reproductive technology-treated and subfertile women. Fertil Steril 2022; 117:593-602. [PMID: 35058044 PMCID: PMC8885864 DOI: 10.1016/j.fertnstert.2021.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 11/01/2021] [Accepted: 11/04/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate hospitalizations up to 8 years after live birth among women who used assisted reproductive technology (ART) or who were subfertile compared with women who conceived naturally. DESIGN Retrospective cohort. SETTING Deliveries among privately insured women aged ≥18 years between 2004 and 2017 from Massachusetts state vital records were linked to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System and hospital observational/inpatient stays. PATIENT(S) We compared patients with ART, medically assisted reproduction (MAR), and unassisted subfertile (USF) delivery with those with fertile delivery. INTERVENTION(S) NA. MAIN OUTCOME MEASURE(S) Postdelivery hospitalization information was derived from the International Classification of Diseases codes for discharges and combined by type. The relative risks and 95% confidence intervals (CIs) of hospitalization for up to the first 8 years postdelivery were modeled. RESULT(S) Among 492,515 deliveries, 5.6% used ART, 1.6% used MAR, and 1.8% were USF. Compared with fertile deliveries, deliveries that used ART or MAR or were USF were more likely to have hospital utilization (inpatient or observational stay) for any reason for up to 8 years of follow-up (USF, adjusted relative risk [aRR], 1.18 [95% CI, 1.12-1.25]; MAR, aRR, 1.20 [1.13-1.27]; and ART, aRR, 1.29 [1.25-1.34]). Assisted reproductive technology deliveries had an increased risk of hospitalization for conditions of the cardiovascular system (aRR, 1.31 [95% CI, 1.20-1.41]), overweight/obesity (aRR, 1.30 [1.17-1.44]), diabetes (aRR, 1.25 [1.05-1.49]), reproductive tract (aRR, 1.62 [1.47-1.79]), digestive tract (aRR, 1.39 [1.30-1.49]), thyroid (aRR, 2.02 [1.80-2.26]), respiratory system (aRR, 1.13 [1.03-1.24]), and cancer (aRR, 1.40 [1.18-1.65]) up to 8 years after delivery. Deliveries with MAR and subfertility had similar patterns of hospitalization as ART deliveries. CONCLUSION(S) Women who conceived through fertility treatment or experienced subfertility were at increased risk of subsequent hospitalization resulting from a variety of chronic and acute conditions.
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Affiliation(s)
- Leslie V. Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona,Department of Obstetrics and Gynecology, College of Medicine- Tucson, University of Arizona
| | - Chia-ling Liu
- Massachusetts Department of Public Health, Bureau of Family Health and Nutrition, Boston, MA
| | - Hafsatou Diop
- Massachusetts Department of Public Health, Bureau of Family Health and Nutrition, Boston, MA
| | - Howard J. Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Stacey A. Missmer
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine Michigan State University, Grand Rapids, MI,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Charles C. Coddington
- Department of Obstetrics and Gynecology, Carolinas Medical Center/Atrium Health, Charlotte, NC
| | - Sunah S. Hwang
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, CO
| | - Judy E. Stern
- Department of Obstetrics and Gynecology, Dartmouth-Hitchcock, Lebanon, NH
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Murugappan G, Leonard SA, Farland LV, Lau ES, Shadyab AH, Wild RA, Schnatz P, Carmichael SL, Stefanick ML, Parikh NI. Association of infertility with atherosclerotic cardiovascular disease among postmenopausal participants in the Women’s Health Initiative. Fertil Steril 2022; 117:1038-1046. [PMID: 35305814 PMCID: PMC9081220 DOI: 10.1016/j.fertnstert.2022.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the association of infertility with atherosclerotic cardiovascular disease (ASCVD) among postmenopausal participants in the Women's Health Initiative (WHI). We hypothesized that nulliparity and pregnancy loss may reveal more extreme phenotypes of infertility, enabling further understanding of the association of infertility with ASCVD. DESIGN Prospective cohort study. SETTING Forty clinical centers in the United States. PATIENT(S) A total of 158,787 postmenopausal participants in the Women's Health Initiative cohort. INTERVENTION(S) Infertility, parity, and pregnancy loss. MAIN OUTCOME MEASURE(S) The primary outcome was risk of ASCVD among women with and without a history of infertility, stratified by history of live birth and pregnancy loss. Cox proportional-hazards models were adjusted for demographics and risk factors for ASCVD. RESULT(S) Among 158,787 women, 25,933 (16.3%) reported a history of infertility; 20,427 (80%) had at least 1 live birth; and 9,062 (35%) had at least 1 pregnancy loss. There was a moderate overall association between infertility and ASCVD (adjusted hazard ratio, 1.02; 95% confidence interval [CI], 0.99-1.06) over 19 years of follow-up. Among nulliparous women, infertility was associated with a 13% higher risk of ASCVD (95% CI, 1.04-1.23). Among nulliparous women who had a pregnancy loss, infertility was associated with a 36% higher risk of ASCVD (95% CI, 1.09-1.71). CONCLUSION(S) Women with a history of infertility overall had a moderately higher risk of ASCVD compared with women without a history of infertility. Atherosclerotic cardiovascular disease risk was much higher among nulliparous infertile women and among nulliparous infertile women who also had a pregnancy loss, suggesting that in these more extreme phenotypes, infertility may be associated with ASCVD risk.
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Affiliation(s)
- Gayathree Murugappan
- Department of Obstetrics and Gynecology, Stanford University Medical Center, Stanford, California.
| | - Stephanie A Leonard
- Department of Obstetrics and Gynecology, Stanford University Medical Center, Stanford, California
| | - Leslie V Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona; Department of Obstetrics and Gynecology, College of Medicine-Tucson, University of Arizona, Tucson, Arizona
| | - Emily S Lau
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Aladdin H Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California
| | - Robert A Wild
- Departments of Obstetrics and Gynecology, Biostatistics, and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Peter Schnatz
- Department of Obstetrics and Gynecology and Internal Medicine, Reading Hospital, Reading, Pennsylvania
| | - Suzan L Carmichael
- Department of Obstetrics and Gynecology, Stanford University Medical Center, Stanford, California; Department of Pediatrics, Stanford University Medical Center, Stanford, California
| | - Marcia L Stefanick
- Department of Obstetrics and Gynecology, Stanford University Medical Center, Stanford, California; Department of Medicine, Stanford Prevention Research Center, Stanford, California
| | - Nisha I Parikh
- Division of Cardiovascular Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
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46
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O’Kelly AC, Michos ED, Shufelt CL, Vermunt JV, Minissian MB, Quesada O, Smith GN, Rich-Edwards JW, Garovic VD, El Khoudary SR, Honigberg MC. Pregnancy and Reproductive Risk Factors for Cardiovascular Disease in Women. Circ Res 2022; 130:652-672. [PMID: 35175837 PMCID: PMC8870397 DOI: 10.1161/circresaha.121.319895] [Citation(s) in RCA: 104] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Beyond conventional risk factors for cardiovascular disease, women face an additional burden of sex-specific risk factors. Key stages of a woman's reproductive history may influence or reveal short- and long-term cardiometabolic and cardiovascular trajectories. Early and late menarche, polycystic ovary syndrome, infertility, adverse pregnancy outcomes (eg, hypertensive disorders of pregnancy, gestational diabetes, preterm delivery, and intrauterine growth restriction), and absence of breastfeeding are all associated with increased future cardiovascular disease risk. The menopause transition additionally represents a period of accelerated cardiovascular disease risk, with timing (eg, premature menopause), mechanism, and symptoms of menopause, as well as treatment of menopause symptoms, each contributing to this risk. Differences in conventional cardiovascular disease risk factors appear to explain some, but not all, of the observed associations between reproductive history and later-life cardiovascular disease; further research is needed to elucidate hormonal effects and unique sex-specific disease mechanisms. A history of reproductive risk factors represents an opportunity for comprehensive risk factor screening, refinement of cardiovascular disease risk assessment, and implementation of primordial and primary prevention to optimize long-term cardiometabolic health in women.
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Affiliation(s)
- Anna C. O’Kelly
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD,Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Chrisandra L. Shufelt
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jane V. Vermunt
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Margo B. Minissian
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA,Geri and Richard Brawerman Nursing Institute, Cedars-Sinai Medical Center, Los Angeles CA
| | - Odayme Quesada
- Women’s Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, OH,The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH
| | - Graeme N. Smith
- Department of Obstetrics and Gynecology, Queen’s University, Kingston, Ontario, Canada
| | - Janet W. Rich-Edwards
- Division of Women’s Health, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Vesna D. Garovic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Samar R. El Khoudary
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Michael C. Honigberg
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA,Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA,Corrigan Women’s Heart Health Program, Massachusetts General Hospital, Boston, MA
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The association of reproductive history with hypertension and obesity according to menopausal status: the J-MICC Study. Hypertens Res 2022; 45:708-714. [PMID: 35031776 DOI: 10.1038/s41440-021-00820-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/26/2021] [Accepted: 11/08/2021] [Indexed: 11/08/2022]
Abstract
Previous studies have reported that the number of pregnancies and childbirths affected the risk of cardiovascular diseases (CVDs). However, the influence of reproductive history on hypertension and obesity, which are important risk factors for CVDs, is still unclear. Moreover, this association may vary depending on menopausal status. We evaluated the association of reproductive history with hypertension and obesity using a large cross-sectional dataset from the Japan Multi-Institutional Collaborative Cohort Study (J-MICC Study). At the baseline survey, physical data, blood samples, and self-reported health questionnaires were collected. Participants with insufficient data were excluded, and 24,558 women from eight study regions were included in this study. Logistic regression analysis was conducted to evaluate the association of reproductive history with hypertension and obesity using multivariable-adjusted odds ratios. In premenopausal women, childbirth showed a generally protective effect on hypertension but not on obesity. In postmenopausal women, childbirth was positively associated with obesity and hypertension but not with hypertension after adjusting for BMI. In conclusion, reproductive history was associated with hypertension and obesity in a large Japanese population, and this association differed between premenopausal and postmenopausal women.
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48
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Miller EC, Wilczek A, Bello NA, Tom S, Wapner R, Suh Y. Pregnancy, preeclampsia and maternal aging: From epidemiology to functional genomics. Ageing Res Rev 2022; 73:101535. [PMID: 34871806 PMCID: PMC8827396 DOI: 10.1016/j.arr.2021.101535] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 11/15/2021] [Accepted: 12/01/2021] [Indexed: 01/03/2023]
Abstract
Women live longer than men but experience greater disability and a longer period of illness as they age. Despite clear sex differences in aging, the impact of pregnancy and its complications, such as preeclampsia, on aging is an underexplored area of geroscience. This review summarizes our current knowledge about the complex links between pregnancy and age-related diseases, including evidence from epidemiology, clinical research, and genetics. We discuss the relationship between normal and pathological pregnancy and maternal aging, using preeclampsia as a primary example. We review the results of human genetics studies of preeclampsia, including genome wide association studies (GWAS), and attempted to catalog genes involved in preeclampsia as a gateway to mechanisms underlying an increased risk of later life cardio- and neuro- vascular events. Lastly, we discuss challenges in interpreting the GWAS of preeclampsia and provide a functional genomics framework for future research needed to fully realize the promise of GWAS in identifying targets for geroprotective prevention and therapeutics against preeclampsia.
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Affiliation(s)
- Eliza C. Miller
- Department of Neurology, Division of Stroke and Cerebrovascular Disease, Columbia University Irving Medical Center, New York, NY, USA
| | - Ashley Wilczek
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
| | - Natalie A. Bello
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Sarah Tom
- Department of Neurology, Division of Neurology Clinical Outcomes Research and Population Science and the Department of Epidemiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Ronald Wapner
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA.
| | - Yousin Suh
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA; Department of Genetics and Development, Columbia University Irving Medical Center, New York, NY, USA.
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Association between female reproductive factors and gout: a nationwide population-based cohort study of 1 million postmenopausal women. Arthritis Res Ther 2021; 23:304. [PMID: 34915918 PMCID: PMC8675498 DOI: 10.1186/s13075-021-02701-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 12/09/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Previous studies have shown that the incidence and risk factors of gout differs according to sex. However, little research has been done on the association between reproductive factors and gout. We conducted an analysis of a large nationwide population-based cohort of postmenopausal women to determine whether there is an association between reproductive factors and the incidence of gout. METHODS A total of 1,076,378 postmenopausal women aged 40-69 years who participated in national health screenings in 2009 were included in the study. The outcome was the occurrence of incident gout, which was defined using the ICD-10 code of gout (M10) in the claim database. Cox proportional hazard models were used for the analyses and stratified analyses according to body mass index (BMI) and the presence/absence of chronic kidney disease (CKD) were performed. RESULTS The mean follow-up duration was 8.1 years, and incident cases of gout were 64,052 (incidence rate 7.31 per 1000 person-years). Later menarche, earlier menopause, and a shorter reproductive span were associated with a high risk of gout. No association between parity and gout incidence was observed. Use of oral contraceptives (OC) and hormone replacement therapy (HRT) were associated with an increased risk of gout. The association between reproductive factors and gout was not statistical significant in the high BMI group. The effects of OC and HRT usage on gout were not significant in the CKD group. CONCLUSION Shorter exposure to endogenous estrogen was associated with a high risk of gout. Conversely, exposure to exogenous estrogen such as OC and HRT was associated with an increased risk of gout.
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50
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Sun J, Kim GR, Lee SJ, Kim HC. Gestational diabetes mellitus and the role of intercurrent type 2 diabetes on long-term risk of cardiovascular events. Sci Rep 2021; 11:21140. [PMID: 34707209 PMCID: PMC8551203 DOI: 10.1038/s41598-021-99993-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 10/01/2021] [Indexed: 01/01/2023] Open
Abstract
Recent studies have shown that gestational diabetes mellitus (GDM) is associated with an increased risk for cardiovascular disease. GDM has also been shown to be a risk factor for type 2 diabetes (T2DM) after pregnancy. However, there is limited evidence regarding the role of intercurrent T2DM on the relationship between GDM and future CVD. Thus, we investigated the risks of incident cardiovascular events among women with GDM during pregnancy compared to women without GDM and whether the increased CVD risk is dependent on intercurrent development of T2DM. We conducted a population-based retrospective cohort study using the Korean National Health Insurance Service claims database. Outcomes were the first occurrence of any CVD (myocardial infarction, treatment with coronary revascularization, heart failure, and cerebrovascular disease). Cox proportional hazard models were used to assess the association between GDM and incident CVD events, using landmark analysis at 4 years. A total of 1,500,168 parous women were included in the analysis, of which 159,066 (10.60%) had GDM. At a median follow-up of 12.8 years, 13,222 incident cases of total CVD were observed. Multivariable-adjusted hazard ratio for total CVD among women with prior GDM, compared with those without GDM, was 1.08 (95% CI 1.02-1.14). Further classifying GDM by progression to T2DM in relation to total CVD risk indicated a positive association for GDM with progression to T2DM vs no GDM or T2DM (HR 1.74; 95% CI 1.40-2.15), and no statistically significant association for GDM only (HR 1.06; 95% CI 1.00-1.12). GDM with subsequent progression to T2DM were linked with an increased risk of cardiovascular diseases. These findings highlight the need for more vigilant postpartum screening for diabetes and the implementation of diabetes interventions in women with a history of GDM to reduce future CVD risk.
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Affiliation(s)
- Jiyu Sun
- Medical Research Collaborating Center, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Gyu Ri Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Health Services Research, Yonsei University, Seoul, Korea
| | - Su Jin Lee
- Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, Korea.
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
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