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Rouhani S, Soleimani A, Jamalian M, Sadeghi M. Reproductive factors and risk of cardiovascular outcomes in women with ST-elevation myocardial infarction. BMC Pregnancy Childbirth 2024; 24:533. [PMID: 39138569 PMCID: PMC11323384 DOI: 10.1186/s12884-024-06726-2] [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: 03/30/2024] [Accepted: 07/29/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND There are many sex-specific factors affecting myocardial infarction (MI) outcomes in males and females. This study aimed to evaluate the relationship between reproductive factors and cardiovascular outcomes in women after ST-elevation MI. METHOD This retrospective cohort study was initiated in 2016-2017 at Chamran Hospital, Isfahan, Iran. One hundred eighty women with a diagnosis of ST-elevation MI were followed up for 3 years, and any occurrence of cardiovascular events (CVs) was recorded. All information regarding reproductive factors was recorded via questionnaire. This information was compared between women with cardiovascular events and women without adverse events using a sample t test, chi-square test, and multiple backward logistic regression analysis. SPSS version 24 was used to conduct all analyses. RESULT Sixty-four women with a mean age of 65.81 ± 13.14 years experienced CV events, and 116 women with a mean age of 65.51 ± 10.88 years did not experience CV events. A history of ischemic heart disease and diabetes mellitus were more prevalent in women with CV events (P = 0.024 and P = 0.019). After adjusting for ischemic heart disease and diabetes mellitus, oral contraceptive pill (OCP) usage was more prevalent in women with CV events than in women without CV events (60.9% vs. 40.4%, P = 0.008). There was a greater chance of CV events in women with OCP usage (OR = 3.546, P = 0.038) and a lower chance of CV events in women with greater age at menarche (OR = 0.630, P = 0.009) and longer breastfeeding duration (OR = 0.798, P = 0.041) according to multiple backward logistic regression models. CONCLUSION Based on this study, OCP consumption is a risk factor, while older age at menarche and longer duration of breastfeeding are protective factors for cardiovascular outcomes in women after STEMI.
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Affiliation(s)
- Sina Rouhani
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azam Soleimani
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
- Chamran Cardiovascular Medical and Research Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Marjan Jamalian
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Mengelkoch S, Cunningham K, Gassen J, Targonskaya A, Zhaunova L, Salimgaraev R, Hill SE. Longitudinal associations between women's cycle characteristics and sexual motivation using Flo cycle tracking data. Sci Rep 2024; 14:10513. [PMID: 38714675 PMCID: PMC11076276 DOI: 10.1038/s41598-024-60599-1] [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: 09/19/2023] [Accepted: 04/25/2024] [Indexed: 05/10/2024] Open
Abstract
In the current research, we used data from a sample of 16,327 menstrual cycle tracking app users to examine the association between menstrual cycle characteristics and sexual motivation tracked over 10 months of app use. Guided by past work that finds links between menstrual cycle characteristics related to conception risk and sexual motivation, we found that (a) between-women, shorter (r = - 0.04, p = 0.007), more regular cycles predicted small increases in sexual motivation (r = - 0.04, p = 0.001); (b) within-women, shorter cycles predicted greater sexual motivation that month (r = - 0.04, p < 0.001) and (c) the next month (βs: - 0.10 to - 0.06, ps < 0.001), but (d) changes in sexual motivation did not reliably precede changes in cycle length (βs: - 0.01 to 0.02, ps > 0.15). Within-woman analyses also revealed that (e) shorter cycles were followed by more frequent reports of fatigue (β = - 0.06, p < 0.001), insomnia (β = - 0.03, p < 0.001), and food cravings (β = - 0.04, p < 0.001). Together, results suggest that menstrual cycles characteristics and sexual motivation may covary together in ways that reflect changing investments in reproduction. Small effect sizes and lack of experimental control warrant cautious interpretations of results.
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Affiliation(s)
- Summer Mengelkoch
- Laboratory for Stress Assessment and Research, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, 90095-7076, USA.
| | - Katja Cunningham
- Department of Psychology, Texas Christian University, Fort Worth, TX, 76129, USA
| | - Jeffrey Gassen
- Laboratory for Stress Assessment and Research, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, 90095-7076, USA
| | | | | | | | - Sarah E Hill
- Department of Psychology, Texas Christian University, Fort Worth, TX, 76129, USA
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Vlachou F, Iakovou D, Daru J, Khan R, Pepas L, Quenby S, Iliodromiti S. Fetal loss and long-term maternal morbidity and mortality: A systematic review and meta-analysis. PLoS Med 2024; 21:e1004342. [PMID: 38335157 PMCID: PMC10857720 DOI: 10.1371/journal.pmed.1004342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 01/03/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Evidence suggests common pathways between pregnancy losses and subsequent long-term maternal morbidity, rendering pregnancy complications an early chronic disease marker. There is a plethora of studies exploring associations between miscarriage and stillbirth with long-term adverse maternal health; however, these data are inconclusive. METHODS AND FINDINGS We systematically searched MEDLINE, EMBASE, AMED, BNI, CINAHL, and the Cochrane Library with relevant keywords and MeSH terms from inception to June 2023 (no language restrictions). We included studies exploring associations between stillbirth or miscarriage and incidence of cardiovascular, malignancy, mental health, other morbidities, and all-cause mortality in women without previous pregnancy loss. Studies reporting short-term morbidity (within a year of loss), case reports, letters, and animal studies were excluded. Study selection and data extraction were performed by 2 independent reviewers. Risk of bias was assessed using the Newcastle Ottawa Scale (NOS) and publication bias with funnel plots. Subgroup analysis explored the effect of recurrent losses on adverse outcomes. Statistical analysis was performed using an inverse variance random effects model and results are reported as risk ratios (RRs) with 95% confidence intervals (CIs) and prediction intervals (PIs) by combining the most adjusted RR, odds ratios (ORs) and hazard ratios (HRs) under the rare outcome assumption. We included 56 observational studies, including 45 in meta-analysis. There were 1,119,815 women who experienced pregnancy loss of whom 951,258 had a miscarriage and 168,557 stillbirth, compared with 11,965,574 women without previous loss. Women with a history of stillbirth had a greater risk of ischaemic heart disease (IHD) RR 1.56, 95% CI [1.30, 1.88]; p < 0.001, 95% PI [0.49 to 5.15]), cerebrovascular (RR 1.71, 95% CI [1.44, 2.03], p < 0.001, 95% PI [1.92, 2.42]), and any circulatory/cardiovascular disease (RR 1.86, 95% CI [1.01, 3.45], p = 0.05, 95% PI [0.74, 4.10]) compared with women without pregnancy loss. There was no evidence of increased risk of cardiovascular disease (IHD: RR 1.11, 95% CI [0.98, 1.27], 95% PI [0.46, 2.76] or cerebrovascular: RR 1.01, 95% CI [0.85, 1.21]) in women experiencing a miscarriage. Only women with a previous stillbirth were more likely to develop type 2 diabetes mellitus (T2DM) (RR: 1.16, 95% CI [1.07 to 2.26]; p < 0.001, 95% PI [1.05, 1.35]). Women with a stillbirth history had an increased risk of developing renal morbidities (RR 1.97, 95% CI [1.51, 2.57], p < 0.001, 95% [1.06, 4.72]) compared with controls. Women with a history of stillbirth had lower risk of breast cancer (RR: 0.80, 95% CI [0.67, 0.96], p-0.02, 95% PI [0.72, 0.93]). There was no evidence of altered risk of other malignancies in women experiencing pregnancy loss compared to controls. There was no evidence of long-term mental illness risk in women with previous pregnancy losses (stillbirth: RR 1.90, 95% CI [0.93, 3.88], 95% PI [0.34, 9.51], miscarriage: RR 1.78, 95% CI [0.88, 3.63], 95% PI [1.13, 4.16]). The main limitations include the potential for confounding due to use of aggregated data with variable degrees of adjustment. CONCLUSIONS Our results suggest that women with a history of stillbirth have a greater risk of future cardiovascular disease, T2DM, and renal morbidities. Women experiencing miscarriages, single or multiple, do not seem to have an altered risk.
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Affiliation(s)
- Florentia Vlachou
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Whitechapel, London, United Kingdom
| | - Despoina Iakovou
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Whitechapel, London, United Kingdom
| | - Jahnavi Daru
- Women’s Health Research Unit, Institute for Population Health, Queen Mary University of London, London, United Kingdom
| | - Rehan Khan
- Royal London Hospital, Department of Obstetrics & Gynaecology, Barts Health NHS Trust, London, United Kingdom
| | - Litha Pepas
- Barts Centre of Reproductive Medicine, Barts NHS Trust, London, United Kingdom
| | - Siobhan Quenby
- Division of Reproductive Health, Centre for Early Life, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Stamatina Iliodromiti
- Women’s Health Research Unit, Institute for Population Health, Queen Mary University of London, London, United Kingdom
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Behboudi-Gandevan S, Moe CF, Skjesol I, Arntzen EC, Bidhendi-Yarandi R. The J shaped association of age at menarche and cardiovascular events: systematic review and meta-analysis. Sci Rep 2024; 14:2695. [PMID: 38302648 PMCID: PMC10834967 DOI: 10.1038/s41598-024-53011-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/25/2024] [Indexed: 02/03/2024] Open
Abstract
This study aimed to evaluate the association between age at menarche and cardiovascular (CV) events through a systematic review and meta-analysis of observational studies. A comprehensive literature search covering studies published from January 1, 2000, to October 31, 2023, was conducted in PubMed, MEDLINE, Embase, and Scopus. Twenty-nine observational studies involving 4,931,160 adult women aged 18 years or older were included. The meta-analysis revealed a J-shaped association between age at menarche and CV events. Individuals with menarche at 12-13 years exhibited the lowest risk, while those with younger (≤ 11 years) or older ages (14-15 years and ≥ 16 years) showed an increased risk. Notably, individuals with age at menarche of 16 years and older had the highest risk of CV events. The pooled odds of CV mortality in age at menarche categories 14-15 years and ≥ 16 years were 37% (OR: 1.37, 95% CI 1.14-1.64, I2: 76.9%) and 64% (OR: 1.64, 95% CI 1.20-2.24, I2: 87%) higher than referent age at menarche 12-13 years. No statistically significant difference was found in CV mortality risk between individuals with age at menarche ≤ 11 years and those with age at menarche 12-13 years. The ORs for coronary heart disease were significantly higher for age at menarche ≥ 16 years (35% increase), while no significant difference was found for age at menarche ≤ 11 years or 14-15 years compared to age at menarche 12-13 years. Regarding stroke, the ORs for age at menarche ≤ 11, 14-15, and ≥ 16 years were significantly higher (7%, 24%, and 94% increase, respectively) compared to age at menarche 12-13 years. Dose-response meta-analysis and one-stage random-effect cubic spline models confirmed the J-shaped risk pattern. Meta-regression indicated that age and BMI were not significant sources of heterogeneity. Sensitivity analyses and the absence of publication bias further supported the robustness of the findings. This study concludes that age at menarche is independently associated with CV events, with a J-shaped pattern. The findings underscore the significance of considering menarche age as an independent risk factor for CV events. Further research is warranted to validate these findings and explore potential underlying mechanisms.
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Affiliation(s)
| | | | - Ingunn Skjesol
- Faculty of Nursing and Health Sciences, Nord University, Namsos, Norway
| | - Ellen Christin Arntzen
- Faculty of Nursing and Health Sciences, Nord University, Post Box: 1490, 8049, Bodø, Norway
| | - Razieh Bidhendi-Yarandi
- Department of Biostatistics and Epidemiology, School of Social Health, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Lo ACQ, Lo CCW, Oliver-Williams C. Cardiovascular disease risk in women with hyperandrogenism, oligomenorrhea/menstrual irregularity or polycystic ovaries (components of polycystic ovary syndrome): a systematic review and meta-analysis. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead061. [PMID: 37404840 PMCID: PMC10317290 DOI: 10.1093/ehjopen/oead061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/18/2023] [Accepted: 06/01/2023] [Indexed: 07/06/2023]
Abstract
Aims Prior meta-analyses indicate polycystic ovary syndrome (PCOS) is associated with cardiovascular diseases (CVDs), but have high statistical heterogeneity, likely because PCOS is a heterogenous syndrome diagnosed by having any two of the three components: hyperandrogenism, oligomenorrhea/menstrual irregularity or polycystic ovaries. Several studies report higher risk of CVDs from individual PCOS components, but a comprehensive assessment of how each component contributes to CVD risk is lacking. This study aims to assess CVD risk for women with one of the PCOS components. Methods and results A systematic review and meta-analysis of observational studies was conducted. PubMed, Scopus, and Web of Science were searched without restrictions in July 2022. Studies meeting inclusion criteria examined the association between PCOS components and risk of a CVD. Two reviewers independently assessed abstracts and full-text articles, and extracted data from eligible studies. Where appropriate, relative risk (RR) and 95% confidence interval (CI) were estimated by random-effects meta-analysis. Statistical heterogeneity was assessed using the I2 statistic. Twenty-three studies, including 346 486 women, were identified. Oligo-amenorrhea/menstrual irregularity was associated with overall CVD (RR = 1.29, 95%CI = 1.09-1.53), coronary heart disease (CHD) (RR = 1.22, 95%CI = 1.06-1.41), and myocardial infarction (MI) (RR = 1.37, 95%CI = 1.01-1.88) but not cerebrovascular disease. These results were broadly consistent even after further adjustment for obesity. There was mixed evidence for the role of hyperandrogenism in CVDs. No studies examined polycystic ovaries as an independent exposure for CVD risk. Conclusion Oligo-amenorrhea/menstrual irregularity is associated with greater risk of overall CVD, CHD, and MI. More research is needed to assess the risks associated with hyperandrogenism or polycystic ovaries.
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Affiliation(s)
| | - Charmaine Chu Wen Lo
- Liverpool Hospital, Liverpool, NSW 2170, Australia
- Faculty of Medicine, University of New South Wales, Kensington, NSW 2052, Australia
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Clare Oliver-Williams
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0BB, UK
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6
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Chen M, Wang Z, Xu H, Chen X, Teng P, Ma L. Genetic liability to age at first sex and birth in relation to cardiovascular diseases: a Mendelian randomization study. BMC Med Genomics 2023; 16:75. [PMID: 37024926 PMCID: PMC10080931 DOI: 10.1186/s12920-023-01496-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/22/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Growing evidence suggests that various reproductive factors, including early menarche, early menopause, and age at first birth, may increase the risk of developing cardiovascular disease (CVD) later in life. However, the associations between reproductive factors and CVDs are inconsistent and controversial. Therefore, we conducted a two-sample Mendelian randomization (MR) analysis to explore the potential links between age at first sex (AFS) and age at first birth (AFB) and several CVDs. METHODS We obtained summary statistics for exposure from the largest genome-wide association studies of AFS and AFB. To serve as instrumental variables, we selected 259 SNPs associated with AFS and 81 SNPs associated with AFB at the genome-wide significance level. We employed a random-effects inverse-variance weighted method to pool estimates, and conducted multivariable MR analysis to determine the direct association between AFS and AFB with CVDs, while accounting for the effects of confounders. RESULTS The genetic liability to later AFS was associated with decreased risks of heart failure (odd ratio [OR] 0.700; 95% confidence interval [CI] 0.639-0.767; p = 2.23 × 10-14), coronary artery disease (OR 0.728; 95% CI 0.657-0.808; p = 1.82 × 10-9), myocardial infarction (OR 0.731; 95% CI 0.657-0.813; p = 8.33 × 10-9), stroke (OR 0.747; 95% CI 0.684-0.816; p = 6.89 × 10-11), and atrial fibrillation (OR 0.871; 95% CI 0.806-0.941; p = 4.48 × 10-4). The genetic liability to later AFB was also associated with decreased risks of CVDs, including myocardial infarction (OR 0.895; 95% CI 0.852-0.940; p = 8.66 × 10-6), coronary heart disease (OR 0.901; 95% CI 0.860-0.943; p = 9.02 × 10-6), heart failure (OR 0.925; 95% CI 0.891-0.961; p = 5.32 × 10-5), and atrial fibrillation (OR 0.944; 95% CI 0.911-0.978; p = 0.001). However, no association was found between AFB and stroke. The associations remained independent from the effects of AFS and AFB on potential confounders, including smoking, alcohol intake, body mass index, and depression. Mediation analysis suggested that education attainment partly mediates the link from AFS and AFB to CVD outcomes. CONCLUSION Our results observed a causal relationship between later AFS, AFB and lower CVDs risk; it emphasizes the importance of providing sex education since early sex and birth may have undesirable effects. Cardiovascular risk stratification that considers reproductive factors may help address CVD risk.
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Affiliation(s)
- Miao Chen
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Number 79 Qingchun Road, Hangzhou, China
| | - Zhen Wang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Number 79 Qingchun Road, Hangzhou, China
| | - Hongfei Xu
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Number 79 Qingchun Road, Hangzhou, China
| | - Xiaofang Chen
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Number 79 Qingchun Road, Hangzhou, China
| | - Peng Teng
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Number 79 Qingchun Road, Hangzhou, China
| | - Liang Ma
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Number 79 Qingchun Road, Hangzhou, China.
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Kyriacou H, Al-Mohammad A, Muehlschlegel C, Foster-Davies L, Bruco MEF, Legard C, Fisher G, Simmons-Jones F, Oliver-Williams C. The risk of cardiovascular diseases after miscarriage, stillbirth, and induced abortion: a systematic review and meta-analysis. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac065. [PMID: 36330356 PMCID: PMC9617475 DOI: 10.1093/ehjopen/oeac065] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/26/2022] [Indexed: 11/14/2022]
Abstract
Aims Miscarriage and stillbirth have been included in cardiovascular disease (CVD) risk guidelines, however heterogeneity in exposures and outcomes and the absence of reviews assessing induced abortion, prevented comprehensive assessment. We aimed to perform a systematic review and meta-analysis of the risk of cardiovascular diseases for women with prior pregnancy loss (miscarriage, stillbirth, and induced abortion). Methods and results Observational studies reporting risk of CVD, coronary heart disease (CHD), and stroke in women with pregnancy loss were selected after searching MEDLINE, Scopus, CINAHL, Web of Knowledge, and Cochrane Library (to January 2020). Data were extracted, and study quality were assessed using the Newcastle-Ottawa Scale. Pooled relative risk (RR) and 95% confidence intervals (CIs) were calculated using inverse variance weighted random-effects meta-analysis.Twenty-two studies involving 4 337 683 women were identified. Seven studies were good quality, seven were fair and eight were poor. Recurrent miscarriage was associated with a higher CHD risk (RR = 1.37, 95% CI: 1.12-1.66). One or more stillbirths was associated with a higher CVD (RR = 1.41, 95% CI: 1.09-1.82), CHD (RR = 1.51, 95% CI: 1.04-1.29), and stroke risk (RR = 1.33, 95% CI: 1.03-1.71). Recurrent stillbirth was associated with a higher CHD risk (RR = 1.28, 95% CI: 1.18-1.39). One or more abortions was associated with a higher CVD (RR = 1.04, 95% CI: 1.02-1.07), as was recurrent abortion (RR = 1.09, 95% CI: 1.05-1.13). Conclusion Women with previous pregnancy loss are at a higher CVD, CHD, and stroke risk. Early identification and risk factor management is recommended. Further research is needed to understand CVD risk after abortion.
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Affiliation(s)
| | | | | | - Lowri Foster-Davies
- School of Clinical Medicine, Addenbrooke's Hospital, Hills Rd, Cambridge CB2 0SP, UK
| | - Maria Eduarda Ferreira Bruco
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK
| | - Chloe Legard
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK
| | - Grace Fisher
- School of Clinical Medicine, Addenbrooke's Hospital, Hills Rd, Cambridge CB2 0SP, UK
| | - Fiona Simmons-Jones
- Health Education East of England, 2.4- Vicotria House, Capital Park, Fulbourn, Cambridge, CB21 5XB, UK
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Wang YX, Mínguez-Alarcón L, Gaskins AJ, Wang L, Ding M, Missmer SA, Rich-Edwards JW, Manson JE, Chavarro JE. Pregnancy loss and risk of cardiovascular disease: the Nurses' Health Study II. Eur Heart J 2022; 43:190-199. [PMID: 34718507 PMCID: PMC8790762 DOI: 10.1093/eurheartj/ehab737] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/13/2021] [Accepted: 10/08/2021] [Indexed: 12/15/2022] Open
Abstract
AIMS The aim of this study was to explore the association of pregnancy loss (PL) with the incidence of cardiovascular disease (CVD) and examine the extent to which this relation is mediated by subsequent metabolic disorders. METHODS AND RESULTS We followed 95 465 ever-gravid women participating in the Nurses' Health Study II between 1993 and 2017. Cox proportional hazards models were used to estimate the hazard ratios (HRs) of CVD, including coronary heart disease (CHD), and stroke, according to the occurrence of PL. A mediation analysis was conducted to explore the intermediating effect of subsequent type 2 diabetes, hypertension, or hypercholesterolaemia. During 2 205 392 person-years of follow-up (mean 23.10 years), 2225 (2.3%) incident CVD cases were documented. After adjusting for confounding factors, PL was associated with an HR of 1.21 [95% confidence interval (CI) 1.10-1.33] for CVD during follow-up. A similar association was observed for CHD (HR 1.20; 95% CI 1.07-1.35) and stroke (HR 1.23; 95% CI 1.04-1.44). The risk of CVD increased with the number of PLs [HR 1.18 (95% CI 1.06-1.31) for 1 and 1.34 (95% CI 1.13-1.59) for ≥2 times] and was greater for PL occurring early in reproductive lifespan [HR 1.40 (95% CI 1.21-1.62) for age ≤23 years, 1.25 (95% CI 1.09-1.43) for age 24-29 years, and 1.03 (95% CI 0.88-1.19) for age ≥30 years]. Hypertension, hypercholesterolaemia, and type 2 diabetes all explained <1.80% of the association between PL and CVD. CONCLUSION PL was associated with a greater CVD risk, independently of subsequent development of metabolic disorders.
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Affiliation(s)
- Yi-Xin Wang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Building II, 3rd Floor, Room # 322, 655 Huntington Avenue, Boston, MA 02115, USA
| | - Lidia Mínguez-Alarcón
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 181 Longwood Ave, Boston, MA, USA
| | - Audrey J. Gaskins
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, USA
| | - Liang Wang
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, One Bear Place #97343 Waco, TX 76798, USA
| | - Ming Ding
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Building II, 3rd Floor, Room # 322, 655 Huntington Avenue, Boston, MA 02115, USA
| | - Stacey A. Missmer
- Department of Obstetrics and Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, 400 Monroe Ave NW, Grand Rapids, MI 49503, USA
| | - Janet W. Rich-Edwards
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 181 Longwood Ave, Boston, MA, USA
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA 02120, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Building II, 3rd Floor, Room # 331, 655 Huntington Avenue, Boston, MA 02115, USA
| | - JoAnn E. Manson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Building II, 3rd Floor, Room # 331, 655 Huntington Avenue, Boston, MA 02115, USA
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 900 Commonwealth Avenue, Boston, MA 02115, USA
| | - Jorge E. Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Building II, 3rd Floor, Room # 322, 655 Huntington Avenue, Boston, MA 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 181 Longwood Ave, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Building II, 3rd Floor, Room # 331, 655 Huntington Avenue, Boston, MA 02115, USA
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El Khoudary SR, Qi M, Chen X, Matthews K, Allshouse AA, Crawford SL, Derby CA, Thurston RC, Kazlauskaite R, Barinas-Mitchell E, Santoro N. Patterns of menstrual cycle length over the menopause transition are associated with subclinical atherosclerosis after menopause. Menopause 2021; 29:8-15. [PMID: 34636354 PMCID: PMC9178927 DOI: 10.1097/gme.0000000000001876] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Longer menstrual cycles have been associated with greater risk of cardiovascular disease, supporting a contribution of abnormal ovarian function. We aimed to characterize trajectories of menstrual cycle length over the menopause transition (MT) and test whether these trajectories are associated with postmenopausal markers of subclinical atherosclerosis. METHODS Women from the Study of Women's Health Across the Nation Daily Hormone Study were included if they had an observed date of the final menstrual period (FMP), recorded cycle lengths from ≥2 annual menstrual cycles (mean±SD: 4.22 ± 1.91 cycles), and had measurements of postmenopausal carotid intima-media thickness (cIMT) and/or brachial-ankle pulse wave velocity (baPWV). Trajectories of cycle length over the MT were identified using group-based trajectory modeling and linked with cIMT and baPWV using linear regression. RESULTS We studied 428 women who had 1,808 cycles over the MT (45.1 ± 2.3 y old at baseline visit), and of whom 263 had cIMT, and 213 had baPWV measured postmenopausally (after 13.88 ± 0.42 and 15.25 ± 0.70 y since baseline visit, respectively). Three distinct trajectories of cycle length were identified: stable (no changes in cycle length over the MT among 62.1% of women), late increase (a late increase 2 y before the FMP among 21.8%), and early-increase (an early increase 5 y before the FMP among 16.2%). Women with the late-increase pattern had significantly lower postmenopausal cIMT (0.72 mm) and baPWV (1392 cm/s) levels than the stable group (0.77 mm and 1508 cm/s, respectively) adjusting for race, concurrent age, socioeconomic status, physical activity level, and premenopausal cardiovascular risk profile. CONCLUSIONS Patterns of cycle length over the MT seem to be a marker of future vascular health that may help identify groups at greater or lesser risk of atherosclerosis after menopause.
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Affiliation(s)
| | - Meiyuzhen Qi
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Xirun Chen
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Karen Matthews
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | | | | | - Rebecca C. Thurston
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
- University of Pittsburgh School of Medicine, Pittsburgh, PA
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Mishra SR, Chung HF, Waller M, Mishra GD. Duration of estrogen exposure during reproductive years, age at menarche and age at menopause, and risk of cardiovascular disease events, all-cause and cardiovascular mortality: a systematic review and meta-analysis. BJOG 2020; 128:809-821. [PMID: 32965759 DOI: 10.1111/1471-0528.16524] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Little is known about the estrogen exposure measurement and mutual effect of age at menarche and age at menopause in the risk of cardiovascular disease (CVD) events. OBJECTIVES To evaluate estrogen exposure measurement and describe mutual effect of age at menarche and age at menopause in the risk of CVD events. SEARCH STRATEGY Systematic review of literature in PubMed, Embase and Web of Science for studies published up to 28 June 2020. SELECTION CRITERIA Observational studies related to estrogen exposure measurement, including mutual effect of age at menarche and age at menopause and risk of CVD events. DATA COLLECTION AND ANALYSIS Synthesis of evidence was conducted by reviewing individual estimates, followed by meta-analysis. The study received no external funding. MAIN RESULTS A total of 75 studies were included in synthesis of evidence, of which 17 studies were included in meta-analysis. Reproductive lifespan (age at menopause - age at menarche), endogenous estrogen exposure and total estrogen exposure were used for estrogen exposure measurement. Reproductive lifespan was by far the most commonly used method for estrogen exposure measurement. A shorter reproductive lifespan was associated with a higher risk of CVD events; the pooled relative risk (95% CI) was 1.31 (1.25-1.36) for stroke events. Robust epidemiological studies with measurement of estrogen exposure and associated health risk would strengthen the evidence. CONCLUSIONS Reproductive lifespan was the most commonly used method for estrogen exposure measurement in epidemiological studies. A shorter reproductive lifespan was associated with a higher risk of CVD events, particularly stroke. TWEETABLE ABSTRACT A systematic review and meta-analysis found that women with a shorter reproductive lifespan have a higher risk of stroke events.
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Affiliation(s)
- S R Mishra
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - H-F Chung
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - M Waller
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - G D Mishra
- School of Public Health, The University of Queensland, Brisbane, Australia
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11
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Wu P, Mamas MA, Gulati M. Pregnancy As a Predictor of Maternal Cardiovascular Disease: The Era of CardioObstetrics. J Womens Health (Larchmt) 2019; 28:1037-1050. [DOI: 10.1089/jwh.2018.7480] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Pensee Wu
- Keele Cardiovascular Research Group, Center for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom
- Academic Unit of Obstetrics and Gynecology, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Center for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom
- Academic Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom
| | - Martha Gulati
- Division of Cardiology, University of Arizona, Phoenix, Arizona
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12
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Niemczyk NA, Bertolet M, Catov JM, Desai M, McClure CK, Roberts JM, Sekikawa A, Tepper PG, Barinas-Mitchell EJ. Common carotid artery intima-media thickness increases throughout the pregnancy cycle: a prospective cohort study. BMC Pregnancy Childbirth 2018; 18:195. [PMID: 29855290 PMCID: PMC5984334 DOI: 10.1186/s12884-018-1841-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 05/22/2018] [Indexed: 12/04/2022] Open
Abstract
Background High parity is associated with greater cardiovascular disease (CVD) among mid-life and older women. Prospective studies of arterial change throughout pregnancy are needed to provide insight into potential mechanisms. This study assessed vascular adaptation across pregnancy in healthy first-time pregnant women. Methods The Maternal Vascular Adaptation to Healthy Pregnancy Study (Pittsburgh, PA, 2010–2015) assessed 37 primigravid women each trimester, 6–8 weeks after delivery and 1–5 years postpartum, with B-mode ultrasound imaging of common carotid artery (CCA) intima-media thickness (IMT) and inter-adventitial diameter (IAD) to assess associations with physical and cardiometabolic measures. Results Thirty-seven women (age 28.2 ± 4.5 years, pre-pregnant BMI 24.4 ± 3.2 kg/m2) experienced uncomplicated pregnancies. After adjustment for age and pre-pregnancy BMI, mean (SE) IAD (mm) increased each trimester, from 6.38 (0.08) in the 1st trimester to 6.92 (0.09) in the 3rd trimester, and then returned to 1st trimester levels postpartum (6.35 [0.07], P < 0.001). In contrast, mean (SE) CCA IMT (mm) increased from the 2nd trimester (i.e., 0.546 [0.01]) onward, and remained higher at an average of 2.7 years postpartum (0.581 [0.02], P = 0.03). Weight partially explained changes in IAD. Conclusions In uncomplicated first pregnancies, IAD increased and returned to 1st trimester levels postpartum. In contrast, CCA IMT remained increased 2 years postpartum. Maternal weight explained vascular changes better than did metabolic changes. Increased postpartum CCA IMT may persist and contribute to long-term CVD risk. Electronic supplementary material The online version of this article (10.1186/s12884-018-1841-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nancy Anderson Niemczyk
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA. .,Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, 3500 Victoria Street, 440 Victoria Building, Pittsburgh, PA, 15261, USA.
| | - Marianne Bertolet
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Janet M Catov
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA.,Department of Obstetrics and Gynecology, School of Medicine, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA, 15213, USA.,Department of Clinical and Translational Research, School of Medicine, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA, 15213, USA
| | - Mansi Desai
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Candace K McClure
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - James M Roberts
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA.,Department of Obstetrics and Gynecology, School of Medicine, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA, 15213, USA.,Department of Clinical and Translational Research, School of Medicine, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA, 15213, USA.,Magee-Womens Research Institute, Magee-Womens Hospital of University of Pittsburgh Medical Center (UPMC), 204 Craft Avenue, Pittsburgh, PA, 15213, USA
| | - Akira Sekikawa
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Ping Guo Tepper
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Emma J Barinas-Mitchell
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA
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13
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Luijken J, van der Schouw YT, Mensink D, Onland-Moret NC. Association between age at menarche and cardiovascular disease: A systematic review on risk and potential mechanisms. Maturitas 2017; 104:96-116. [PMID: 28923182 DOI: 10.1016/j.maturitas.2017.07.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 07/20/2017] [Indexed: 10/19/2022]
Abstract
Age at menarche (AAM) has been reported to be associated with the risk of cardiovascular disease (CVD), but the shape of and the mechanisms behind this association remain unclear. We reviewed the data on the association between AAM and different subtypes of CVD, and used shared genetic loci to identify possible mechanisms underlying this association using shared genetic association. We searched the databases of PubMed, Web of Science and Embase through to April 2017. We included articles with any clinically manifest CVD endpoint and for any ethnicity. We identified single nucleotide polymorphisms (SNPs) for AAM in genome-wide association studies (GWAS) in Caucasians through PubMed and HuGE Navigator, and searched whether these SNPs or any of their proxies were associated with any CVD-related trait. Eight studies in Caucasian populations reported an inverse linear relation between AAM and CVD risk, whereas one large study reported a significant U-shaped relation between them. Data from Asian populations were contradictory and inconclusive. In total, 122 AAM SNPs were identified at a genome-wide significance level (p<5×10-8). Of those, 18 were also associated with various CVD-related traits, primarily body mass index (BMI), obesity, and height. In conclusion, early AAM and possibly also late AAM increase the risk of CVD in Caucasian populations. Weight and height may be part of the mechanism underlying the relation between AAM and CVD risk in Caucasians. Data on other ethnicities are too limited for meaningful analysis and conclusions.
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Affiliation(s)
- Janneke Luijken
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Daniëlle Mensink
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands; Cardialysis, Rotterdam, The Netherlands
| | - N Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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14
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Rosendaal NTA, Pirkle CM. Age at first birth and risk of later-life cardiovascular disease: a systematic review of the literature, its limitation, and recommendations for future research. BMC Public Health 2017; 17:627. [PMID: 28679414 PMCID: PMC5498883 DOI: 10.1186/s12889-017-4519-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 06/20/2017] [Indexed: 01/03/2023] Open
Abstract
Background Cardiovascular disease (CVD) is the principal contributor to the burden of disease and mortality worldwide. Previous studies observed associations between early age at first birth (AFB) and all-cause mortality. AFB may be associated with CVD both through physiological and sociobiological pathways. In this paper, we review the literature on AFB and CVD events and mortality. Additionally, we provide an overview of limitations of the current research and recommendations for future research. Methods PubMed and Web of Science databases were searched for observational studies published between 1980-June 2016, investigating associations between AFB and CVD events and mortality. Data were extracted using a pre-defined list. Results A total of 20 publications, reporting on 33 associations, were included in the review. Ten studies observed a positive association between early AFB and CVD while two studies observed a positive association between later AFB and CVD. Substantial methodological limitations were observed related to: operationalization of exposure categories, choice of reference category, sample size, follow-up time and possibly over adjustment. Conclusions Early AFB is possibly related to CVD. More work, in particular from large cohort studies starting before reproductive age is reached, is needed to better investigate this relationship, and to ascertain causal pathways that may explain observed associations. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4519-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nicole T A Rosendaal
- Office of Public Health Studies, University of Hawaii, 1960 East-West Road, Biomed D104T, Honolulu, HI, 96822-2319, USA.
| | - Catherine M Pirkle
- Office of Public Health Studies, University of Hawaii, 1960 East-West Road, Biomed D104T, Honolulu, HI, 96822-2319, USA
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15
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Salmoirago-Blotcher E, Dunsiger S, Swales HH, Aurigemma GP, Ockene I, Rosman L, Wittstein IS. Reproductive History of Women With Takotsubo Cardiomyopathy. Am J Cardiol 2016; 118:1922-1928. [PMID: 27742423 DOI: 10.1016/j.amjcard.2016.08.083] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 08/19/2016] [Accepted: 08/19/2016] [Indexed: 10/21/2022]
Abstract
Takotsubo cardiomyopathy (TC) occurs predominantly in postmenopausal women, suggesting a possible role of reproductive and hormonal factors in the pathophysiology of this condition. Yet reproductive characteristics of women with TC have received limited attention. This prospective case-control study sought to explore reproductive characteristics associated with TC. Incident TC cases and myocardial infarction (MI) controls were recruited among consecutive women presenting at the emergency departments of 2 large medical centers in Massachusetts and Connecticut. Female healthy controls were recruited from a registry of research volunteers. Information about reproductive history was collected 1 month after discharge using standardized questionnaires completed during phone interviews. Linear and logistic regression models were used to estimate associations with reproductive factors. From March 2013 to October 2015, 209 women were screened for eligibility and 107 (45 TC, 32 MI, and 30 healthy controls) were enrolled. Conditions uniquely associated with TC were a history of irregular menses (adjusted OR, TC vs MI 8.30; 95% CI 1.01 to 69.18), number of pregnancies (adjusted β coefficient 0.69; SE 0.35, p = 0.05), and use of post-menopausal hormone replacement therapy (OR 5.79; CI 1.20 to 28.02). We did not find associations with history of infertility, breastfeeding, hysterectomy or oophorectomy, oral contraceptive use, and age at menopause. In conclusion, our findings suggest that premenopausal reproductive factors may play an important role in the onset of TC at a later age. These results need to be confirmed in future studies with larger populations.
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16
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Zheng Y, Zhang G, Chen Z, Zeng Q. Association between Age at Menarche and Cardiovascular Disease Risk Factors in China: A Large Population-Based Investigation. Cardiorenal Med 2016; 6:307-16. [PMID: 27648012 DOI: 10.1159/000445506] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 01/29/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The association between age at menarche (AAM) and cardiovascular disease (CVD) has previously been investigated with controversial results. The relationship between the psychological characteristic of AAM and many cardiovascular risk factors remains unclear. PURPOSE To assess the association between AAM and CVD risk factors in a large population. DESIGN AND SETTING 13,242 women aged 24-79 years were recruited from China mainland during 2009-2013 for a cross-sectional, population-based study to investigate the association between AAM and CVD risk factors. Information on AAM was obtained from self-report and information on CVD risk factors from physical examination. RESULTS In age-, body-mass-index- and height-adjusted analyses, AAM was positively associated with hypertension and 'college or above' educational level and incident CVD events. The adjusted odds ratios (ORs) and 95% confidence intervals for hypertension across AAM categories (≤12, 13-14, 15-16, and ≥17 years) were 0.820 (0.70-0.96), 0.82 (0.70-0.96), 0.88 (0.79-0.99) and 1 (referent), respectively; adjusted ORs for high educational level ('college or above') were 0.29 (0.24-0.34), 0.60 (0.41-0.51), 0.69 (0.62-0.76), and 1 (referent), respectively; adjusted ORs for incident CVD events were 0.18 (0.08-0.41), 0.18 (0.08-0.41), 0.62 (0.41-0.93), 1 (referent), respectively. CONCLUSIONS Earlier AAM were positively associated with incident CVD events, hypertension and 'college or above' educational level.
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Affiliation(s)
| | - Guilan Zhang
- Central Hospital of Xiaogan Health Examination, Tongji Medical College, Huazhong University of Science and Technology, Xiaogan, China
| | | | - Qiang Zeng
- Health Management Institute, Beijing China; Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing China
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17
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Duration of ovarian hormone exposure and atherosclerotic cardiovascular disease in Korean women. Menopause 2016; 23:60-6. [DOI: 10.1097/gme.0000000000000489] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Jang M, Lee Y, Choi J, Kim B, Kang J, Kim Y, Cho S. Association between Parity and Blood Pressure in Korean Women: Korean National Health and Nutrition Examination Survey, 2010-2012. Korean J Fam Med 2015; 36:341-8. [PMID: 26634103 PMCID: PMC4666872 DOI: 10.4082/kjfm.2015.36.6.341] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 08/23/2015] [Accepted: 10/07/2015] [Indexed: 01/05/2023] Open
Abstract
Background Pregnancy considerably alters cardiovascular dynamics, and thereby affects the transition of blood pressure after delivery in women. We aimed to analyze the association between parity and blood pressure in Korean adult women. Methods We included 8,890 women who participated in Korean National Health and Nutrition Examination Survey between 2010 and 2012. We divided the population according to the menopause status and analyzed the association between parity and blood pressure by using multiple regression analysis, and on hypertension, by using logistic regression analysis. Results Systolic and diastolic blood pressures were significantly associated with parity in premenopausal women (β=-0.091 [P<0.001] and β=-0.069 [P<0.001], respectively). In the analysis that excluded women receiving antihypertensive medication, the systolic and diastolic blood pressure of postmenopausal women were significantly associated with parity (β=-0.059 [P=0.022] and β=-0.054 [P=0.044], respectively). Parity was found to prevent hypertension after adjustment for confounders in postmenopausal women (odds ratio, 0.55; 95% confidence interval, 0.310-0.985). Conclusion We found that parity prevented hypertension in Korean women.
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Affiliation(s)
- Miae Jang
- Department of Family Medicine, Inha University School of Medicine, Incheon, Korea
| | - Yeonji Lee
- Department of Family Medicine, Inha University School of Medicine, Incheon, Korea
| | - Jiho Choi
- Department of Family Medicine, Inha University School of Medicine, Incheon, Korea
| | - Beomseok Kim
- Department of Family Medicine, Inha University School of Medicine, Incheon, Korea
| | - Jayeon Kang
- Department of Family Medicine, Inha University School of Medicine, Incheon, Korea
| | - Yongchae Kim
- Department of Family Medicine, Inha University School of Medicine, Incheon, Korea
| | - Sewook Cho
- Department of Family Medicine, Inha University School of Medicine, Incheon, Korea
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Parity and Cardiovascular Disease Mortality: a Dose-Response Meta-Analysis of Cohort Studies. Sci Rep 2015; 5:13411. [PMID: 26299306 PMCID: PMC4547137 DOI: 10.1038/srep13411] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 07/27/2015] [Indexed: 12/03/2022] Open
Abstract
Parity has been shown to inversely associate with cardiovascular disease (CVD) mortality, but the evidence of epidemiological studies is still controversial. Therefore, we quantitatively assessed the relationship between parity and CVD mortality by summarizing the evidence from prospective studies. We searched MEDLINE (PubMed), EMBASE and ISI Web of Science databases for relevant prospective studies of parity and CVD mortality through the end of March 2015. Fixed- or random-effects models were used to estimate summary relative risks (RRs) and 95% confidence intervals (CIs). Heterogeneity among studies was assessed using the I2 statistics. All statistical tests were two-sided. Ten prospective studies were included with a total of 994,810 participants and 16,601 CVD events. A borderline significant inverse association was observed while comparing parity with nulliparous, with summarized RR = 0.79 (95% CI: 0.60–1.06; I2 = 90.9%, P < 0.001). In dose-response analysis, we observed a significant nonlinear association between parity number and CVD mortality. The greatest risk reduction appeared when the parity number reached four. The findings of this meta-analysis suggests that ever parity is inversely related to CVD mortality. Furthermore, there is a statistically significant nonlinear inverse association between parity number and CVD mortality.
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21
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Parker DR, Lu B, Sands-Lincoln M, Kroenke CH, Lee CC, O'Sullivan M, Park HL, Parikh N, Schenken RS, Eaton CB. Risk of cardiovascular disease among postmenopausal women with prior pregnancy loss: the women's health initiative. Ann Fam Med 2014; 12:302-9. [PMID: 25024237 PMCID: PMC4096466 DOI: 10.1370/afm.1668] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Metabolic, hormonal, and hemostatic changes associated with pregnancy loss (stillbirth and miscarriage) may contribute to the development of cardiovascular disease (CVD) in adulthood. This study evaluated prospectively the association between a history of pregnancy loss and CVD in a cohort of postmenopausal women. METHODS Postmenopausal women (77,701) were evaluated from 1993-1998. Information on baseline reproductive history, sociodemographic, and CVD risk factors were collected. The associations between 1 or 2 or more miscarriages and 1 or more stillbirths with occurrence of CVD were evaluated using multiple logistic regression. RESULTS Among 77,701 women in the study sample, 23,538 (30.3%) reported a history of miscarriage; 1,670 (2.2%) reported a history of stillbirth; and 1,673 (2.2%) reported a history of both miscarriage and stillbirth. Multivariable-adjusted odds ratio (OR) for coronary heart disease (CHD) for 1 or more stillbirths was 1.27 (95% CI, 1.07-1.51) compared with no stillbirth; for women with a history of 1 miscarriage, the OR=1.19 (95% CI, 1.08-1.32); and for 2 or more miscarriages the OR=1.18 (95% CI, 1.04-1.34) compared with no miscarriage. For ischemic stroke, the multivariable odds ratio for stillbirths and miscarriages was not significant. CONCLUSIONS Pregnancy loss was associated with CHD but not ischemic stroke. Women with a history of 1 or more stillbirths or 1 or more miscarriages appear to be at increased risk of future CVD and should be considered candidates for closer surveillance and/or early intervention; research is needed into better understanding the pathophysiologic mechanisms behind the increased risk of CVD associated with pregnancy loss.
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Affiliation(s)
- Donna R Parker
- Departments of Family Medicine and Epidemiology, Alpert Medical School of Brown University, Providence, Rhode Island (Parker, Eaton); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island (Parker, Eaton); Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts (Lu); University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, Pennsylvania (Sands-Lincoln); Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas (Brzyski, Schenken); Kaiser Permanente Division of Research, Oakland, California (Kroenke); Division of Geriatric Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (Lee); University of Miami, Miller School of Medicine, Department of Obstetrics/Gynecology, Miami, Florida (O'Sullivan); UC Irvine School of Medicine, Department of Epidemiology, Irvine, California (Park); John A. Burns School of Medicine (JABSOM), University of Hawaii, Honolulu, Hawaii (Parikh).
| | - Bing Lu
- Departments of Family Medicine and Epidemiology, Alpert Medical School of Brown University, Providence, Rhode Island (Parker, Eaton); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island (Parker, Eaton); Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts (Lu); University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, Pennsylvania (Sands-Lincoln); Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas (Brzyski, Schenken); Kaiser Permanente Division of Research, Oakland, California (Kroenke); Division of Geriatric Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (Lee); University of Miami, Miller School of Medicine, Department of Obstetrics/Gynecology, Miami, Florida (O'Sullivan); UC Irvine School of Medicine, Department of Epidemiology, Irvine, California (Park); John A. Burns School of Medicine (JABSOM), University of Hawaii, Honolulu, Hawaii (Parikh)
| | - Megan Sands-Lincoln
- Departments of Family Medicine and Epidemiology, Alpert Medical School of Brown University, Providence, Rhode Island (Parker, Eaton); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island (Parker, Eaton); Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts (Lu); University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, Pennsylvania (Sands-Lincoln); Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas (Brzyski, Schenken); Kaiser Permanente Division of Research, Oakland, California (Kroenke); Division of Geriatric Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (Lee); University of Miami, Miller School of Medicine, Department of Obstetrics/Gynecology, Miami, Florida (O'Sullivan); UC Irvine School of Medicine, Department of Epidemiology, Irvine, California (Park); John A. Burns School of Medicine (JABSOM), University of Hawaii, Honolulu, Hawaii (Parikh)
| | - Candyce H Kroenke
- Departments of Family Medicine and Epidemiology, Alpert Medical School of Brown University, Providence, Rhode Island (Parker, Eaton); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island (Parker, Eaton); Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts (Lu); University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, Pennsylvania (Sands-Lincoln); Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas (Brzyski, Schenken); Kaiser Permanente Division of Research, Oakland, California (Kroenke); Division of Geriatric Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (Lee); University of Miami, Miller School of Medicine, Department of Obstetrics/Gynecology, Miami, Florida (O'Sullivan); UC Irvine School of Medicine, Department of Epidemiology, Irvine, California (Park); John A. Burns School of Medicine (JABSOM), University of Hawaii, Honolulu, Hawaii (Parikh)
| | - Cathy C Lee
- Departments of Family Medicine and Epidemiology, Alpert Medical School of Brown University, Providence, Rhode Island (Parker, Eaton); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island (Parker, Eaton); Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts (Lu); University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, Pennsylvania (Sands-Lincoln); Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas (Brzyski, Schenken); Kaiser Permanente Division of Research, Oakland, California (Kroenke); Division of Geriatric Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (Lee); University of Miami, Miller School of Medicine, Department of Obstetrics/Gynecology, Miami, Florida (O'Sullivan); UC Irvine School of Medicine, Department of Epidemiology, Irvine, California (Park); John A. Burns School of Medicine (JABSOM), University of Hawaii, Honolulu, Hawaii (Parikh)
| | - Mary O'Sullivan
- Departments of Family Medicine and Epidemiology, Alpert Medical School of Brown University, Providence, Rhode Island (Parker, Eaton); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island (Parker, Eaton); Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts (Lu); University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, Pennsylvania (Sands-Lincoln); Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas (Brzyski, Schenken); Kaiser Permanente Division of Research, Oakland, California (Kroenke); Division of Geriatric Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (Lee); University of Miami, Miller School of Medicine, Department of Obstetrics/Gynecology, Miami, Florida (O'Sullivan); UC Irvine School of Medicine, Department of Epidemiology, Irvine, California (Park); John A. Burns School of Medicine (JABSOM), University of Hawaii, Honolulu, Hawaii (Parikh)
| | - Hannah L Park
- Departments of Family Medicine and Epidemiology, Alpert Medical School of Brown University, Providence, Rhode Island (Parker, Eaton); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island (Parker, Eaton); Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts (Lu); University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, Pennsylvania (Sands-Lincoln); Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas (Brzyski, Schenken); Kaiser Permanente Division of Research, Oakland, California (Kroenke); Division of Geriatric Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (Lee); University of Miami, Miller School of Medicine, Department of Obstetrics/Gynecology, Miami, Florida (O'Sullivan); UC Irvine School of Medicine, Department of Epidemiology, Irvine, California (Park); John A. Burns School of Medicine (JABSOM), University of Hawaii, Honolulu, Hawaii (Parikh)
| | - Nisha Parikh
- Departments of Family Medicine and Epidemiology, Alpert Medical School of Brown University, Providence, Rhode Island (Parker, Eaton); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island (Parker, Eaton); Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts (Lu); University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, Pennsylvania (Sands-Lincoln); Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas (Brzyski, Schenken); Kaiser Permanente Division of Research, Oakland, California (Kroenke); Division of Geriatric Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (Lee); University of Miami, Miller School of Medicine, Department of Obstetrics/Gynecology, Miami, Florida (O'Sullivan); UC Irvine School of Medicine, Department of Epidemiology, Irvine, California (Park); John A. Burns School of Medicine (JABSOM), University of Hawaii, Honolulu, Hawaii (Parikh)
| | - Robert S Schenken
- Departments of Family Medicine and Epidemiology, Alpert Medical School of Brown University, Providence, Rhode Island (Parker, Eaton); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island (Parker, Eaton); Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts (Lu); University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, Pennsylvania (Sands-Lincoln); Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas (Brzyski, Schenken); Kaiser Permanente Division of Research, Oakland, California (Kroenke); Division of Geriatric Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (Lee); University of Miami, Miller School of Medicine, Department of Obstetrics/Gynecology, Miami, Florida (O'Sullivan); UC Irvine School of Medicine, Department of Epidemiology, Irvine, California (Park); John A. Burns School of Medicine (JABSOM), University of Hawaii, Honolulu, Hawaii (Parikh)
| | - Charles B Eaton
- Departments of Family Medicine and Epidemiology, Alpert Medical School of Brown University, Providence, Rhode Island (Parker, Eaton); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island (Parker, Eaton); Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts (Lu); University of Pennsylvania Perelman School of Medicine, Center for Sleep and Circadian Neurobiology, Philadelphia, Pennsylvania (Sands-Lincoln); Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas (Brzyski, Schenken); Kaiser Permanente Division of Research, Oakland, California (Kroenke); Division of Geriatric Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (Lee); University of Miami, Miller School of Medicine, Department of Obstetrics/Gynecology, Miami, Florida (O'Sullivan); UC Irvine School of Medicine, Department of Epidemiology, Irvine, California (Park); John A. Burns School of Medicine (JABSOM), University of Hawaii, Honolulu, Hawaii (Parikh)
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Hahn KA, Wise LA, Riis AH, Mikkelsen EM, Rothman KJ, Banholzer K, Hatch EE. Correlates of menstrual cycle characteristics among nulliparous Danish women. Clin Epidemiol 2013; 5:311-9. [PMID: 23983490 PMCID: PMC3751379 DOI: 10.2147/clep.s46712] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective We examined the association between lifestyle factors and menstrual cycle characteristics among nulliparous Danish women aged 18–40 years who were participating in an Internet-based prospective cohort study of pregnancy planners. Methods We used cross-sectional data collected at baseline to assess the association of age, body mass index (BMI), physical activity, alcohol and caffeine consumption, and smoking with the prevalence of irregular cycles, short (≤25 days) and long (≥33 days) cycles, and duration and amount of menstrual flow. We used log-binomial and multinomial logistic regression to estimate prevalence ratios and 95% confidence intervals. Results Low physical activity and heavy alcohol consumption were associated with an increased prevalence of irregular periods. High BMI, smoking, and caffeine and alcohol consumption were related to an increased prevalence of short menstrual cycles and heavy menstrual bleeding. Women in their mid-to-late thirties had shorter and lighter menstrual flow, but a lower prevalence of irregular cycles, compared with women 18–25 years of age. Discussion In this study, increased age, high BMI, and sedentary behavior were associated with menstrual-pattern irregularities. These factors may influence the balance and level of endogenous hormones conducive to optimal menstrual function.
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Affiliation(s)
- Kristen A Hahn
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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Edstedt Bonamy AK, Parikh NI. Predicting Women’s Future Cardiovascular Health from Pregnancy Complications. CURRENT CARDIOVASCULAR RISK REPORTS 2013. [DOI: 10.1007/s12170-013-0314-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Oliver-Williams CT, Heydon EE, Smith GCS, Wood AM. Miscarriage and future maternal cardiovascular disease: a systematic review and meta-analysis. Heart 2013; 99:1636-44. [PMID: 23539554 PMCID: PMC3812894 DOI: 10.1136/heartjnl-2012-303237] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Context The 2011 American Heart Association guidelines identified pregnancy complications as a risk factor for cardiovascular disease in women. However, miscarriage was not mentioned within the guidelines, and there is no consensus on the association between miscarriage and future risk of cardiovascular disease. Objective To confirm or refute the association, a meta-analysis of published papers was conducted. Data sources PubMed, Web of Knowledge and Scopus were systematically searched to identify appropriate articles. Reference lists were then hand searched for additional relevant titles. Study Selection To be included, articles had to assess the association between miscarriage and subsequent cardiovascular disease in otherwise healthy women. Only women who had miscarriages were considered exposed. Pooled association measures, using random effects meta-analysis, were calculated for coronary heart disease and cerebrovascular disease. Publication bias and between-study heterogeneity were evaluated. Data Extraction Two authors individually reviewed all studies and extracted data on patient and study characteristics along with cardiovascular outcomes. Results 10 studies were identified, with 517 504 individuals included in the coronary heart disease meta-analysis and 134 461 individuals in the cerebrovascular disease analysis. A history of miscarriage was associated with a greater odds of developing coronary heart disease, OR (95% CI) =1.45 (1.18 to 1.78), but not with cerebrovascular disease, OR=1.11 (0.72 to 1.69). There was a strong association between recurrent miscarriage and coronary heart disease OR=1.99 (1.13 to 3.50). Evidence was found for moderate between-study heterogeneity and publication bias in the coronary heart disease analysis. Conclusions The meta-analysis indicates that a history of miscarriage or recurrent miscarriage is associated with a greater risk of subsequent coronary heart disease.
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Stamatelopoulos KS, Georgiopoulos G, Papaioannou T, Lambrinoudaki I, Kouzoupis A, Vlachopoulos C, Georgiou SP, Manios E, Alevizaki M, Papamichael CM, Sfikakis PP. Can premenstrual syndrome affect arterial stiffness or blood pressure? Atherosclerosis 2012; 224:170-6. [DOI: 10.1016/j.atherosclerosis.2012.05.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Revised: 05/23/2012] [Accepted: 05/27/2012] [Indexed: 11/25/2022]
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26
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Jahanfar S. Genetic and environmental determinants of menstrual characteristics. INDIAN JOURNAL OF HUMAN GENETICS 2012; 18:187-92. [PMID: 23162294 PMCID: PMC3491292 DOI: 10.4103/0971-6866.100759] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The impact of women's menstrual cycle on her quality of life, health, work, and community is substantial. Menstrual disturbance is linked with general ill conditions such as migraine, asthma, and endocrinopathies. The clinical significance of medical interventions to prevent these conditions becomes clear if the role of genetic or environment is clarified. AIMS To identify the genetic and environmental contribution on menstrual characteristics. SETTING AND DESIGN This was a cross-sectional study in 2 Asian countries. MATERIALS AND METHODS 2 cohorts of monozygotic and dizygotic twins born between (1945-1988, n = 122) and (1951-1993, n = 71) were taken. A standard questionnaire was designed inclusive of socio- demographic characteristics of subjects as well as menstrual history (duration, interval, amount, irregularity). Subjects were interviewed by phone. STATISTICAL ANALYSIS Quantitative variables were analyzed using Falconars' formula as well as maximum likelihood analysis. Structural modeling was then applied to twin correlations to provide estimates of the relative genetic and/or environmental factors contribution in determining the measured trait. RESULTS Menstrual characteristics were found to be under environmental influence where the best fitting model for menstrual interval and duration was common environment. CDF plotting confirmed the results for both variables. Proband-wise concordance analysis for amount of menstruation, amenorrhea, and irregular menstruation revealed no genetic influence. The best fitting model for menstrual irregularity was CE (C73%, E27%). The same model was defined for amenorrhea (C48%, E52%). CONCLUSIONS Environmental factors are most likely responsible to determine the menstrual flow, its integrity, and regularity. These factors need to be studied further.
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Affiliation(s)
- Shayesteh Jahanfar
- Department of Epidemiology and Biostatistics, School of Population and Public Health, University of British Columbia
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Jacobs MB, Kritz-Silverstein D, Wingard DL, Barrett-Connor E. The association of reproductive history with all-cause and cardiovascular mortality in older women: the Rancho Bernardo Study. Fertil Steril 2011; 97:118-24. [PMID: 22130321 DOI: 10.1016/j.fertnstert.2011.10.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 10/10/2011] [Accepted: 10/24/2011] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To examine associations of gravidity and parity with all-cause, cardiovascular disease (CVD), and coronary heart disease (CHD) mortality in postmenopausal women. DESIGN Prospective cohort study. SETTING Rancho Bernardo, a southern California community. PATIENT(S) One thousand two hundred ninety-four postmenopausal women ages 50-96 who attended a 1984-87 research clinic visit at which reproductive and medical histories were obtained and who were followed through 2007. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) All-cause, CVD, CHD, and non-CHD CVD mortality, determined by nosologist-coded death certificates. RESULT(S) Average baseline age was 70.6 ± 9.2. Numbers of pregnancies ranged from 0 to 13 (median = 2); births ranged from 0 to 11 (median = 2). During a median of 19.3 years of follow-up, 707 women (54.6%) died, with 46.5% attributed to CVD, 20.5% to CHD, and 26.0% to non-CHD CVD. Trend analyses showed inverse associations of gravidity with CVD mortality and non-CHD CVD mortality. Women with four or more pregnancies were less likely than nulligravidas to have fatal CVD (hazard ratio [HR] = 0.63, 95% confidence interval [CI] = 0.40-0.99) and non-CHD CVD (HR = 0.48, 95% CI = 0.26-0.91) independent of age, years postmenopause, obesity, and HDL. Associations increased after the first decade of follow-up. Parity and gravidity were not associated with overall or CHD mortality. CONCLUSION(S) High gravidity was associated with reduced CVD and non-CHD CVD mortality in postmenopausal women. Protective associations could reflect biological mechanisms that occur with repeated pregnancy or greater social support related to family size among multiparous women.
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Affiliation(s)
- Marni B Jacobs
- Division of Epidemiology, Department of Family and Preventive Medicine, University of California, San Diego, California 92093-0607, USA
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28
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Reproductive risk factors for cardiovascular disease mortality among postmenopausal women in Korea. Menopause 2011; 18:1205-12. [DOI: 10.1097/gme.0b013e31821adb43] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jacobsen BK, Knutsen SF, Oda K, Fraser GE. Parity and total, ischemic heart disease and stroke mortality. The Adventist Health Study, 1976-1988. Eur J Epidemiol 2011; 26:711-8. [PMID: 21701914 PMCID: PMC3186890 DOI: 10.1007/s10654-011-9598-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Accepted: 06/11/2011] [Indexed: 11/30/2022]
Abstract
In a prospective study with information about life style and reproductive factors, we assessed the relationship between parity and total, ischemic heart disease, and stroke mortality. The large majority of the 19,688 California Seventh-day Adventist women included did not smoke or drink alcohol, 31 percent never ate meat and physical activity was relatively high. Cox proportional hazard analysis was conducted with parity as the main independent variable and with adjustment for a number of other possible confounders. During follow-up from 1976 through 1988, there were 3,122 deaths; 782 deaths from ischemic heart disease and 367 deaths due to stroke. There were no relationships between parity and total mortality (P-value for overall effect of parity = 0.32). Grand multiparous women (>4 children) had somewhat increased ischemic heart disease mortality (MRR = 1.45, 95% CI: 1.15, 1.84) before adjustment for educational level. After adjustment for educational level and marital status, there were no relationship with mortality from ischemic heart disease (P = 0.29) or stroke (P = 0.72). In parous women, there were, after adjustment for age at first delivery, some suggestions of an increased total mortality in women with one child. For ischemic heart disease and stroke mortality, no associations were found. Stratified and adjusted analyses confirmed these results. Thus, we found no consistent relationships between parity and total, ischemic heart disease or stroke mortality. However, a longer follow-up would have been helpful and the conclusions may be somewhat influenced by the lifestyle of the women included.
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Menopause and myocardial infarction risk among employed women in relation to work and family psychosocial factors in Lithuania. Maturitas 2010; 66:94-8. [DOI: 10.1016/j.maturitas.2010.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Revised: 02/12/2010] [Accepted: 02/22/2010] [Indexed: 01/08/2023]
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Lakshman R, Forouhi NG, Sharp SJ, Luben R, Bingham SA, Khaw KT, Wareham NJ, Ong KK. Early age at menarche associated with cardiovascular disease and mortality. J Clin Endocrinol Metab 2009; 94:4953-60. [PMID: 19880785 DOI: 10.1210/jc.2009-1789] [Citation(s) in RCA: 358] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT The relationship between age at menarche and cardiovascular disease remains unclear. Two recent studies found an inverse association between age at menarche and all-cause mortality. OBJECTIVE The aim of this study was to examine the relationship between age at menarche and cardiovascular disease risk factors, events, and mortality. DESIGN, SETTING, AND PARTICIPANTS A population-based prospective study involving 15,807 women, aged 40-79 yr in 1993-1997 and followed up to March 2007 for cardiovascular disease events (median follow-up 10.6 yr) and February 2008 for mortality (median follow-up 12.0 yr) was used. MAIN OUTCOME MEASURES Odds ratios for cardiovascular disease risk factors and hazard ratios for incident cardiovascular disease and mortality were calculated. RESULTS There were 3888 incident cardiovascular disease events (1323 coronary heart disease, 602 stroke, and 1963 other) and 1903 deaths (640 cardiovascular disease, 782 cancer, and 481 other) during follow-up. Compared with other women, those who had early menarche (<12 yr) had higher risks of hypertension [1.13 (1.02-1.24)], incident cardiovascular disease [1.17 (1.07-1.27)], incident coronary heart disease [1.23 (1.06-1.43)], all-cause mortality [1.22 (1.07-1.39)], cardiovascular disease mortality [1.28 (1.02-1.62)], and cancer mortality [1.25 (1.03-1.51)], adjusted for age, physical activity, smoking, alcohol, educational level, occupational social class, oral contraceptive use, hormone replacement therapy, parity, body mass index, and waist circumference. CONCLUSIONS Early age at menarche (before age 12 yr) was associated with increased risk of cardiovascular disease events, cardiovascular disease mortality, and overall mortality in women, and this association appeared to be only partly mediated by increased adiposity.
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Affiliation(s)
- Rajalakshmi Lakshman
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge CB2 0QQ, United Kingdom.
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Shively CA, Clarkson TB. The unique value of primate models in translational research. Nonhuman primate models of women's health: introduction and overview. Am J Primatol 2009; 71:715-21. [PMID: 19507247 DOI: 10.1002/ajp.20720] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This special issue of AJP is focused on research using nonhuman primates as models to further the understanding of women's health. Nonhuman primates play a unique role in translational science by bridging the gap between basic and clinical investigations. The use of nonhuman primates in biomedical research challenges our resolve to treat all life as sacred. The scientific community has responded by developing ethical guidelines for the care and the use of primates and clarifying the responsibility of investigators to insure the physical and psychological well-being of nonhuman primates used in research. Preclinical investigations often involve the use of animal models. Rodent models have been the mainstay of biomedical science and have provided enormous insight into the workings of many mammalian systems that have proved applicable to human biological systems. Rodent models are dissimilar to primates in numerous ways, which may limit the generalizability to human biological systems. These limitations are much less likely in nonhuman primates and in Old World primates, in particular, Macaques are useful models for investigations involving the reproductive system, bioenergetics, obesity and diabetes, cardiovascular health, central nervous system function, cognitive and social behavior, the musculoskeletal system, and diseases of aging. This issue considers primate models of polycystic ovary syndrome; diet effects on glycemic control, breast and endometrium; estrogen, reproductive life stage and atherosclerosis; estrogen and diet effects on inflammation in atherogenesis; the neuroprotective effects of estrogen therapy; social stress and visceral obesity; and sex differences in the role of social status in atherogenesis. Unmet research needs in women's health include the use of diets in nonhuman primate studies that are similar to those consumed by human beings, primate models of natural menopause, dementia, hypertension, colon cancer, and frailty in old age, and dedicated colonies for the study of breast cancer.
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Affiliation(s)
- Carol A Shively
- Wake Forest University Primate Center, Department of Pathology, Section on Comparative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1040, USA.
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Rich-Edwards JW. Reproductive health as a sentinel of chronic disease in women. ACTA ACUST UNITED AC 2009; 5:101-5. [PMID: 19245346 DOI: 10.2217/17455057.5.2.101] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Jacobsen BK, Oda K, Knutsen SF, Fraser GE. Age at menarche, total mortality and mortality from ischaemic heart disease and stroke: the Adventist Health Study, 1976-88. Int J Epidemiol 2009; 38:245-52. [PMID: 19188208 DOI: 10.1093/ije/dyn251] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Little is known about the relationship between age at menarche and total mortality and mortality from ischaemic heart disease and stroke. METHODS A cohort study of 19 462 Californian Seventh-Day Adventist women followed-up from 1976 to 1988. A total of 3313 deaths occurred during follow-up, of which 809 were due to ischaemic heart disease and 378 due to stroke. RESULTS An early menarche was associated with increased total mortality (P-value for linear trend <0.001), ischaemic heart disease (P-value for linear trend = 0.01) and stroke (P-value for linear trend = 0.02) mortality. There were, however, also some indications of an increased ischaemic heart disease mortality in women aged 16-18 at menarche (5% of the women). When assessed as a linear relationship, a 1-year delay in menarche was associated with 4.5% (95% CI 2.3-6.7) lower total mortality. The association was stronger for ischaemic heart disease [6.0% (95% CI 1.2-10.6)] and stroke [8.6% (95% CI 1.6-15.1)] mortality. CONCLUSIONS The results suggest that there is a linear, inverse relationship between age at menarche and total mortality as well as with ischaemic heart disease and stroke mortality.
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Affiliation(s)
- B K Jacobsen
- Institute of Community Medicine, University of Tromsø, Tromsø, N-9037 Tromsø, Norway.
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Jukic AMZ, Weinberg CR, Baird DD, Wilcox AJ. Lifestyle and reproductive factors associated with follicular phase length. J Womens Health (Larchmt) 2007; 16:1340-7. [PMID: 18001191 PMCID: PMC2834565 DOI: 10.1089/jwh.2007.0354] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Variability in menstrual cycle length, largely determined by variation in follicular phase length, is related to several health outcomes, yet the causes of this variability are incompletely understood. We sought to identify characteristics associated with follicular phase length. METHODS We used the North Carolina Early Pregnancy Study to describe factors correlated with timing of ovulation (follicular phase length). Women collected daily urine specimens and recorded vaginal bleeding. Specimens were assayed for estrone 3-glucuronide and pregnanediol 3-glucuronide, which in turn were used to estimate the day of ovulation. All other variables were assessed through interview. Associations with follicular phase length were evaluated using a multiple regression model. RESULTS We determined follicular phase length for the first cycles of 201 women. Women with a history of miscarriage tended to have shorter follicular phases (2.2 days). Longer duration of oral contraceptive (OC) use and recent OC use (in the last 90 days) were both correlated with longer follicular phase. Occasional marijuana users (up to three times in the last 3 months) had a longer follicular phase than nonusers (3.5 days); the follicular phase in frequent users (more than three times) was almost 2 days longer than that of nonusers. CONCLUSIONS The association between marijuana use and longer follicular phase is consistent with prior rhesus monkey research that shows ovulatory delay or inhibition.
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Affiliation(s)
- Anne Marie Zaura Jukic
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina 27709, USA.
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