Relation of Parity With Common Carotid Intima-Media Thickness Among Women of the Study of Health in Pomerania

Number of Pregnancies and Risk of Atherosclerotic Cardiovascular Disease in Postmenopausal Women: A Cross-Sectional Study of NHANES from 1999 to 2018

Background: Atherosclerotic cardiovascular disease (ASCVD) remains the most common cause of death in women. Pregnancy is an exposure unique to women leading to significant changes in maternal cardiovascular function. However, studies of the relationship between the number of pregnancies and ASCVD are rare. We aimed to clarify the association between the number of pregnancies and ASCVD. Methods: In this cross-sectional study, we used publicly available data from the National Health and Nutrition Examination Survey from 1999 to 2018. The number of pregnancies was divided into 0 (reference), 1, 2-3, 4-5, or ≥6, to create more stable estimates. A multiple logistic regression approach was used to examine the correlation between pregnancy and ASCVD in women aged 45 years or older who reported no menstruation in the past 12 months due to menopause, as well as in those aged 55 years or older, encompassing various age groups. We also separately estimated the association between the exposure of pregnancy and individual components of ASCVD. Results: In this study, age-adjusted data showed that women with six or more pregnancies had a doubled risk (odds ratio [OR]: 2.07) of ASCVD. The risk remained elevated at 1.69 times in women with four to five pregnancies and further increased to 1.90 times in women with six or more pregnancies, after adjusting for social factors. Similar patterns were observed when considering reproductive health and cardiovascular risk factors. Across the full population, every model that accounted for these variables consistently indicated that with an increasing number of pregnancies, we observed higher ORs for ASCVD risk (all p values <0.05). Conclusions: A higher number of pregnancies was associated with a higher risk of ASCVD after menopause, especially among women aged 45-64 years. Moreover, this association is particularly significant in the risk of stroke, cardiovascular heart disease, and heart attack.

Cooking fuels use and carotid intima-media thickness during early pregnancy of women in Myanmar

BACKGROUND

Fuels burned in households for cooking cause indoor air pollution, exposing those who are cooking. Despite the mounting evidence of the effects of fuels use on health, few studies focus on the effect of cooking fuels have on carotid intima-media thickness (CIMT), a surrogate atherosclerosis biomarker in the early stages of pregnancy. This study aimed to examine the association between the use of cooking fuels and CIMT during early trimester of pregnancy among cooking women in Myanmar.

METHODOLOGY

In this cross-sectional study, a part of an ongoing birth cohort analysis, a total of 192 cooking pregnant women over 18 years with gestational weeks less than 18 were recruited from 15 rural health centers in Nay Pyi Taw from September to November 2019. Sociodemographic data, residential data, and fuels use data were collected with semi-structured questionnaires in face-to-face interviews. Anthropometric, hemodynamic, blood lipids, and ultrasound CIMT measurements were performed under standard protocols. Multiple linear regression was modeled to explore associations.

RESULTS

The study included 70 firewood fuel users, 26 charcoal fuel users, and 96 electricity fuel users. Following adjustments for potential confounding factors, firewood use was significantly associated with the increase of all CIMT analyzed. Importantly, a greater increase of mean CIMT of the right common carotid artery (RCCA; β = 0.033 mm; 95%CI: 0.006, 0.058; P<0.05) had significant association with charcoal use compared to firewood use (β = 0.029 mm; 95%CI: 0.010, 0.049; P<0.05).

CONCLUSIONS

Our findings demonstrate that the indoor use of cooking fuels that cause indoor air pollution, such as firewood and charcoal, is a considerable risk factor for human health and is associated with increased CIMT, wherein charcoal use contributes to more increase of mean CIMT of the RCCA. Measures to prevent health risks related to the use of such fuels should be instituted early on during pregnancy.

Infertility, Gravidity, and Risk Of Diabetes among High-Risk Women in the Diabetes Prevention Program Outcomes Study

OBJECTIVE

The extent to which infertility and pregnancy independently increase risk of diabetes and subclinical atherosclerosis is not known.

RESEARCH DESIGN AND METHODS

We conducted a secondary analysis of Diabetes Prevention Program (DPP) and the DPP Outcomes Study over a 15-year period. We included women who answered questions about gravidity and infertility at baseline (n = 2085). Infertility was defined as > 1 year of unsuccessful attempts to conceive; thus, women could have histories of infertility as well as pregnancy. Risk of diabetes associated with gravidity and infertility was calculated using Cox proportional hazards models adjusting for age, race/ethnicity, treatment arm, body mass index, and pregnancy during the study. Among women who underwent assessment of coronary artery calcification (CAC) (n = 1337), odds of CAC were calculated using logistic regression models with similar covariates.

RESULTS

Among premenopausal women (n = 1075), women with histories of pregnancy and infertility (n = 147; hazard ratio [HR] 1.80; 95% confidence interval [CI] 1.30, 2.49) and women with histories of pregnancy without infertility (n = 736; HR 1.49; 95% CI 1.15, 1.93) had greater diabetes risk than nulligravid women without infertility (n = 173). Premenopausal nulligravid women with histories of infertility had a non-significant elevation in risk, although the number of these women was small (n = 19; HR 1.63; 95% CI 0.88, 3.03). Associations were not observed among postmenopausal women (n = 1010). No associations were observed between infertility or pregnancy with CAC.

CONCLUSIONS

Pregnancy, particularly combined with a history of infertility, confers increased risk of diabetes but not CAC among glucose-intolerant premenopausal women.

Maternal reproductive history and premenopausal risk of hypertension and cardiovascular disease: a Danish cohort study

OBJECTIVES

The metabolic changes of pregnancy resemble a cardiovascular risk profile and may persist postpartum, with body mass index (BMI) as a potential modifier. We examined the association between the number of live-birth pregnancies and maternal premenopausal risks of hypertension and cardiovascular disease (CVD), accounting for pre-pregnancy BMI as well as abortions and stillbirths.

DESIGN

A prospective cohort study.

SETTING

Mothers from the Danish National Birth Cohort (1996 to 2002). For each of these women, registry data on all pregnancies from 1973 to 2011 were obtained, as were self-reported pre-pregnancy weight and height.

PARTICIPANTS

A total of 44 552 first-time mothers in the Danish National Birth Cohort.

OUTCOME MEASURES

Risks of hypertension and CVD during and between live-birth pregnancies separately and combined as live-birth cycles.

RESULTS

After adjustment for abortions, stillbirths, pre-pregnancy BMI and other covariates, a higher risk of hypertension was observed in the first (HR 1.53, 95% CI: 1.37 to 1.72) and fourth and subsequent live-birth cycles (HR 1.72, 95% CI: 1.15 to 2.58), compared with the second. However, as number of live-birth pregnancies increased, risk of hypertension decreased during live-birth pregnancies and increased between live-birth pregnancies (tests for trend, p<0.01). For CVD, we found an overall J-shaped but non-significant association with number of live-birth pregnancies. No interaction with pre-pregnancy BMI (<25 versus ≥25 kg/m²) was observed.

CONCLUSIONS

Premenopausal women had the highest risk of hypertension and CVD during their first live-birth pregnancy and after their fourth live-birth pregnancy. All risks were independent of BMI before the first live-birth pregnancy and of number of abortions and stillbirths.

Association between reproductive factors and carotid atherosclerosis in post-menopausal women

OBJECTIVES

Assessment of cardiovascular risk in women is specific and hormonal factors should be considered to avoid its underestimation. So far, studies on this issue are lacking and the impact of reproductive factors on cardiovascular risk has yet to be determined. We study the association between reproductive factors and carotid atherosclerosis, a non-invasive marker of cardiovascular diseases, in post-menopause.

STUDY DESIGN

In this cross-sectional study, data were analyzed from post-menopausal women with at least one cardiovascular risk factor followed through a dedicated healthcare pathway at the Lille University Hospital between January 1st, 2013 and December 31st, 2016.

MAIN OUTCOME AND MEASURES

The primary outcome was the presence of plaque or stenosis at carotid ultrasound.

RESULTS

We included 370 post-menopausal women with a mean age of 63.4 ± 0.5 years. Carotid atherosclerosis was found in 161 (43,3%) women. Women with 3 or more children had higher odds of having carotid atherosclerosis than women with fewer than 3 children after adjustment for age, OR 1,69 [CI 95% 1,09-2,61], p = 0,019, and after further adjustment for anthropometric measures, traditional cardiovascular risk factors and pregnancy-related complications: OR 1,65 [CI 95% 1,05-2,62], p = 0,031. No other reproductive factor was significantly associated with carotid atherosclerosis.

CONCLUSIONS

A higher parity was associated with higher odds of carotid atherosclerosis independently of age, traditional risk factors, anthropometric measures and gestational diseases among post-menopausal women at risk of cardiovascular diseases. This suggests the importance of considering the number of children when assessing cardiovascular risk in women.

Association between number of children and carotid intima-media thickness in Bangladesh

Previous studies on the association between number of children and carotid intima-media thickness (cIMT) were limited to Western populations. Pregnancy in women is associated with physiologic changes that may influence the risk of cardiovascular disease. Comparing the association between number of children and cIMT in men and women can provide insights on whether the association may be due to pregnancy. We investigated the association between number of children and cIMT among 718 female (mean age 37.5 years) and 417 male participants (mean age 41.3 years), randomly selected from the Health Effect of Arsenic Longitudinal Study (HEALS), a population-based cohort study in Bangladesh. Multivariate linear regression was used to assess the association and to control for education attainment, history of diabetes, age, smoking, betel use, BMI, systolic blood pressure, and diastolic blood pressure. The average number of children was 4.43 for women and 3.74 for men. There were no nulliparous women. We observed a positive association between number of children and cIMT in women. Mean cIMT increased by 4.5 μm (95% CI, 0.8–8.1) per increment of one birth (P = 0.02). Compared to women with two children, cIMT in women with 4 children and ≥5 children was 23.6μm (95%CI, 2.6–44.7; P = 0.03) and 25.1 μm (95%CI, 3.5–46.6; P = 0.02) greater, respectively. The association was not modified by BMI, SBP, betel use or age. Data in men showed no evidence of association (P = 0.4). The finding suggests a role of high parity in atherosclerosis in women of a low-income, high parity population.

Common carotid artery intima-media thickness increases throughout the pregnancy cycle: a prospective cohort study

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.

Pregnancy complications and later vascular ultrasound measures: A cohort study

OBJECTIVES

Pregnancy complications predict or even predispose to later cardiovascular disease in the mother. We examined whether pregnancy complications are associated with post-pregnancy measures of endothelial dysfunction and arterial stiffness.

STUDY DESIGN

Prospective cohort; Data for 847 women female participants in the Cardiovascular Risk in Young Finns study were linked with the national birth registry. Preterm birth (<37weeks), low birthweight (<2500g), small-for-gestational-age (weight <10th percentile for gestational age), and hypertensive disorders of pregnancy were examined as predictors of later vascular measures.

MAIN OUTCOME MEASURES

Flow-mediated dilatation (FMD), carotid intima-media thickness (IMT), Young's elastic modulus (YEM), and carotid artery distensibility.

RESULTS

In some analyses, gestational hypertension and pre-eclampsia were associated with increased YEM. Low birthweight was also associated with an increase in IMT, and this increased risk was present prior to the pregnancy.

CONCLUSIONS

The increased cardiovascular risk in the mother observed after low birthweight and hypertensive disorders may be due to vascular changes, and some of this increased risk may be present before pregnancy.

Pregnancy increases stroke risk up to 1 year postpartum and reduces long-term risk

BACKGROUND

: The incidence of stroke in pregnant women is low but trending upward. There are few studies of the topic in women of Asian ethnicity.

AIM

We aim to evaluate stroke risk in Asian women during and after pregnancy.

DESIGN

: Using the Taiwan National Health Insurance database, we designed a retrospective study that included 18-45-year-old pregnant women between the years 2000 and 2010. We selected a 1:1 age-matched control group of non-pregnant women. The endpoint was any type of stroke during pregnancy or the postpartum period; otherwise, the patients were tracked until 31 December 2010.

METHODS

: The risk factors for stroke were found using Cox proportional regression to calculate the hazard ratio (HR) with a 95% CI compared with the control group.

RESULTS

: The incidence of stroke within 1 year postpartum was 71/100,000. The risk of postpartum stroke within 1 year was an HR of 1.208 (95% CI: 1.001-5.129). The occurrence of stroke was associated with hypertension, diabetes mellitus, coagulation disorders, migraine, obesity, cerebrovascular malformation and parity. Women with third and fourth parity carried increased risks of 13.3% and 2.5%, respectively, compared with first parity women. In long-term follow-ups, stroke risk was significantly lower, with an adjusted HR of 0.362 (95% CI: 0.269-0.489).

CONCLUSION

The risk of stroke was elevated during the first year postpartum, but lower in subsequent years. Stroke risk increased in multiparous (≥3) women. Physicians should be on alert for pregnancy complications and ensure appropriate management to prevent postpartum stroke.

Parity and serum lipid levels: a cross-sectional study in chinese female adults

Reproductive factors have been shown to correlate with lipid metabolism. The aim of this study was to investigate the relationship between parity and serum lipid levels in community-based Chinese female adults. A total of 4,217 female participants were enrolled. Parity was recorded according to questionnaire and serum lipid profile, including triglycerides (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), and high density lipoprotein cholesterol (HDL-C), was measured. Logistic regression models were used to analyze the association of parity to serum lipid levels, while adjusting for demographics and metabolic risk factors. Parity in this population ranged from 0 to 7. After adjusting for potential confounders, it indicated that females with more than 2 parities appeared to be less likely to suffer from abnormal serum TC level compared with nulliparae (parity = 2, odds ratio (OR) = 0.457, 95% confidence interval (CI) = 0.284–0.736; parity ≥ 3, OR = 0.363, 95% CI = 0.202–0.653). These findings suggested that parity could correlate with lipid metabolism in Chinese women. Individuals with higher parity appeared to have a lower total cholesterol in blood.

Parity and Risk of Stroke among Chinese Women: Cross-sectional Evidence from the Dongfeng-Tongji Cohort Study

Epidemiological studies have investigated the association between parity and the risk of stroke, but the results have been inconsistent. The objective of this study was to assess the association among middle-aged and older Chinese women. We used data from the Dongfeng-Tongji Cohort Study. In total, 14,277 women were included in the analysis. Participants were classified into four groups according to parity. Stroke cases were self-reported during face-to-face interviews. Multivariable logistic regression models were used to investigate the association between parity and the risk of stroke while controlling for potential confounders. The prevalence of stroke among the study subjects was 2.7% (380 of 14,277). In the fully adjusted model, women who had experienced two, three, or four or more live births had 1.24 times (95% CI, 0.85-1.81), 1.97 times (95% CI, 1.30-2.98) and 1.86 times (95% CI, 1.14-3.03), higher risk of stroke, respectively, compared with women who had experienced one live birth. High parity was associated with an increasing risk of stroke in the present study. Further longitudinal studies are needed to confirm the association and to explore the unclear mechanism underlying the link between parity and stroke risk.

Nulliparity is associated with less healthy markers of subclinical cardiovascular disease in young women with overweight and obesity

OBJECTIVE

Higher parity is associated with increased subclinical cardiovascular disease (CVD) in mid-life and older women and with increased CVD risk overall. The relationship between parity, subclinical CVD, and infertility in young women with overweight and obesity has been infrequently evaluated.

METHODS

Reproductive histories were obtained in 191 (66%) young women with overweight and obesity (BMI 25-39.9 kg/m(2) ) participating in a weight loss trial. Baseline carotid intima-media thickness (IMT) and inter-adventitial diameter (IAD) were assessed via B-mode ultrasound. Linear regression was used to estimate the relationship between parity and carotid measures, adjusted for demographic, cardiovascular, and reproductive risk factors.

RESULTS

Nulliparous women (n = 70, age 34.9 ± 7.1) had increased common carotid IAD (0.230 mm, SE 0.08, P = 0.003) and mean common carotid artery (CCA) IMT (0.031 mm, SE 0.01, P = 0.007) compared with parous women (n = 102, age 39.5 ± 4.9), persisting after adjustment for age, race, and CVD risk factors. No other reproductive factors were statistically significantly associated.

CONCLUSIONS

Nulliparity is associated with markers of less healthy carotid arteries in a sample of disease-free 25- to 45-year-old women with overweight or obesity. This may represent a beneficial effect of pregnancy or indicate overall better health in women with overweight/obesity who are capable of childbearing.

Reproductive factors, intima media thickness and carotid plaques in a cross-sectional study of postmenopausal women enrolled in the population-based KORA F4 study

BACKGROUND

Reproductive events may affect the onset of chronic diseases. We examined the possible association between reproductive parameters and intima media thickness (IMT) or carotid plaques in the common carotid artery in a population-based sample.

METHODS

This cross-sectional study analysed data of 800 postmenopausal women aged 50 to 81 years of the population-based KORA F4 study, conducted between 2006 and 2008 in Southern Germany. Reproductive parameters were obtained by standardised interviews.

RESULTS

Age at menarche below 12 years compared to 12-15 years was significantly associated with carotid plaques (age-adjusted OR 2.23, 95% CI 1.13-4.43, p-value 0.018, multivariable adjusted 2.11, 1.05-4.26, 0.037), but not with IMT. Ever use of hormone replacement therapy was inversely associated with carotid plaques (age-adjusted 0.60, 0.44-0.81, p = 0.001, multivariable-adjusted 0.62, 0.45-0.86, 0.003) and IMT in the age-adjusted model (mean 0.89, 95% CI 0.88-0.90, p = 0.033) but not in the multivariable-adjusted model (mean 0.89, 95% CI 0.88-0.90, p = 0.075). Parity, age at menopause, time since menopause, duration of fertile period, current use of hormone replacement therapy, ever use of oral contraceptives, hysterectomy, bilateral oophorectomy, hot flashes and depressive mood in relation to the menopausal transition were not associated with carotid plaques or IMT.

CONCLUSION

Our study showed, that there may be an independent association between the reproductive parameters age at menarche and ever use of hormone replacement therapy with carotid plaques in the common carotid artery, but not with IMT. Further research, especially in studies with prospective population-based study design, is necessary to assess in detail what events in women's life lead to increased IMT or CP.

Intima-media thickness in women with borderline personality disorder

OBJECTIVE

Patients with borderline personality disorder (BPD) may have a higher risk of developing cardiovascular disease caused by altered endocrine, metabolic, and inflammatory parameters. Increased intima-media thickness (IMT) is considered an early marker of atherosclerosis and is associated with most cardiovascular risk factors.

METHODS

The mean IMT of the common carotid arteries was assessed by B-mode ultrasound in 47 women with BPD and 28 age-matched healthy women. Mean (standard deviation) age for BPD participants was 31.2 (10.4) years and 31.9 (11.0) years for the comparison group. In addition, Adult Treatment Panel III criteria for metabolic syndrome and markers of inflammation were measured. The patients were characterized by applying DSM-IV criteria and obtaining self-reports of adverse childhood experiences.

RESULTS

Women with BPD had a significantly higher IMT than healthy women (mean [standard deviation] = 0.41 [0.11] versus 0.34 [0.11] mm, p = .02). In linear regression analysis, IMT was significantly associated with BPD even when adjusting for body mass index (β = 0.27, p = .04) and physical activity (β = 0.29, p = .02).

CONCLUSIONS

The data suggest that women with BPD are at increased risk of developing subsequent cardiovascular disease.

Childbearing, Child-Rearing, Cardiovascular Risk Factors, and Progression of Carotid Intima-Media Thickness

Background and Purpose— Parity is associated with the risk of clinical cardiovascular events and the severity of preclinical atherosclerosis in older subjects. We sought to determine whether childbearing is associated with concurrent changes in cardiovascular risk factors and the progression of carotid intima-media thickness.

Methods— We examined the association between the number of children born during a 6-year period and concurrent changes in cardiovascular risk factors and progression of carotid intima-media thickness in men and women of reproductive age from the Cardiovascular Risk in Young Finns study. Complete data for parity and carotid intima-media thickness were available for 1786 subjects (1005 females, 781 males).

Results— For females, childbirth during the 6-year follow-up was associated with concurrent reductions in high-density lipoprotein cholesterol ( P trend <0.0001), apolipoprotein A-I ( P trend <0.0001), and apolipoprotein B ( P trend =0.01); a redistribution of adiposity to abdominal deposits; and increased progression of carotid intima-media thickness (7.5±3.2 μm/birth [mean±SEM], P =0.02). The association of childbirth with carotid intima-media thickness progression was not greatly modified by adjustment for concurrent changes in cardiovascular risk factors (fully adjusted: P =0.05). This association was significantly stronger in females than males ( P heterogeneity =0.001), who served as a control group exposed to the social and lifestyle influences of child-rearing but not the biological influences of childbearing.

Conclusions— The progression of carotid atherosclerosis over a 6-year period is increased in females who gave birth during the same period, independent of traditional risk factors. Mechanisms that underlie this observation possibly include parity-induced changes in nontraditional risk factors or an acute influence of pregnancy itself.

Decreased paraoxonase and arylesterase activities in the pathogenesis of future atherosclerotic heart disease in women with gestational diabetes mellitus

OBJECTIVE

The aim of this study was to investigate serum paraoxonase, arlyesterase activities, and lipid hydroperoxide (LOOH) levels in patients with gestational diabetes mellitus (GDM).

METHODS

Paraoxonase and arylesterase activities, and LOOH levels were assessed for GDM cases (n = 55) and controls (n = 59). Serum basal and salt-stimulated paraoxonase and arylesterase activities were measured spectrophotometrically. LOOH levels were measured by ferrous oxidation with a xylenol orange assay.

RESULTS

Basal and salt-stimulated paraoxonase and arylesterase activities were significantly lower (p = 0.002, p = 0.004; and p = 0.013, respectively) in patients with GDM compared to controls, while LOOH levels were significantly higher (p < 0.001). Among gestational diabetes patients, serum paraoxonase and arylesterase activities were inversely correlated with LOOH levels (r = - 0.390, p = 0.003; and r = - 0.287, p = 0.034, respectively).

CONCLUSIONS

Findings of the present study have shown that serum paraoxonase and arylesterase activities are significantly reduced in women with GDM. Decreased serum paraoxonase and arylesterase activities might play a role in the potential early pathogenesis for atherosclerotic heart disease in GDM beyond their antioxidant properties.

Pregnancy, childrearing, and risk of stroke in Chinese women

BACKGROUND AND PURPOSE

Although it has been suggested that high gravidity and parity increase the risk for coronary heart disease, their associations with stroke are unclear.

METHODS

We evaluated associations of gravidity and parity with incidence of stroke in the Shanghai Women's Health Study (SWHS), a population-based cohort study of 74 942 Chinese women aged 40 to 70 years at enrollment (1996 to 2000). We also examined the association between number of children and stroke prevalence in both SWHS participants and their husbands. Stroke cases were ascertained through in-person interviews and linkage with vital statistics registries.

RESULTS

During a mean follow-up of 7.3 years, 2343 incident cases of stroke were identified. Women with more pregnancies or live births had a significantly increased risk for incident stroke. After adjustment for socioeconomic status and other potential confounders, women with > or =5 pregnancies had a hazard ratio for incident stroke of 1.45 (95% CI, 1.18 to 1.77) compared with those with only one pregnancy. At baseline recruitment, 859 and 1274 prevalent cases of stroke were reported among SWHS participants and their husbands, respectively. Stroke prevalence increased with increasing number of children in both women and men. Adjusted ORs of prevalent stroke for having > or =5 children versus having one child were 1.61 (95% CI, 1.16 to 2.23) in women and 1.45 (1.11 to 1.89) in men.

CONCLUSIONS

High gravidity or parity may be related to increased risk of stroke in women. Chronic stress and adverse lifestyle factors related to childrearing may contribute importantly to the increased risk.

Parity and carotid atherosclerosis in men and women: insights into the roles of childbearing and child-rearing

BACKGROUND AND PURPOSE

Parity appears to be associated with carotid atherosclerosis in women aged 45 years and older. Studying this association among younger women and men may provide insight into whether this association relates predominantly to childbearing or child-rearing.

METHODS

The association between parity and carotid atherosclerosis (intima-media thickness and presence of plaques) was assessed in a cohort consisting of 750 women and 1164 men, all with at least one traditional cardiovascular risk factor, aged 18 to 80 years of age. Traditional cardiovascular risk factors were also assessed, and the Framingham Risk Score calculated.

RESULTS

In age-adjusted analyses, the number of children was associated with adiposity, fasting glucose, 2-hour glucose, Framingham risk score, and carotid atherosclerosis in women, but not in men. Multivariate linear regression models indicate that the prevalence of plaques was increased by 15% (95% CI, 2 to 29) per child among women, and 0% (95% CI, -10 to 11) among men, after adjustment for age, socioeconomic and lifestyle factors (including waist circumference). The association between parity and carotid intima-media thickness was similar in younger and older women (P(Heterogeneity)=0.20).

CONCLUSIONS

A higher number of children is associated with increased carotid atherosclerosis in both younger and older women, but not among men. These findings indicate that childbearing, but not child-rearing, may be a risk factor for atherosclerosis, and suggest the potential importance of considering the number of children when assessing the level of cardiovascular risk in women.

Association of breast arterial calcification and carotid intima-media thickness

Breast arterial calcification (BAC) on mammography has been identified as calcific medial sclerosis of medium-sized breast arteries, and has been reported to be associated with cardiovascular risk factors, coronary artery disease, and cardiovascular mortality. Carotid intima-media thickness (C-IMT) is a well-known surrogate marker of atherosclerosis and predictor of cardiovascular morbidity and mortality. Consequently, the present study was designed to investigate the association between the presence of BAC on mammography and C-IMT. Twenty-five postmenopausal cases with BAC and 29 subjects without BAC on mammography were included in the study. Cardiovascular risk factors, number of childbirths, postmenopausal duration, and age at menopause were all noted besides detailed physical and laboratory examination. In the whole study population C-IMT was measured with B-mode ultrasound. The women with BAC had significantly increased number of childbirths, postmenopausal duration, frequency of diabetes mellitus, systolic blood pressure, fasting glucose, and CIMT (0.87 +/- 0.17 mm versus 0.60 +/- 0.19 mm) in comparison with the women without BAC (P < 0.05 for all). The C-IMT was correlated with age, number of childbirths, postmenopausal duration, presence of BAC, and serum triglyceride level (P < 0.05 for all). Independent predictors of C-IMT were the presence of BAC on mammography (beta = 0.463, P < 0.001) and serum triglyceride level (beta = 0.222, P = 0.042), whereas the only independent predictor of BAC was CIMT (chi(2) = 23.41, beta = 7.56, P = 0.004). Findings of the present study suggest that the BAC on mammography is independently associated with C-IMT. Screening mammographies merit to be evaluated for the presence of BAC, which might benefit cardiovascular preventive medicine in women by predicting atherosclerosis.

Pregnancy-related factors and the risk of isolated systolic hypertension

BACKGROUND

Isolated systolic hypertension (ISH) is known to be a strong predictor of cerebrovascular and cardiac events, especially in women. Metabolic and hormonal changes associated with reproductive history may contribute to the development of cardiovascular diseases. The aim of this study was to identify associations between pregnancy-related factors and ISH.

METHODS

A cross-sectional study based on a random sample of 3937 Finnish women aged 30-99 was carried out. Associations between pregnancy-related factors and ISH were analyzed using multivariate analyses.

RESULTS

Of 3470 subjects, 26% had ISH. Younger age at first delivery predicted a higher risk of ISH (odds ratio after adjustment for age, education, smoking, height and weight = 1.31, 95% CI 1.07-1.61). Age at first and last delivery was significantly associated with age, education, marital status and use at any time of hormone replacement therapy (HRT); age at first delivery was also associated with toxemia in any pregnancy, weight and body mass index (BMI). In the univariate analyses, ISH was significantly associated with age, height, weight, BMI, education, marital status, oral contraceptive pills use at any time and HRT use at any time.

CONCLUSION

This population-based study showed that early age at first delivery increased the risk of ISH, which may in turn increase cerebrovascular and cardiac events after menopause. Age at first delivery is heavily dependent on education, which may be linked to the risk of developing of cardiovascular disease throughout adulthood. The other plausible mechanism may be adiposity due to pregnancy.

Number of children and coronary heart disease risk factors in men and women from a British birth cohort

OBJECTIVE

To examine the association between number of children and coronary heart disease (CHD) risk factors in women and men.

DESIGN

Prospective cohort study.

SETTING

Britain.

SAMPLE

A total of 2977 individuals (51% women) from the Medical Research Council National Survey of Health and Development, a birth cohort study of individuals born in Britain in 1946 and followed up regularly throughout life.

MAIN OUTCOME MEASURES

Blood pressure, body mass index (BMI), waist to hip ratio (WHR), total, high-density lipoprotein and low-density lipoprotein cholesterol and triglyceride levels, and glycated haemoglobin (HbA1C) measured at age of 53 years.

RESULTS

Number of children showed no consistent relationship with CHD risk factors at age 53 years in either men or women, and no obvious and consistent sex differences were observed. Mean BMI (95% CI) increased with increasing numbers of children (P = 0.01) in women from 27.4 kg/m2 (26.6-28.2) in those with one child to 28.6 kg/m2 (27.6-29.6) in those with four or more children. WHR and type II diabetes in women and HbA1C in men were the only other risk factors exhibiting a linearly increasing trend with increasing number of children. These associations were largely explained by adjustment for behavioural and lifestyle variables.

CONCLUSION

Our findings suggest that any association between number of children and CHD risk factors is a result of lifestyle and behaviours associated with family life rather than being as result of the biological impact of pregnancy in women.

Health Hazards in Middle-Aged Women with Cardiovascular Disease: A Case-Control Study of Swedish Women. The Women's Health in the Lund Area (WHILA) Study

OBJECTIVE

To delineate the health profile in middle-aged women with cardiovascular disease (CVD).

METHODS

The Women's Health in the Lund Area (WHILA) project covered all women born 1935-1945 (n = 10,766) living in the Lund area; 6917 (64.2%) women completed a generic questionnaire and underwent physical and laboratory assessments. Of the 6917 women, 6416 were postmenopausal women, of whom 104 had CVD. For each woman with CVD, two controls were selected and matched for age, smoking habits, body mass index (BMI), waist/hip ratio (WHR), low-density lipoprotein cholesterol (LDL-C), high-density liproprotein cholesterol (HDL-C), diastolic blood pressure and hormonal status.

RESULTS

One hundred four women (1.6%) reported CVD. Forty-nine had a myocardial infarction (MI), 49 had a stroke, and 6 women had both events; 71.4% were postmenopausal, with never use of hormone therapy (HT) (PM0), and 28.6% were postmenopausal with ever use of HT (PMT). Compared with the control group, serum androstendione was lower (p = 0.004) in the case group, and menopausal estradiol (E(2)) values were less frequent (p = 0.037) in cases from the PM0 group. Among psychological and somatic symptoms, nervousness (p < 0.05), difficulty relaxing, crying easily, visual disturbance (p </= 0.01 for all), dizziness, difficulties in voiding urine, shortness of breath, breast tenderness, and constipation (p </= 0.001 for all) were more common among women with CVD. Women with CVD expressed less satisfaction with feeling healthy, body image, memory loss, irritability, and sexuality (p </= 0.05 for all). The case group had more problems with daily activities, more days spent in hospital during the previous 5 years, and more regular medical appointments with healthcare centers, more often had diabetes mellitus (DM) (p < 0.001 for all), and had experienced more falls in the previous year (p < 0.05). Urinary incontinence and decreased body weight were more common among cases (p </= 0.01 for both).

CONCLUSION

Several health hazards as well as somatic and psychological symptoms were more common in subjects with CVD, rendering them more susceptible to future disease.