June 09, 2017
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Risk for incident HF may be higher in postmenopausal women

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Postmenopausal women with a shorter total reproductive period had a higher risk for incident HF, and those who had never given birth had increased risk for HF with preserved ejection fraction, according to a study in the Journal of the American College of Cardiology.

Philip S. Hall, MD, a clinical fellow at the University of California, San Francisco, and colleagues reviewed data from 28,516 postmenopausal women from the Women’s Health Initiative to determine the link between HF risk and reproductive factors. Those with pre-existing CVD, such as stroke, HF, CHD or MI, were excluded from the study. Patients were followed up for a mean of 13.1 years.

The mean age for women was 63 years at screening, 13 years at menarche and 47 years at menopause. Total reproduction duration for all women was 34 years.

The time to first hospitalization for definite or probable acute decompensated HF or newly diagnosed stable HF was the primary outcome. Other outcomes included the time to develop HFpEF (ejection fraction 50%) or HF with reduced ejection fraction (ejection fraction < 50%).

Incident adjudicated HF hospitalization occurred in 5.2% of women (n = 1,494). Those with shorter total reproductive duration had an increased risk for HF (multivariable-adjusted HR = 0.99 per year; 95% CI, 0.98-0.99), with a 5-year adjusted HR of 0.95 (95% CI, 0.91-0.99).

When adjusted for age, an increased risk for incident HF was linked to women who were first pregnant before age 20 years (HR = 1.42; 95% CI, 1.16-1.75) or with nulliparity (HR = 1.8; 95% CI, 1.07-3.03). After multivariable adjustment, the links were not statistically significant for both nulliparity (HR = 1.7; 95% CI, 0.95-3.03) and younger pregnancy (HR = 1.42; 95% CI, 1.16-1.75).

Women with nulliparity had a statistically increased risk for HFpEF in multivariable-adjusted models (HR = 2.75; 95% CI, 1.16-6.52) and age-adjusted models (HR = 2.57; 95% CI, 1.22-5.44).

Earlier age for menopause was related to a link between increased risk for incident HF and shorter reproduction duration (adjusted HR = 0.99 per additional year before menopause; 95% CI, 0.98-0.99). The link was also seen in women with natural menopause (adjusted HR = 0.97 per year before natural menopause; 95% CI, 0.96-0.99).

“These findings raise interesting questions about the cardiometabolic effects of sex hormone exposure over a woman’s lifetime and continue to raise important questions for future research,” Nandita S. Scott, MD, of the division of cardiology at Massachusetts General Hospital, wrote in a related editorial. – by Darlene Dobkowski

Disclosure: The study was supported in part by the American College of Cardiology Merck Award. The researchers report no relevant financial disclosures.