Reproductive profiles in women may indicate future CVD risk
Several reproductive factors, including preeclampsia, preterm birth and early menopause, may increase risk for CVD in women, researchers found.
“In summary, the evidence reported in this umbrella review suggests that, from menarche to menopause, the reproductive profile of women is associated with their future risk of cardiovascular disease,” Kelvin Okoth, doctoral student in cardiovascular disease epidemiology at the Institute of Applied Health Research at University of Birmingham in the United Kingdom, and colleagues wrote in the study published in The BMJ.
In this umbrella review of systematic reviews, researchers analyzed data from 32 reviews assessing reproductive factors in women of reproductive age and their link with CVD. Exposures included adverse pregnancy outcomes and fertility-related factors. Outcomes of interest were angina, ischemic heart disease, MI, cerebrovascular accident, CAD, peripheral artery disease, HF and composite CVD, defined as cerebrovascular accident, ischemic heart disease, PAD and HF.
Preeclampsia, preterm birth and stillbirth were linked to a twofold increased risk for composite CVD. Placental abruption, gestational hypertension and premature ovarian insufficiency increased this risk by 1.5- to 1.9-fold, whereas polycystic ovary syndrome, early menarche, early menopause and every parity increased the risk for composite CVD by less than 1.5-fold.
Women who breastfed their children for a longer period of time had a reduced risk for CVD.
The risk for ischemic heart disease increased by twofold or greater in women with recurrent preeclampsia, preterm birth, preeclampsia and gestational diabetes. This risk increased by 1.5- to 1.9-fold in those with recurrent miscarriage, early menopause, premature ovarian insufficiency and the use of combined oral contraceptives. Menopausal symptoms, menopause and polycystic ovary syndrome increased the risk for ischemic heart disease by less than 1.5-fold.
Preeclampsia, the use of any oral contraceptive and recurrent preeclampsia increased the risk for stroke by twofold or more. Stroke risk increased by 1.5- to 1.9-fold in women with gestational diabetes, combined oral contraceptives and preterm birth. Women with polycystic ovary syndrome had less than 1.5-fold increased risk for stroke.
Preeclampsia increased the risk for HF by fourfold.
Several factors were not found to be linked to CVD outcomes, including use of non-oral hormonal contraceptive agents, use of progesterone-only contraceptives and fertility treatment.
“Large prospective studies are needed to confirm the association between current use of combined oral contraceptives in patients with obesity and the risk of cardiovascular disease,” Okoth and colleagues wrote. “Similarly, prospective studies with a longer duration of follow-up are needed to investigate the association between reproductive factors and the risk of heart failure.”