Aspects of pregnancy, menstruation associated with higher CVD risk in later life
Results agreed with some, but not all, previous studies that reported that early menarche was associated with an increased risk of cardiovascular disease (CVD).
Earlier menarche or menopause and a history of miscarriage, stillbirth, or hysterectomy were independently associated with a higher risk of cardiovascular disease (CVD) in later life, a study found.
Researchers used a British database of more than 500,000 people age 40 to 69 years from 2006 to 2010 to assess the relationship between reproductive factors and incident CVD. Over seven years of follow-up, 9,054 incident cases of CVD (34% women), 5,782 cases of coronary heart disease (CHD) (28% women), and 3,489 cases of stroke (43% women) were recorded among 267,440 women and 215,088 men without a history of CVD at baseline.
Early menarche was defined as having a first menstrual period before age 12 years, while early menopause was defined as the permanent absence of menstrual periods before age 47 years. The main study endpoints were incidence of fatal or nonfatal myocardial infarction or stroke. Results were published by Heart on Jan. 15.
Adjusted hazard ratios for CVD were 1.10 (95% CI, 1.01 to 1.30) for early menarche, 0.97 (95% CI, 0.96 to 0.98) for each year of increase in age at first birth, 1.04 (95% CI, 1.00 to 1.09) for each miscarriage, 1.14 (95% CI, 1.02 to 1.28) for each stillbirth, and 1.33 (95% CI, 1.19 to 1.49) for early menopause. For hysterectomy without oophorectomy or with previous oophorectomy, adjusted hazard ratios were 1.16 (95% CI, 1.06 to 1.28) and 2.30 (95% CI, 1.20 to 4.43) for CVD, respectively. Each additional child was associated with a hazard ratio for CVD of 1.03 (95% CI, 1.00 to 1.06) in women and 1.03 (95% CI, 1.02 to 1.05) in men.
Results agreed with some, but not all, previous studies that reported that early menarche was associated with an increased risk of CVD, the authors noted. “However, the findings of the present study were robust to adjustment for [body-mass index] and were similar between healthy weight and overweight or obese women, suggesting that other mechanisms are involved,” they wrote.
The association between the number of children and the risk of CVD and stroke was largely identical between women and men. This agrees with other studies, and the authors wrote that the link between repeated childbirth and CVD risk in women may be more likely to be explained by social, cultural, psychological, and behavioral factors related to parenthood than by biological ones.
The authors wrote, “More frequent cardiovascular screening would seem to be sensible among women who are early in their reproductive cycle, or who have a history of adverse reproductive events or a hysterectomy, as this might help to delay or prevent their onset of CVD. Cardiovascular risk stratification that accounts for key reproductive factors should be considered to help address the considerable CVD risk among women.”