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J Am Coll Cardiol. 2017 May 23;69(20):2517-2526. doi: 10.1016/j.jacc.2017.03.557.

Reproductive Factors and Incidence of Heart Failure Hospitalization in the Women's Health Initiative.

Author information

1
Division of Cardiology, University of California, San Francisco, San Francisco, California.
2
MedStar Health Research Institute and Georgetown/Howard Universities Center for Clinical and Translational Research, Hyattsville, Maryland.
3
Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
4
Division of Preventive Medicine, University of California, San Diego, La Jolla, California.
5
Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, Wisconsin.
6
Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
7
Department of Preventive Medicine and Public Health, University of Kansas School of Medicine-Wichita, Wichita, Kansas.
8
Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
9
Division of Cardiology, University of California, San Francisco, San Francisco, California. Electronic address: nisha.parikh@ucsf.edu.

Abstract

BACKGROUND:

Reproductive factors reflective of endogenous sex hormone exposure might have an effect on cardiac remodeling and the development of heart failure (HF).

OBJECTIVES:

This study examined the association between key reproductive factors and the incidence of HF.

METHODS:

Women from a cohort of the Women's Health Initiative were systematically evaluated for the incidence of HF hospitalization from study enrollment through 2014. Reproductive factors (number of live births, age at first pregnancy, and total reproductive duration [time from menarche to menopause]) were self-reported at study baseline in 1993 to 1998. We employed Cox proportional hazards regression analysis in age- and multivariable-adjusted models.

RESULTS:

Among 28,516 women, with an average age of 62.7 ± 7.1 years at baseline, 1,494 (5.2%) had an adjudicated incident HF hospitalization during an average follow-up of 13.1 years. After adjusting for covariates, total reproductive duration in years was inversely associated with incident HF: hazard ratios (HRs) of 0.99 per year (95% confidence interval [CI]: 0.98 to 0.99 per year) and 0.95 per 5 years (95% CI: 0.91 to 0.99 per 5 years). Conversely, early age at first pregnancy and nulliparity were significantly associated with incident HF in age-adjusted models, but not after multivariable adjustment. Notably, nulliparity was associated with incident HF with preserved ejection fraction in the fully adjusted model (HR: 2.75; 95% CI: 1.16 to 6.52).

CONCLUSIONS:

In post-menopausal women, shorter total reproductive duration was associated with higher risk of incident HF, and nulliparity was associated with higher risk for incident HF with preserved ejection fraction. Whether exposure to endogenous sex hormones underlies this relationship should be investigated in future studies.

KEYWORDS:

cardiovascular disease; menarche; menopause; pregnancy; women

PMID:
28521890
PMCID:
PMC5602586
DOI:
10.1016/j.jacc.2017.03.557
[Indexed for MEDLINE]
Free PMC Article

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