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Hall PS, Nah G, Howard BV, Lewis CE, Allison MA, Sarto GE, Waring ME, Jacobson LT, Manson JE, Klein L, Parikh NI. Reproductive Factors and Incidence of Heart Failure Hospitalization in the Women's Health Initiative. J Am Coll Cardiol 2017; 69:2517-2526. [PMID: 28521890 PMCID: PMC5602586 DOI: 10.1016/j.jacc.2017.03.557] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/10/2017] [Accepted: 03/12/2017] [Indexed: 12/21/2022]
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.
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Affiliation(s)
- Philip S Hall
- Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - Gregory Nah
- Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - Barbara V Howard
- MedStar Health Research Institute and Georgetown/Howard Universities Center for Clinical and Translational Research, Hyattsville, Maryland
| | - Cora E Lewis
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Matthew A Allison
- Division of Preventive Medicine, University of California, San Diego, La Jolla, California
| | - Gloria E Sarto
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Molly E Waring
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Lisette T Jacobson
- Department of Preventive Medicine and Public Health, University of Kansas School of Medicine-Wichita, Wichita, Kansas
| | - JoAnn E Manson
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Liviu Klein
- Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - Nisha I Parikh
- Division of Cardiology, University of California, San Francisco, San Francisco, California.
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Jo YS, Cheon JY, Ahn JW, Kim Y, Lee GSR. Pentraxin 3 and lipid profile status in pregnancy. J OBSTET GYNAECOL 2017; 37:727-730. [DOI: 10.1080/01443615.2017.1291596] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Yun Sung Jo
- Department of Obstetrics and Gynecology, College of Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ju Young Cheon
- Department of Obstetrics and Gynecology, College of Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Whan Ahn
- Department of Obstetrics and Gynecology, College of Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yeongsic Kim
- Department of Laboratory Medicine, College of Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Gui Se Ra Lee
- Department of Obstetrics and Gynecology, College of Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
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Choi SR, Kim YM, Cho MS, Kim SH, Shim YS. Association Between Duration of Breast Feeding and Metabolic Syndrome: The Korean National Health and Nutrition Examination Surveys. J Womens Health (Larchmt) 2017; 26:361-367. [DOI: 10.1089/jwh.2016.6036] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Se Rin Choi
- Department of Pediatrics, Hallym University, College of Medicine, Seoul, Korea
| | - Yong Min Kim
- Department of Pediatrics, Hallym University, College of Medicine, Seoul, Korea
| | - Min Su Cho
- Department of Pediatrics, Hallym University, College of Medicine, Seoul, Korea
| | - So Hyun Kim
- Department of Pediatrics, Hallym University, College of Medicine, Seoul, Korea
| | - Young Suk Shim
- Department of Pediatrics, Hallym University, College of Medicine, Seoul, Korea
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Verit FF, Yildiz Zeyrek F, Zebitay AG, Akyol H. Cardiovascular risk may be increased in women with unexplained infertility. Clin Exp Reprod Med 2017; 44:28-32. [PMID: 28428941 PMCID: PMC5395549 DOI: 10.5653/cerm.2017.44.1.28] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 11/15/2016] [Accepted: 11/21/2016] [Indexed: 12/15/2022] Open
Abstract
Objective Growing evidence suggests that increased cardiovascular disease (CVD) risk is associated with female infertility caused by conditions such as polycystic ovarian disease, obesity, thyroid dysfunction, and endometriosis. The aim of this study was to evaluate whether any relationship exists between CVD and unexplained infertility. Methods Sixty-five women with unexplained infertility and 65 fertile controls were enrolled in the study. CVD risk markers such as low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol (TC), triglycerides (TG), insulin resistance (defined by the homeostasis model assessment ratio), and high-sensitivity C-reactive protein (hs-CRP) were assessed. Results TG, TC, LDL, and hs-CRP levels were higher and HDL levels were lower in patients with unexplained infertility than in fertile controls (p<0.05 for all). Positive associations were found between unexplained infertility and TG, TC, LDL, and hs-CRP levels, and a negative correlation was found for HDL (p<0.05 for all). Multivariate logistic regression analysis showed that TG, HDL, and hs-CRP were independent variables associated with unexplained infertility. Conclusion Our study showed that women with unexplained infertility had an atherogenic lipid profile and elevated hs-CRP levels, suggesting a higher risk of developing CVD in the future. Further studies with larger groups are needed to investigate the nature of this link.
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Affiliation(s)
- Fatma Ferda Verit
- Department of Obstetrics and Gynecology, Suleymaniye Maternity, Research, and Training Hospital, Istanbul, Turkey
| | - Fadile Yildiz Zeyrek
- Department of Microbiology, Harran University Faculty of Medicine, Sanliurfa, Turkey
| | - Ali Galip Zebitay
- Department of Obstetrics and Gynecology, Suleymaniye Maternity, Research, and Training Hospital, Istanbul, Turkey
| | - Hurkan Akyol
- Department of Obstetrics and Gynecology, Suleymaniye Maternity, Research, and Training Hospital, Istanbul, Turkey
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106
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Cramer DW, Vitonis AF. Signatures of reproductive events on blood counts and biomarkers of inflammation: Implications for chronic disease risk. PLoS One 2017; 12:e0172530. [PMID: 28234958 PMCID: PMC5325665 DOI: 10.1371/journal.pone.0172530] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 02/06/2017] [Indexed: 11/24/2022] Open
Abstract
Whether inflammation mediates how reproductive events affect chronic-disease risk is unclear. We studied inflammatory biomarkers in the context of reproductive events using National Health and Nutrition Examination Survey (NHANES) data. From 15,986 eligible women from the 1999–2011 data cycles, we accessed information on reproductive events, blood counts, C-reactive protein (CRP), and total homocysteine (tHCY). We calculated blood-count ratios including: platelet-lymphocyte (PLR), lymphocyte-monocyte (LMR), platelet-monocyte (PMR), and neutrophil-monocyte (NMR). Using sampling weights per NHANES guidelines, means for counts, ratios, or biomarkers by reproductive events were compared using linear regression. We performed trend tests and calculated p-values with partial sum of squares F-tests. Higher PLR and lower LMR were associated with nulliparity. In postmenopausal women, lower PMR was associated with early age at first birth and higher NMR with later age at and shorter interval since last birth. Lower PNR and higher neutrophils and tHCY were associated with early natural menopause. In all women, the neutrophil count correlated positively with CRP; but, in premenopausal women, correlated inversely with tHCY. Reproductive events leave residual signatures on blood counts and inflammatory biomarkers that could underlie their links to chronic disease risk.
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Affiliation(s)
- Daniel W. Cramer
- Obstetrics and Gynecology Epidemiology Center, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Allison F. Vitonis
- Obstetrics and Gynecology Epidemiology Center, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
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107
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Peters SAE, Yang L, Guo Y, Chen Y, Bian Z, Millwood IY, Wang S, Yang L, Hu Y, Liu J, Wang T, Chen J, Peto R, Li L, Woodward M, Chen Z. Parenthood and the risk of cardiovascular diseases among 0.5 million men and women: findings from the China Kadoorie Biobank. Int J Epidemiol 2017; 46:180-189. [PMID: 27649806 PMCID: PMC5837253 DOI: 10.1093/ije/dyw144] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2016] [Indexed: 11/14/2022] Open
Abstract
Background Women's parity has been associated with risk of cardiovascular disease (CVD). It is unclear, however, whether it reflects biological effects of childbearing or uncontrolled socio-economic and lifestyle factors associated with childrearing. We assessed the association between number of children and incident CVD outcomes separately in women and men. Methods In 2004-08, the nationwide China Kadoorie Biobank recruited 0.5 million individuals aged 30-79 years from 10 diverse regions. During 7 years of follow-up, 24 432 incident cases of coronary heart disease (CHD) and 35 736 of stroke were recorded among 489 762 individuals without prior CVD. Multivariable Cox regression models were used to estimate sex-specific hazard ratios (HRs) and 95% confidence intervals (CIs) for CHD and stroke associated with number of children. Results Overall, 98% of all participants had children and the mean number of children declined progressively from four in older participants to one or two in younger participants. Compared with childless women, women with children had an increased risk of CHD, but not of stroke [HR (95% CI): 1.14 (1.00; 1.30) and 1.03 (0.92; 1.16)]. Corresponding results for men were 1.20 (1.06; 1.35) and 1.13 (1.03; 1.24), respectively. In individuals with children, there was a log-linear association between number of children and CVD outcomes; in women, each additional child was associated with adjusted HRs of 1.02 (1.01; 1.04) for CHD and 1.02 (1.01; 1.03) for stroke, similar in magnitude to that in men [1.03 (1.01; 1.04) for CHD and 1.02 (1.01; 1.03) for stroke]. Conclusion In Chinese adults, the association between the number of children and risk of CHD and stroke was similar between men and women, suggesting that factors associated with parenthood and childrearing are more likely to affect the risk of CVD outcomes than factors associated with childbearing.
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Affiliation(s)
- Sanne AE Peters
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Ling Yang
- Clinical Trials Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Yu Guo
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China
| | - Yiping Chen
- Clinical Trials Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China
| | - Iona Y Millwood
- Clinical Trials Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Shaojie Wang
- Qingdao CDC NCDs Prevention and Control Department, Qingdao, Shandong, China
| | - Liqiu Yang
- Nangang CDC, Haerbin, Heilongjiang, China
| | - Yihe Hu
- Suzhou CDC NCDs Prevention and Control Department, Suzhou, Jiangsu, China
| | | | - Tao Wang
- Maiji CDC, Tianshui, Gansu, China
| | - Junshi Chen
- China National Center for Food Safety Risk Assessment, Chaoyang District, Beijing, China
| | - Richard Peto
- Clinical Trials Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Liming Li
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China
- Department of Public Health, Beijing University, Beijing, China
| | - Mark Woodward
- The George Institute for Global Health, University of Oxford, Oxford, UK
- The George Institute for Global Health, University of Sydney, Australia and
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Zhengming Chen
- Clinical Trials Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
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Iacobaeus C, Andolf E, Thorsell M, Bremme K, Jörneskog G, Östlund E, Kahan T. Longitudinal study of vascular structure and function during normal pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:46-53. [PMID: 27731532 DOI: 10.1002/uog.17326] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 09/26/2016] [Accepted: 10/05/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To examine alterations in maternal vascular structure and function during normal pregnancy. METHODS We assessed brachial and central blood pressure, pulse-wave velocity and augmentation index (by pulse-wave analysis and applanation tonometry), common carotid artery structure (by ultrasonography) and endothelial function in the brachial artery (by postischemic hyperemia-induced flow-mediated vasodilatation by glyceryl trinitrate) and in the forearm skin microcirculation (by laser Doppler perfusion imaging during iontophoretic administration of acetylcholine and sodium nitroprusside) in 52 healthy nulliparous women at 14, 24 and 34 weeks' gestation, and at 9 months postpartum. RESULTS During pregnancy, brachial and central systolic and diastolic blood pressures initially decreased but subsequently increased (all P < 0.05). Flow-mediated vasodilatation in the brachial artery increased during early pregnancy (P < 0.05), whereas non-specific vasodilatation by glyceryl trinitrate decreased (P < 0.01), indicating improved endothelial function. Thus, endothelial function index (forearm blood flow/glyceryl trinitrate) increased during pregnancy (0.30 ± 0.18 in the non-pregnant state at 9 months postpartum and 0.51 ± 0.19, 0.61 ± 0.39 and 0.49 ± 0.30 in the first, second and third trimesters, respectively) (P < 0.001). Endothelium-dependent skin microvascular reactivity to acetylcholine also increased (P < 0.01). Carotid-femoral pulse-wave velocity decreased during pregnancy (5.88 ± 0.91 m/s in the non-pregnant state and 5.55 ± 0.67, 5.12 ± 0.66 and 5.62 ± 0.74 m/s in the first, second and third trimesters, respectively) (P < 0.001). CONCLUSION During normal pregnancy, the blood volume expansion necessary for sufficient fetal growth is accommodated by early and marked changes in the matvascular system. This seems to be dependent on normal adaptive endothelial and vascular function. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- C Iacobaeus
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Division of Obstetrics and Gynaecology, Stockholm, Sweden
| | - E Andolf
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Division of Obstetrics and Gynaecology, Stockholm, Sweden
| | - M Thorsell
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Division of Obstetrics and Gynaecology, Stockholm, Sweden
| | - K Bremme
- Department of Women's and Children's Health, Karolinska Institutet, Division of Obstetrics and Gynaecology, Stockholm, Sweden
| | - G Jörneskog
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Division of Cardiovascular Medicine, Stockholm, Sweden
| | - E Östlund
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Obstetrics/Gynaecology, Stockholm, Sweden
| | - T Kahan
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Division of Cardiovascular Medicine, Stockholm, Sweden
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Vladutiu CJ, Siega-Riz AM, Sotres-Alvarez D, Stuebe AM, Ni A, Tabb KM, Gallo LC, Potter JE, Heiss G. Parity and Components of the Metabolic Syndrome Among US Hispanic/Latina Women: Results From the Hispanic Community Health Study/Study of Latinos. CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES 2016; 9:S62-9. [PMID: 26908862 DOI: 10.1161/circoutcomes.115.002464] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Physiological adaptations occurring across successive pregnancies may increase the risk of adverse cardiovascular health outcomes in later life. METHODS AND RESULTS The association between parity and metabolic syndrome was examined among 7467 Hispanic/Latina women of diverse backgrounds, aged 18 to 74 years, who participated in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) from 2008 to 2011. Metabolic syndrome components were defined according to American Heart Association/National Heart, Lung, and Blood Institute criteria and included abdominal obesity, elevated triglycerides, low high-density lipoprotein cholesterol, high blood pressure, and elevated fasting glucose. Logistic regression models estimated odds ratios (ORs) adjusting for sociodemographic, behavioral, and reproductive characteristics. At HCHS/SOL baseline, women reported none (21.1%), 1 (19.9%), 2 (25.7%), 3 (18.6%), 4 (8.8%), and ≥ 5 (5.9%) live births. When compared with women with 1 birth, those with 4 births had the highest odds of abdominal obesity (OR, 2.0; 95% confidence interval, 1.5-2.8) and overall metabolic syndrome (OR, 1.4; 95% confidence interval, 1.0-2.0) and those with ≥ 5 births had the highest odds of low high-density lipoprotein cholesterol (OR, 1.5; 95% confidence interval, 1.2-2.0) and elevated fasting glucose (OR, 1.6; 95% confidence interval, 1.1-2.4), after adjusting for age, background, education, marital status, income, nativity, smoking, physical activity, menopause, oral contraceptive use, hormone therapy, and field center. Further adjustment for percent body fat attenuated these associations. No associations were observed between parity and elevated triglycerides or high blood pressure. CONCLUSIONS Higher parity is associated with an increased prevalence of selected components of the metabolic syndrome among Hispanic/Latina women in the US. High parity among Hispanics/Latinas with a high prevalence of abdominal obesity suggests high risk for metabolic dysregulation.
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Affiliation(s)
- Catherine J Vladutiu
- From the Department of Obstetrics and Gynecology, School of Medicine, (C.J.V., A.M.S.), Department of Epidemiology, Gillings School of Global Public Health (C.J.V., A.M.S.-R., G.H.), Department of Nutrition, Gillings School of Global Public Health (A.M.S.-R.), Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health (D.S.-A., A.N.), Department of Maternal and Child Health, Gillings School of Global Public Health (A.M.S.), University of North Carolina, Chapel Hill; School of Social Work, University of Illinois at Urbana-Champaign (K.M.T.); Department of Psychology, San Diego State University, CA (L.C.G.); and Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, FL (J.E.P.).
| | - Anna Maria Siega-Riz
- From the Department of Obstetrics and Gynecology, School of Medicine, (C.J.V., A.M.S.), Department of Epidemiology, Gillings School of Global Public Health (C.J.V., A.M.S.-R., G.H.), Department of Nutrition, Gillings School of Global Public Health (A.M.S.-R.), Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health (D.S.-A., A.N.), Department of Maternal and Child Health, Gillings School of Global Public Health (A.M.S.), University of North Carolina, Chapel Hill; School of Social Work, University of Illinois at Urbana-Champaign (K.M.T.); Department of Psychology, San Diego State University, CA (L.C.G.); and Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, FL (J.E.P.)
| | - Daniela Sotres-Alvarez
- From the Department of Obstetrics and Gynecology, School of Medicine, (C.J.V., A.M.S.), Department of Epidemiology, Gillings School of Global Public Health (C.J.V., A.M.S.-R., G.H.), Department of Nutrition, Gillings School of Global Public Health (A.M.S.-R.), Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health (D.S.-A., A.N.), Department of Maternal and Child Health, Gillings School of Global Public Health (A.M.S.), University of North Carolina, Chapel Hill; School of Social Work, University of Illinois at Urbana-Champaign (K.M.T.); Department of Psychology, San Diego State University, CA (L.C.G.); and Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, FL (J.E.P.)
| | - Alison M Stuebe
- From the Department of Obstetrics and Gynecology, School of Medicine, (C.J.V., A.M.S.), Department of Epidemiology, Gillings School of Global Public Health (C.J.V., A.M.S.-R., G.H.), Department of Nutrition, Gillings School of Global Public Health (A.M.S.-R.), Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health (D.S.-A., A.N.), Department of Maternal and Child Health, Gillings School of Global Public Health (A.M.S.), University of North Carolina, Chapel Hill; School of Social Work, University of Illinois at Urbana-Champaign (K.M.T.); Department of Psychology, San Diego State University, CA (L.C.G.); and Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, FL (J.E.P.)
| | - Andy Ni
- From the Department of Obstetrics and Gynecology, School of Medicine, (C.J.V., A.M.S.), Department of Epidemiology, Gillings School of Global Public Health (C.J.V., A.M.S.-R., G.H.), Department of Nutrition, Gillings School of Global Public Health (A.M.S.-R.), Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health (D.S.-A., A.N.), Department of Maternal and Child Health, Gillings School of Global Public Health (A.M.S.), University of North Carolina, Chapel Hill; School of Social Work, University of Illinois at Urbana-Champaign (K.M.T.); Department of Psychology, San Diego State University, CA (L.C.G.); and Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, FL (J.E.P.)
| | - Karen M Tabb
- From the Department of Obstetrics and Gynecology, School of Medicine, (C.J.V., A.M.S.), Department of Epidemiology, Gillings School of Global Public Health (C.J.V., A.M.S.-R., G.H.), Department of Nutrition, Gillings School of Global Public Health (A.M.S.-R.), Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health (D.S.-A., A.N.), Department of Maternal and Child Health, Gillings School of Global Public Health (A.M.S.), University of North Carolina, Chapel Hill; School of Social Work, University of Illinois at Urbana-Champaign (K.M.T.); Department of Psychology, San Diego State University, CA (L.C.G.); and Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, FL (J.E.P.)
| | - Linda C Gallo
- From the Department of Obstetrics and Gynecology, School of Medicine, (C.J.V., A.M.S.), Department of Epidemiology, Gillings School of Global Public Health (C.J.V., A.M.S.-R., G.H.), Department of Nutrition, Gillings School of Global Public Health (A.M.S.-R.), Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health (D.S.-A., A.N.), Department of Maternal and Child Health, Gillings School of Global Public Health (A.M.S.), University of North Carolina, Chapel Hill; School of Social Work, University of Illinois at Urbana-Champaign (K.M.T.); Department of Psychology, San Diego State University, CA (L.C.G.); and Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, FL (J.E.P.)
| | - JoNell E Potter
- From the Department of Obstetrics and Gynecology, School of Medicine, (C.J.V., A.M.S.), Department of Epidemiology, Gillings School of Global Public Health (C.J.V., A.M.S.-R., G.H.), Department of Nutrition, Gillings School of Global Public Health (A.M.S.-R.), Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health (D.S.-A., A.N.), Department of Maternal and Child Health, Gillings School of Global Public Health (A.M.S.), University of North Carolina, Chapel Hill; School of Social Work, University of Illinois at Urbana-Champaign (K.M.T.); Department of Psychology, San Diego State University, CA (L.C.G.); and Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, FL (J.E.P.)
| | - Gerardo Heiss
- From the Department of Obstetrics and Gynecology, School of Medicine, (C.J.V., A.M.S.), Department of Epidemiology, Gillings School of Global Public Health (C.J.V., A.M.S.-R., G.H.), Department of Nutrition, Gillings School of Global Public Health (A.M.S.-R.), Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health (D.S.-A., A.N.), Department of Maternal and Child Health, Gillings School of Global Public Health (A.M.S.), University of North Carolina, Chapel Hill; School of Social Work, University of Illinois at Urbana-Champaign (K.M.T.); Department of Psychology, San Diego State University, CA (L.C.G.); and Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, FL (J.E.P.)
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110
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Wang Q, Würtz P, Auro K, Mäkinen VP, Kangas AJ, Soininen P, Tiainen M, Tynkkynen T, Jokelainen J, Santalahti K, Salmi M, Blankenberg S, Zeller T, Viikari J, Kähönen M, Lehtimäki T, Salomaa V, Perola M, Jalkanen S, Järvelin MR, Raitakari OT, Kettunen J, Lawlor DA, Ala-Korpela M. Metabolic profiling of pregnancy: cross-sectional and longitudinal evidence. BMC Med 2016; 14:205. [PMID: 27955712 PMCID: PMC5153817 DOI: 10.1186/s12916-016-0733-0] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 10/31/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pregnancy triggers well-known alterations in maternal glucose and lipid balance but its overall effects on systemic metabolism remain incompletely understood. METHODS Detailed molecular profiles (87 metabolic measures and 37 cytokines) were measured for up to 4260 women (24-49 years, 322 pregnant) from three population-based cohorts in Finland. Circulating molecular concentrations in pregnant women were compared to those in non-pregnant women. Metabolic profiles were also reassessed for 583 women 6 years later to uncover the longitudinal metabolic changes in response to change in the pregnancy status. RESULTS Compared to non-pregnant women, all lipoprotein subclasses and lipids were markedly increased in pregnant women. The most pronounced differences were observed for the intermediate-density, low-density and high-density lipoprotein triglyceride concentrations. Large differences were also seen for many fatty acids and amino acids. Pregnant women also had higher concentrations of low-grade inflammatory marker glycoprotein acetyls, higher concentrations of interleukin-18 and lower concentrations of interleukin-12p70. The changes in metabolic concentrations for women who were not pregnant at baseline but pregnant 6 years later (or vice versa) matched (or were mirror-images of) the cross-sectional association pattern. Cross-sectional results were consistent across the three cohorts and similar longitudinal changes were seen for 653 women in 4-year and 497 women in 10-year follow-up. For multiple metabolic measures, the changes increased in magnitude across the three trimesters. CONCLUSIONS Pregnancy initiates substantial metabolic and inflammatory changes in the mothers. Comprehensive characterisation of normal pregnancy is important for gaining understanding of the key nutrients for fetal growth and development. These findings also provide a valuable molecular reference in relation to studies of adverse pregnancy outcomes.
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Affiliation(s)
- Qin Wang
- Computational Medicine, Faculty of Medicine, University of Oulu and Biocenter Oulu, Oulu, Finland
- NMR Metabolomics Laboratory, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Peter Würtz
- Computational Medicine, Faculty of Medicine, University of Oulu and Biocenter Oulu, Oulu, Finland
| | - Kirsi Auro
- National Institute for Health and Welfare, Helsinki, Finland
- Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Ville-Petteri Mäkinen
- Computational Medicine, Faculty of Medicine, University of Oulu and Biocenter Oulu, Oulu, Finland
- Heart Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
- School of Biological Sciences, University of Adelaide, Adelaide, Australia
| | - Antti J. Kangas
- Computational Medicine, Faculty of Medicine, University of Oulu and Biocenter Oulu, Oulu, Finland
| | - Pasi Soininen
- Computational Medicine, Faculty of Medicine, University of Oulu and Biocenter Oulu, Oulu, Finland
- NMR Metabolomics Laboratory, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Mika Tiainen
- Computational Medicine, Faculty of Medicine, University of Oulu and Biocenter Oulu, Oulu, Finland
- NMR Metabolomics Laboratory, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Tuulia Tynkkynen
- Computational Medicine, Faculty of Medicine, University of Oulu and Biocenter Oulu, Oulu, Finland
- NMR Metabolomics Laboratory, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Jari Jokelainen
- Center for Life Course Health Research and Biocenter Oulu, University of Oulu, Oulu, Finland
- Unit of Primary Care, Oulu University Hospital, Oulu, Finland
| | - Kristiina Santalahti
- Department of Medical Microbiology and Immunology, and MediCity Research Laboratory, University of Turku, Turku, Finland
| | - Marko Salmi
- Department of Medical Microbiology and Immunology, and MediCity Research Laboratory, University of Turku, Turku, Finland
| | - Stefan Blankenberg
- Clinic for General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK e.V.), partner site Hamburg, Lübeck, Kiel Germany
| | - Tanja Zeller
- Clinic for General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK e.V.), partner site Hamburg, Lübeck, Kiel Germany
| | - Jorma Viikari
- Department of Medicine, University of Turku, Turku, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
| | - Mika Kähönen
- Department of Clinical Physiology, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories, School of Medicine, University of Tampere, Tampere, Finland
| | - Veikko Salomaa
- National Institute for Health and Welfare, Helsinki, Finland
| | - Markus Perola
- National Institute for Health and Welfare, Helsinki, Finland
- Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland
- Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - Sirpa Jalkanen
- Department of Medical Microbiology and Immunology, and MediCity Research Laboratory, University of Turku, Turku, Finland
| | - Marjo-Riitta Järvelin
- Center for Life Course Health Research and Biocenter Oulu, University of Oulu, Oulu, Finland
- Unit of Primary Care, Oulu University Hospital, Oulu, Finland
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Olli T. Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Johannes Kettunen
- Computational Medicine, Faculty of Medicine, University of Oulu and Biocenter Oulu, Oulu, Finland
- NMR Metabolomics Laboratory, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
- National Institute for Health and Welfare, Helsinki, Finland
| | - Debbie A. Lawlor
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Mika Ala-Korpela
- Computational Medicine, Faculty of Medicine, University of Oulu and Biocenter Oulu, Oulu, Finland
- NMR Metabolomics Laboratory, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Vladutiu CJ, Meyer ML, Malek AM, Stuebe AM, Mosher A, Aggarwal S, Kleindorfer D, Howard VJ. Racial Differences in the Association between Parity and Incident Stroke: Results from the REasons for Geographic and Racial Differences in Stroke Study. J Stroke Cerebrovasc Dis 2016; 26:749-755. [PMID: 27839767 DOI: 10.1016/j.jstrokecerebrovasdis.2016.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 08/03/2016] [Accepted: 10/11/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Circulatory and vascular changes across consecutive pregnancies may increase the risk of later-life cerebrovascular health outcomes. METHODS The association between parity and incident stroke was assessed among 7674 white and 6280 black women, aged 45 years and older, and enrolled in the REasons for Geographic and Racial Differences in Stroke Study from 2003 to 2007. Parity was assessed at baseline, and incident stroke was ascertained from physician-adjudicated medical records through September 2014. Cox proportional hazards models were used to estimate hazard ratios (HR) for the association between parity and stroke, adjusting for baseline measures. RESULTS At baseline, 12.7% of white women and 16.2% of black women reported 1 live birth, while 8.2% and 19.0%, respectively, reported 5 or more live births. Mean follow-up time was 7.5 years (standard deviation = 2.8); there were 447 incident strokes. A significant interaction between race and parity was detected (P = .05). Among white women, those with 5 or more live births had a higher stroke risk than those with 1 live birth (HR = 1.57; 95% confidence interval [CI] .93-2.65). However, the association was eliminated after adjustment for baseline characteristics (HR = 1.00, 95% CI .59-1.71). For black women, those with 5 or more live births had the highest stroke risk compared with those with 1 live birth (HR = 1.91, 95% CI 1.25-2.93), but the association was attenuated and no longer statistically significant after adjustment for confounders (HR = 1.40, 95% CI .89-2.18). CONCLUSIONS In adjusted models, no statistically significantassociations were observed between parity and stroke risk in a diverse cohort of U.S. women. Further studies are needed to elucidate the role of lifestyle and psychosocial factors in the race-specific associations that were observed.
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Affiliation(s)
- Catherine J Vladutiu
- Department of Epidemiology, Gillings School of Global Public Health, UNC, Chapel Hill, North Carolina; Department of Obstetrics & Gynecology, UNC School of Medicine, Chapel Hill, North Carolina.
| | - Michelle L Meyer
- Department of Epidemiology, Gillings School of Global Public Health, UNC, Chapel Hill, North Carolina
| | - Angela M Malek
- Department of Public Health Sciences, MUSC, Charleston, South Carolina
| | - Alison M Stuebe
- Department of Obstetrics & Gynecology, UNC School of Medicine, Chapel Hill, North Carolina; Department of Maternal and Child Health, Gillings School of Global Public Health, UNC, Chapel Hill, North Carolina
| | - Aleena Mosher
- Department of Biostatistics, UAB School of Public Health, Birmingham, Alabama
| | - Shivani Aggarwal
- Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Dawn Kleindorfer
- Department of Neurology, University of Cincinnati, Cincinnati, Ohio
| | - Virginia J Howard
- Department of Epidemiology, UAB School of Public Health, Birmingham, Alabama
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Peters SA, van der Schouw YT, Wood AM, Sweeting MJ, Moons KG, Weiderpass E, Arriola L, Benetou V, Boeing H, Bonnet F, Butt ST, Clavel-Chapelon F, Drake I, Gavrila D, Key TJ, Klinaki E, Krogh V, Kühn T, Lassale C, Masala G, Matullo G, Merritt M, Molina-Portillo E, Moreno-Iribas C, Nøst TH, Olsen A, Onland-Moret NC, Overvad K, Panico S, Redondo ML, Tjønneland A, Trichopoulou A, Tumino R, Turzanski-Fortner R, Tzoulaki I, Wennberg P, Winkvist A, Thompson SG, Di Angelantonio E, Riboli E, Wareham NJ, Danesh J, Butterworth AS. Parity, breastfeeding and risk of coronary heart disease: A pan-European case-cohort study. Eur J Prev Cardiol 2016; 23:1755-1765. [PMID: 27378766 PMCID: PMC6217919 DOI: 10.1177/2047487316658571] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 06/15/2016] [Indexed: 01/12/2023]
Abstract
OBJECTIVE There is uncertainty about the direction and magnitude of the associations between parity, breastfeeding and the risk of coronary heart disease (CHD). We examined the separate and combined associations of parity and breastfeeding practices with the incidence of CHD later in life among women in a large, pan-European cohort study. METHODS Data were used from European Prospective Investigation into Cancer and Nutrition (EPIC)-CVD, a case-cohort study nested within the EPIC prospective study of 520,000 participants from 10 countries. Information on reproductive history was available for 14,917 women, including 5138 incident cases of CHD. Using Prentice-weighted Cox regression separately for each country followed by a random-effects meta-analysis, we calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for CHD, after adjustment for age, study centre and several socioeconomic and biological risk factors. RESULTS Compared with nulliparous women, the adjusted HR was 1.19 (95% CI: 1.01-1.41) among parous women; HRs were higher among women with more children (e.g., adjusted HR: 1.95 (95% CI: 1.19-3.20) for women with five or more children). Compared with women who did not breastfeed, the adjusted HR was 0.71 (95% CI: 0.52-0.98) among women who breastfed. For childbearing women who never breastfed, the adjusted HR was 1.58 (95% CI: 1.09-2.30) compared with nulliparous women, whereas for childbearing women who breastfed, the adjusted HR was 1.19 (95% CI: 0.99-1.43). CONCLUSION Having more children was associated with a higher risk of CHD later in life, whereas breastfeeding was associated with a lower CHD risk. Women who both had children and breastfed did have a non-significantly higher risk of CHD.
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Affiliation(s)
- Sanne Ae Peters
- The George Institute for Global Health, University of Oxford, Oxford, UK Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Angela M Wood
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK The National Institute for Health Research Blood and Transplant Unit (NIHR BTRU) in Donor Health and Genomics at the University of Cambridge, UK
| | - Michael J Sweeting
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK
| | - Karel Gm Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Elisabete Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
| | - Larraitz Arriola
- Public Health Division of Gipuzkoa, Instituto Bio-Donostia, Basque Government, CIBERESP, Spain
| | - Vassiliki Benetou
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece Hellenic Health Foundation, Athens, Greece
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition (DIfE), Potsdam-Rehbrücke, Germany
| | - Fabrice Bonnet
- Centre Hospitalier Universitaire Rennes, University of Rennes, Villejuif, France
| | - Salma T Butt
- Department of Surgery, Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Françoise Clavel-Chapelon
- INSERM, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones, and Women's Health Team, Institut Gustave Roussy, Villejuif, France
| | - Isabel Drake
- Department of Clinical Science, Lund University, Malmö, Sweden
| | - Diana Gavrila
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Timothy J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
| | | | - Vittorio Krogh
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Tilman Kühn
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany
| | - Camille Lassale
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Giovanna Masala
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy
| | - Giuseppe Matullo
- Human Genetics Foundation, Turin, Italy Department of Medical Sciences, University of Turin, Italy
| | - Melissa Merritt
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Elena Molina-Portillo
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - Conchi Moreno-Iribas
- Public Health Institute of Navarra, Pamplona, Spain Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Madrid, Spain
| | - Therese H Nøst
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Anja Olsen
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - N Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kim Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Salvatore Panico
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
| | | | - Anne Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Antonia Trichopoulou
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece Hellenic Health Foundation, Athens, Greece
| | - Rosario Tumino
- Cancer Registry and Histopathology Unit, Civic - M.P. Arezzo Hospital, ASP Ragusa, Italy
| | | | - Ioanna Tzoulaki
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Patrik Wennberg
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Anna Winkvist
- Nutritional Research, Umeå University, Umeå, Sweden Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Simon G Thompson
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK The National Institute for Health Research Blood and Transplant Unit (NIHR BTRU) in Donor Health and Genomics at the University of Cambridge, UK
| | - Emanuele Di Angelantonio
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Nicholas J Wareham
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - John Danesh
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK The National Institute for Health Research Blood and Transplant Unit (NIHR BTRU) in Donor Health and Genomics at the University of Cambridge, UK Wellcome Trust Sanger Institute, Genome Campus, Hinxton, UK
| | - Adam S Butterworth
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK The National Institute for Health Research Blood and Transplant Unit (NIHR BTRU) in Donor Health and Genomics at the University of Cambridge, UK
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Parity, coronary heart disease and mortality in the old order Amish. Atherosclerosis 2016; 254:14-19. [PMID: 27680773 DOI: 10.1016/j.atherosclerosis.2016.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 08/18/2016] [Accepted: 09/07/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS Prior data on the association between parity and mortality are limited by the presence of sociodemographic confounders including cultural norms of parity. Our objective was to determine the association between parity and mortality in the Amish, a socioeconomically homogenous group with large numbers of children per family. METHODS We conducted a population-based cohort study among 518 Old Order Amish women enrolled in a cardiovascular awareness program. The mean length of follow-up for mortality was 13.52 years. We determined the adjusted associations between parity and obesity, prevalent coronary heart disease and mortality. RESULTS The mean number of total births per woman was 6.7 ± 3.6 with a mode of 8. No significant association was observed between parity and all-cause mortality when adjusted for age (HR 1.00 per additional birth; 95% CI 0.96-1.05; p = 0.85) or in multivariate analysis (HR 1.00, 95% CI 0.95-1.05; p = 0.95). There was also no association of parity in age- or multivariable adjusted models with prevalent diabetes, hypertension or coronary heart disease. Despite the lack of effect of parity on mortality, a significant association of ten or more births was observed with higher body mass index (BMI) compared to the referent group of 8-9 total births. CONCLUSIONS In a highly homogeneous population with high rates of parity, no association between overall mortality and parity was observed. Ten or more births were significantly associated with a higher BMI but not with overall mortality.
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Sjöberg L, He L, Kaaja R, Tuomilehto J, Pitkäniemi J. Parity and mortality in cases of childhood-onset diabetes mellitus. Diabetes Metab Res Rev 2016; 32:607-14. [PMID: 26787459 DOI: 10.1002/dmrr.2778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 12/29/2015] [Indexed: 11/09/2022]
Abstract
AIMS This study aims to assess the association between parity and mortality in adults with childhood-onset type 1 diabetes (T1D) and their matched controls. METHODS Individual data (308 617 person-years) on mortality and the reproductive histories of a Finnish cohort of 2307 women and 2819 men with T1D, each with two matched controls, were obtained from the National Population Register. All persons with diabetes had been diagnosed with T1D in 1965-1979 at the age of 17 or under. RESULTS All-cause mortality in people without offspring was significantly higher than that in people with children among both people with diabetes and non-diabetic control persons in both sexes (all p-values <0.01). In men with offspring, the decrease of mortality rate compared with men without offspring was less marked among those with diabetes (9% reduction in mortality hazard ratio (HR) with one offspring, 47% with two) than among those without diabetes (33% HR (p = 0.025) and 61% HR (p = 0.023) reduction, respectively). In women with offspring, the association between parity and mortality was independent of diabetes status. Having at least two offspring was associated with a decreased hazard of diabetes-related death regardless of sex; among women with diabetes, even having one offspring was associated with a decreased hazard of dying from diabetes (HR = 0.46; 95% CI 0.31, 0.69). CONCLUSIONS The association between parity and mortality follows different patterns in men and women with T1D. To what extent this reflects effects of health on family planning decisions in people with T1D cannot be defined without further studies. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- L Sjöberg
- University of Helsinki, Department of Public Health, Helsinki, Finland
- University of Helsinki, Department of General Practice and Primary Health Care, Helsinki, Finland
- National Institute of Health and Welfare, Department of Chronic Disease Prevention, Diabetes Prevention Unit, Helsinki, Finland
| | - L He
- University of Helsinki, Department of Public Health, Helsinki, Finland
| | - R Kaaja
- University Hospital of Turku and University of Turku, Turku, Finland
| | - J Tuomilehto
- University of Helsinki, Department of Public Health, Helsinki, Finland
- Centre for Vascular Prevention, Danube-University Krems, Krems, Austria
- Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - J Pitkäniemi
- University of Helsinki, Department of Public Health, Helsinki, Finland
- Finnish Cancer Registry, Helsinki, Finland
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Abstract
OBJECTIVE Several studies have reported the detrimental effects on maternal health due to pregnancy during adolescence, but no studies have reported the influence of adolescent pregnancy on blood pressure in women's later life. METHOD We investigated whether there was an association between adolescent pregnancy and the risk of hypertension in Korean postmenopausal women. This study used the data of 2538 postmenopausal women from the Korean National Health and Nutrition Examination Survey in 2010-2011. Multivariate logistic regression analyses were used to evaluate the independent association between adolescent pregnancy and hypertension by adjusting for potential confounding factors. RESULTS Postmenopausal women with a history of adolescent pregnancy had a higher prevalence of hypertension than those without a history of adolescent pregnancy. After fully adjusting for potential confounding factors such as age, lifestyle, sociodemographic factors, known hypertension risk factors, and reproductive factors, a history of adolescent pregnancy was significantly associated with hypertension (odds ratio, 1.702; 95% confidence interval, 1.125-2.574). CONCLUSION This study showed that a history of adolescent pregnancy is significantly and independently associated with a higher risk of hypertension in postmenopausal women.
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116
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Parikh NI, Jeppson RP, Berger JS, Eaton CB, Kroenke CH, LeBlanc ES, Lewis CE, Loucks EB, Parker DR, Rillamas-Sun E, Ryckman KK, Waring ME, Schenken RS, Johnson KC, Edstedt-Bonamy AK, Allison MA, Howard BV. Reproductive Risk Factors and Coronary Heart Disease in the Women's Health Initiative Observational Study. Circulation 2016; 133:2149-58. [PMID: 27143682 PMCID: PMC4889516 DOI: 10.1161/circulationaha.115.017854] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 03/30/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Reproductive factors provide an early window into a woman's coronary heart disease (CHD) risk; however, their contribution to CHD risk stratification is uncertain. METHODS AND RESULTS In the Women's Health Initiative Observational Study, we constructed Cox proportional hazards models for CHD including age, pregnancy status, number of live births, age at menarche, menstrual irregularity, age at first birth, stillbirths, miscarriages, infertility ≥1 year, infertility cause, and breastfeeding. We next added each candidate reproductive factor to an established CHD risk factor model. A final model was then constructed with significant reproductive factors added to established CHD risk factors. Improvement in C statistic, net reclassification index (or net reclassification index with risk categories of <5%, 5 to <10%, and ≥10% 10-year risk of CHD), and integrated discriminatory index were assessed. Among 72 982 women (CHD events, n=4607; median follow-up,12.0 [interquartile range, 8.3-13.7] years; mean [standard deviation] age, 63.2 [7.2] years), an age-adjusted reproductive risk factor model had a C statistic of 0.675 for CHD. In a model adjusted for established CHD risk factors, younger age at first birth, number of still births, number of miscarriages, and lack of breastfeeding were positively associated with CHD. Reproductive factors modestly improved model discrimination (C statistic increased from 0.726 to 0.730; integrated discriminatory index, 0.0013; P<0.0001). Net reclassification for women with events was not improved (net reclassification index events, 0.007; P=0.18); and, for women without events, net reclassification was marginally improved (net reclassification index nonevents, 0.002; P=0.04) CONCLUSIONS: Key reproductive factors are associated with CHD independently of established CHD risk factors, very modestly improve model discrimination, and do not materially improve net reclassification.
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Affiliation(s)
- Nisha I Parikh
- From Division of Cardiology, University of California San Francisco (N.I.P.); Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.J., K.K.R.); Cardiology, Hematology, Vascular Surgery, NYU School of Medicine, New York (J.S.B.); Departments of Family Medicine and Epidemiology, Brown University, Providence, RI (C.B.E., D.R.P.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Kaiser Permanente Center for Health Research, Portland, OR (E.S.L.); University of Alabama at Birmingham (C.E.L.); Department of Epidemiology, Brown University School of Public Health, Providence, RI (E.B.L.); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (D.R.P.); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (E.R.-S.); Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.E.W.); Department of Obstetrics and Gynecology, The University of Texas Health Science Center, San Antonio (R.S.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Unit for Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden (A.-K.E.-B.); Department of Family Medicine, USCD, La Jolla, CA (M.A.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); and Georgetown University Center for Clinical and Translational Science, Washington, DC (B.V.H.).
| | - Rebecca P Jeppson
- From Division of Cardiology, University of California San Francisco (N.I.P.); Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.J., K.K.R.); Cardiology, Hematology, Vascular Surgery, NYU School of Medicine, New York (J.S.B.); Departments of Family Medicine and Epidemiology, Brown University, Providence, RI (C.B.E., D.R.P.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Kaiser Permanente Center for Health Research, Portland, OR (E.S.L.); University of Alabama at Birmingham (C.E.L.); Department of Epidemiology, Brown University School of Public Health, Providence, RI (E.B.L.); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (D.R.P.); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (E.R.-S.); Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.E.W.); Department of Obstetrics and Gynecology, The University of Texas Health Science Center, San Antonio (R.S.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Unit for Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden (A.-K.E.-B.); Department of Family Medicine, USCD, La Jolla, CA (M.A.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); and Georgetown University Center for Clinical and Translational Science, Washington, DC (B.V.H.)
| | - Jeffrey S Berger
- From Division of Cardiology, University of California San Francisco (N.I.P.); Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.J., K.K.R.); Cardiology, Hematology, Vascular Surgery, NYU School of Medicine, New York (J.S.B.); Departments of Family Medicine and Epidemiology, Brown University, Providence, RI (C.B.E., D.R.P.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Kaiser Permanente Center for Health Research, Portland, OR (E.S.L.); University of Alabama at Birmingham (C.E.L.); Department of Epidemiology, Brown University School of Public Health, Providence, RI (E.B.L.); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (D.R.P.); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (E.R.-S.); Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.E.W.); Department of Obstetrics and Gynecology, The University of Texas Health Science Center, San Antonio (R.S.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Unit for Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden (A.-K.E.-B.); Department of Family Medicine, USCD, La Jolla, CA (M.A.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); and Georgetown University Center for Clinical and Translational Science, Washington, DC (B.V.H.)
| | - Charles B Eaton
- From Division of Cardiology, University of California San Francisco (N.I.P.); Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.J., K.K.R.); Cardiology, Hematology, Vascular Surgery, NYU School of Medicine, New York (J.S.B.); Departments of Family Medicine and Epidemiology, Brown University, Providence, RI (C.B.E., D.R.P.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Kaiser Permanente Center for Health Research, Portland, OR (E.S.L.); University of Alabama at Birmingham (C.E.L.); Department of Epidemiology, Brown University School of Public Health, Providence, RI (E.B.L.); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (D.R.P.); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (E.R.-S.); Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.E.W.); Department of Obstetrics and Gynecology, The University of Texas Health Science Center, San Antonio (R.S.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Unit for Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden (A.-K.E.-B.); Department of Family Medicine, USCD, La Jolla, CA (M.A.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); and Georgetown University Center for Clinical and Translational Science, Washington, DC (B.V.H.)
| | - Candyce H Kroenke
- From Division of Cardiology, University of California San Francisco (N.I.P.); Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.J., K.K.R.); Cardiology, Hematology, Vascular Surgery, NYU School of Medicine, New York (J.S.B.); Departments of Family Medicine and Epidemiology, Brown University, Providence, RI (C.B.E., D.R.P.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Kaiser Permanente Center for Health Research, Portland, OR (E.S.L.); University of Alabama at Birmingham (C.E.L.); Department of Epidemiology, Brown University School of Public Health, Providence, RI (E.B.L.); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (D.R.P.); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (E.R.-S.); Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.E.W.); Department of Obstetrics and Gynecology, The University of Texas Health Science Center, San Antonio (R.S.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Unit for Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden (A.-K.E.-B.); Department of Family Medicine, USCD, La Jolla, CA (M.A.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); and Georgetown University Center for Clinical and Translational Science, Washington, DC (B.V.H.)
| | - Erin S LeBlanc
- From Division of Cardiology, University of California San Francisco (N.I.P.); Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.J., K.K.R.); Cardiology, Hematology, Vascular Surgery, NYU School of Medicine, New York (J.S.B.); Departments of Family Medicine and Epidemiology, Brown University, Providence, RI (C.B.E., D.R.P.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Kaiser Permanente Center for Health Research, Portland, OR (E.S.L.); University of Alabama at Birmingham (C.E.L.); Department of Epidemiology, Brown University School of Public Health, Providence, RI (E.B.L.); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (D.R.P.); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (E.R.-S.); Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.E.W.); Department of Obstetrics and Gynecology, The University of Texas Health Science Center, San Antonio (R.S.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Unit for Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden (A.-K.E.-B.); Department of Family Medicine, USCD, La Jolla, CA (M.A.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); and Georgetown University Center for Clinical and Translational Science, Washington, DC (B.V.H.)
| | - Cora E Lewis
- From Division of Cardiology, University of California San Francisco (N.I.P.); Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.J., K.K.R.); Cardiology, Hematology, Vascular Surgery, NYU School of Medicine, New York (J.S.B.); Departments of Family Medicine and Epidemiology, Brown University, Providence, RI (C.B.E., D.R.P.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Kaiser Permanente Center for Health Research, Portland, OR (E.S.L.); University of Alabama at Birmingham (C.E.L.); Department of Epidemiology, Brown University School of Public Health, Providence, RI (E.B.L.); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (D.R.P.); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (E.R.-S.); Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.E.W.); Department of Obstetrics and Gynecology, The University of Texas Health Science Center, San Antonio (R.S.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Unit for Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden (A.-K.E.-B.); Department of Family Medicine, USCD, La Jolla, CA (M.A.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); and Georgetown University Center for Clinical and Translational Science, Washington, DC (B.V.H.)
| | - Eric B Loucks
- From Division of Cardiology, University of California San Francisco (N.I.P.); Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.J., K.K.R.); Cardiology, Hematology, Vascular Surgery, NYU School of Medicine, New York (J.S.B.); Departments of Family Medicine and Epidemiology, Brown University, Providence, RI (C.B.E., D.R.P.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Kaiser Permanente Center for Health Research, Portland, OR (E.S.L.); University of Alabama at Birmingham (C.E.L.); Department of Epidemiology, Brown University School of Public Health, Providence, RI (E.B.L.); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (D.R.P.); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (E.R.-S.); Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.E.W.); Department of Obstetrics and Gynecology, The University of Texas Health Science Center, San Antonio (R.S.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Unit for Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden (A.-K.E.-B.); Department of Family Medicine, USCD, La Jolla, CA (M.A.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); and Georgetown University Center for Clinical and Translational Science, Washington, DC (B.V.H.)
| | - Donna R Parker
- From Division of Cardiology, University of California San Francisco (N.I.P.); Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.J., K.K.R.); Cardiology, Hematology, Vascular Surgery, NYU School of Medicine, New York (J.S.B.); Departments of Family Medicine and Epidemiology, Brown University, Providence, RI (C.B.E., D.R.P.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Kaiser Permanente Center for Health Research, Portland, OR (E.S.L.); University of Alabama at Birmingham (C.E.L.); Department of Epidemiology, Brown University School of Public Health, Providence, RI (E.B.L.); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (D.R.P.); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (E.R.-S.); Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.E.W.); Department of Obstetrics and Gynecology, The University of Texas Health Science Center, San Antonio (R.S.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Unit for Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden (A.-K.E.-B.); Department of Family Medicine, USCD, La Jolla, CA (M.A.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); and Georgetown University Center for Clinical and Translational Science, Washington, DC (B.V.H.)
| | - Eileen Rillamas-Sun
- From Division of Cardiology, University of California San Francisco (N.I.P.); Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.J., K.K.R.); Cardiology, Hematology, Vascular Surgery, NYU School of Medicine, New York (J.S.B.); Departments of Family Medicine and Epidemiology, Brown University, Providence, RI (C.B.E., D.R.P.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Kaiser Permanente Center for Health Research, Portland, OR (E.S.L.); University of Alabama at Birmingham (C.E.L.); Department of Epidemiology, Brown University School of Public Health, Providence, RI (E.B.L.); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (D.R.P.); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (E.R.-S.); Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.E.W.); Department of Obstetrics and Gynecology, The University of Texas Health Science Center, San Antonio (R.S.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Unit for Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden (A.-K.E.-B.); Department of Family Medicine, USCD, La Jolla, CA (M.A.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); and Georgetown University Center for Clinical and Translational Science, Washington, DC (B.V.H.)
| | - Kelli K Ryckman
- From Division of Cardiology, University of California San Francisco (N.I.P.); Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.J., K.K.R.); Cardiology, Hematology, Vascular Surgery, NYU School of Medicine, New York (J.S.B.); Departments of Family Medicine and Epidemiology, Brown University, Providence, RI (C.B.E., D.R.P.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Kaiser Permanente Center for Health Research, Portland, OR (E.S.L.); University of Alabama at Birmingham (C.E.L.); Department of Epidemiology, Brown University School of Public Health, Providence, RI (E.B.L.); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (D.R.P.); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (E.R.-S.); Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.E.W.); Department of Obstetrics and Gynecology, The University of Texas Health Science Center, San Antonio (R.S.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Unit for Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden (A.-K.E.-B.); Department of Family Medicine, USCD, La Jolla, CA (M.A.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); and Georgetown University Center for Clinical and Translational Science, Washington, DC (B.V.H.)
| | - Molly E Waring
- From Division of Cardiology, University of California San Francisco (N.I.P.); Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.J., K.K.R.); Cardiology, Hematology, Vascular Surgery, NYU School of Medicine, New York (J.S.B.); Departments of Family Medicine and Epidemiology, Brown University, Providence, RI (C.B.E., D.R.P.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Kaiser Permanente Center for Health Research, Portland, OR (E.S.L.); University of Alabama at Birmingham (C.E.L.); Department of Epidemiology, Brown University School of Public Health, Providence, RI (E.B.L.); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (D.R.P.); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (E.R.-S.); Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.E.W.); Department of Obstetrics and Gynecology, The University of Texas Health Science Center, San Antonio (R.S.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Unit for Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden (A.-K.E.-B.); Department of Family Medicine, USCD, La Jolla, CA (M.A.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); and Georgetown University Center for Clinical and Translational Science, Washington, DC (B.V.H.)
| | - Robert S Schenken
- From Division of Cardiology, University of California San Francisco (N.I.P.); Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.J., K.K.R.); Cardiology, Hematology, Vascular Surgery, NYU School of Medicine, New York (J.S.B.); Departments of Family Medicine and Epidemiology, Brown University, Providence, RI (C.B.E., D.R.P.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Kaiser Permanente Center for Health Research, Portland, OR (E.S.L.); University of Alabama at Birmingham (C.E.L.); Department of Epidemiology, Brown University School of Public Health, Providence, RI (E.B.L.); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (D.R.P.); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (E.R.-S.); Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.E.W.); Department of Obstetrics and Gynecology, The University of Texas Health Science Center, San Antonio (R.S.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Unit for Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden (A.-K.E.-B.); Department of Family Medicine, USCD, La Jolla, CA (M.A.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); and Georgetown University Center for Clinical and Translational Science, Washington, DC (B.V.H.)
| | - Karen C Johnson
- From Division of Cardiology, University of California San Francisco (N.I.P.); Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.J., K.K.R.); Cardiology, Hematology, Vascular Surgery, NYU School of Medicine, New York (J.S.B.); Departments of Family Medicine and Epidemiology, Brown University, Providence, RI (C.B.E., D.R.P.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Kaiser Permanente Center for Health Research, Portland, OR (E.S.L.); University of Alabama at Birmingham (C.E.L.); Department of Epidemiology, Brown University School of Public Health, Providence, RI (E.B.L.); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (D.R.P.); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (E.R.-S.); Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.E.W.); Department of Obstetrics and Gynecology, The University of Texas Health Science Center, San Antonio (R.S.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Unit for Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden (A.-K.E.-B.); Department of Family Medicine, USCD, La Jolla, CA (M.A.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); and Georgetown University Center for Clinical and Translational Science, Washington, DC (B.V.H.)
| | - Anna-Karin Edstedt-Bonamy
- From Division of Cardiology, University of California San Francisco (N.I.P.); Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.J., K.K.R.); Cardiology, Hematology, Vascular Surgery, NYU School of Medicine, New York (J.S.B.); Departments of Family Medicine and Epidemiology, Brown University, Providence, RI (C.B.E., D.R.P.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Kaiser Permanente Center for Health Research, Portland, OR (E.S.L.); University of Alabama at Birmingham (C.E.L.); Department of Epidemiology, Brown University School of Public Health, Providence, RI (E.B.L.); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (D.R.P.); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (E.R.-S.); Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.E.W.); Department of Obstetrics and Gynecology, The University of Texas Health Science Center, San Antonio (R.S.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Unit for Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden (A.-K.E.-B.); Department of Family Medicine, USCD, La Jolla, CA (M.A.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); and Georgetown University Center for Clinical and Translational Science, Washington, DC (B.V.H.)
| | - Matthew A Allison
- From Division of Cardiology, University of California San Francisco (N.I.P.); Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.J., K.K.R.); Cardiology, Hematology, Vascular Surgery, NYU School of Medicine, New York (J.S.B.); Departments of Family Medicine and Epidemiology, Brown University, Providence, RI (C.B.E., D.R.P.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Kaiser Permanente Center for Health Research, Portland, OR (E.S.L.); University of Alabama at Birmingham (C.E.L.); Department of Epidemiology, Brown University School of Public Health, Providence, RI (E.B.L.); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (D.R.P.); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (E.R.-S.); Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.E.W.); Department of Obstetrics and Gynecology, The University of Texas Health Science Center, San Antonio (R.S.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Unit for Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden (A.-K.E.-B.); Department of Family Medicine, USCD, La Jolla, CA (M.A.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); and Georgetown University Center for Clinical and Translational Science, Washington, DC (B.V.H.)
| | - Barbara V Howard
- From Division of Cardiology, University of California San Francisco (N.I.P.); Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.J., K.K.R.); Cardiology, Hematology, Vascular Surgery, NYU School of Medicine, New York (J.S.B.); Departments of Family Medicine and Epidemiology, Brown University, Providence, RI (C.B.E., D.R.P.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Kaiser Permanente Center for Health Research, Portland, OR (E.S.L.); University of Alabama at Birmingham (C.E.L.); Department of Epidemiology, Brown University School of Public Health, Providence, RI (E.B.L.); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (D.R.P.); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (E.R.-S.); Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.E.W.); Department of Obstetrics and Gynecology, The University of Texas Health Science Center, San Antonio (R.S.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Unit for Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden (A.-K.E.-B.); Department of Family Medicine, USCD, La Jolla, CA (M.A.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); and Georgetown University Center for Clinical and Translational Science, Washington, DC (B.V.H.)
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Sanghavi M, Gulati M. Cardiovascular Disease in Women: Primary and Secondary Cardiovascular Disease Prevention. Obstet Gynecol Clin North Am 2016; 43:265-85. [PMID: 27212092 DOI: 10.1016/j.ogc.2016.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Cardiovascular disease remains the leading cause of death in the United States. Primary prevention of cardiovascular disease requires involvement of an extended health care team. Obstetricians and gynecologists are uniquely positioned within the health care system because they are often the primary or only contact women have with the system. This review article discusses initial assessment, treatment recommendations, and practical tips regarding primary and secondary prevention of cardiovascular disease in women with a focus on coronary heart disease; discussion includes peripheral and cerebrovascular disease.
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Affiliation(s)
- Monika Sanghavi
- Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9047, USA
| | - Martha Gulati
- Division of Cardiology, University of Arizona-Phoenix, 1300 North 12th Street, Suite 407, Phoenix, AZ 85006, USA.
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O’Flaherty M, Baxter J, Haynes M, Turrell G. The Family Life Course and Health: Partnership, Fertility Histories, and Later-Life Physical Health Trajectories in Australia. Demography 2016; 53:777-804. [DOI: 10.1007/s13524-016-0478-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kim HL, Kim MA, Shim WJ, Park SM, Kim YH, Na JO, Shin MS, Kim YJ, Yoon HJ, Shin GJ, Cho Y, Kim SE, Hong KS, Cho KI. Reproductive Factors Predicting Angiographic Obstructive Coronary Artery Disease: The KoRean wOmen'S Chest Pain rEgistry (KoROSE). J Womens Health (Larchmt) 2016; 25:443-8. [DOI: 10.1089/jwh.2015.5381] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hack-Lyoung Kim
- Seoul National University Boramae Medical Center, Seoul, Korea
| | - Myung-A Kim
- Seoul National University Boramae Medical Center, Seoul, Korea
| | - Wan-Joo Shim
- Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Seong Mi Park
- Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Yong Hyun Kim
- Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Jin Oh Na
- Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Mi Seung Shin
- Gachon Medical School Gil Medical Center, Incheon, Korea
| | - Yong-Jin Kim
- Seoul National University Hospital, Seoul, Korea
| | - Hyun Ju Yoon
- Chonnam National University Hospital, Gwangju, Korea
| | - Gil Ja Shin
- Ewha Womans University Hospital, Seoul, Korea
| | | | - Sung-Eun Kim
- Hallym University Medical Center, Seoul and Chuncheon, Korea
| | - Kyung-Soon Hong
- Hallym University Medical Center, Seoul and Chuncheon, Korea
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Association of Women's Reproductive History With Long-term Mortality and Effect of Socioeconomic Factors. Obstet Gynecol 2016; 126:1181-1187. [PMID: 26551179 DOI: 10.1097/aog.0000000000001155] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To assess the effects of socioeconomic factors on the association between parity and long-term maternal mortality. METHODS This was a population-based cohort study of mothers with births registered in the Medical Birth Registry of Norway during the period 1967-2009. We estimated age-specific (40-69 years) cardiovascular and noncardiovascular mortality ratios by number of births using Cox proportional hazard models. To assess effect modification by mothers' attained education, we stratified on low (less than 11 years) and high (11 years or greater) educational level. We further evaluated fathers' mortality by number of births using the same analytical approach. RESULTS Mothers with low education had higher mortality (cardiovascular: hazard ratio 2.62, 95% confidence interval [CI] 2.34-2.93, noncardiovascular: hazard ratio 1.67, 95% CI 1.62-1.73). Among mothers with low education, cardiovascular mortality increased linearly with each additional birth above one (P trend=.02). In contrast, among mothers with high education, cardiovascular mortality declined with added births (P trend=.045). For noncardiovascular mortality there was no association among mothers with low education, whereas mortality declined with increasing number of births among mothers with high education (P trend<.01). Father's mortality showed similar associations with number of births when stratified on maternal education. CONCLUSION Women's long-term mortality rose with number of births only for cardiovascular causes of death and only among mothers with low education. Partners of women with low education had similar increasing risk with increasing number of births. Maternal educational level is a strong modifier of the association between parity and long-term mortality. LEVEL OF EVIDENCE II.
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Chung E, Kim Y, Usen O. Associations Between Parity, Obesity, and Cardiovascular Risk Factors Among Middle-Aged Women. J Womens Health (Larchmt) 2016; 25:818-25. [PMID: 26886718 DOI: 10.1089/jwh.2015.5581] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Several studies have demonstrated an association between parity and the risk of developing cardiovascular disease (CVD) in middle-aged women; however, some inconsistencies still remain in the literature after accounting for obesity. The purpose of this study was to examine the association between parity and the risk factors of CVD while accounting for current obesity status in middle-aged women. METHOD Data for this study came from the National Health and Nutrition Examination Survey 2007-2012. The final analytic sample included 2024 middle-aged women (40-60 years old). General linear models predicting CVD risk factors based on parity (nulliparous, 1, 2, 3, and ≥4) were established after controlling for study covariates. Least square adjusted means of CVD risk factors and associated 95% confidence intervals were estimated across parity and body mass index (BMI) levels. RESULTS Women with ≥4 parity (8.34%; standard error [SE] = 0.84) showed significantly distinct demographic characteristics and health conditions, including obesity (49.08%; SE = 3.55). There were no significant associations between parity and CVD risk factors after controlling for covariates. Follow-up analyses showed consistent results across parity; however, CVD risk factors were significantly increased with higher BMI levels, regardless of parity status. CONCLUSIONS Our results suggest that parity is not a significant predictor of CVD risk factors in middle-aged women, whereas current overweight or obesity status is more important when explaining the risk of the development of CVD.
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Affiliation(s)
- Eunhee Chung
- Department of Kinesiology and Sport Management, Texas Tech University , Lubbock, Texas
| | - Youngdeok Kim
- Department of Kinesiology and Sport Management, Texas Tech University , Lubbock, Texas
| | - Oduware Usen
- Department of Kinesiology and Sport Management, Texas Tech University , Lubbock, Texas
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McKibben RA, Al Rifai M, Mathews LM, Michos ED. Primary Prevention of Atherosclerotic Cardiovascular Disease in Women. CURRENT CARDIOVASCULAR RISK REPORTS 2015; 10. [PMID: 28149430 DOI: 10.1007/s12170-015-0480-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality among women. Despite improvements in cardiovascular disease prevention efforts, there remain gaps in cardiovascular disease awareness among women, as well as age and racial disparities in ASCVD outcomes for women. Disparity also exists in the impact the traditional risk factors confer on ASCVD risk between women and men, with smoking and diabetes both resulting in stronger relative risks in women compared to men. Additionally there are risk factors that are unique to women (such as pregnancy-related factors) or that disproportionally affect women (such as auto-immune disease) where preventive efforts should be targeted. Risk assessment and management must also be sex-specific to effectively reduce cardiovascular disease and improve outcomes among women. Evidence supports the use of statin therapy for primary prevention in women at higher ASCVD risk. However, some pause should be given to prescribing aspirin therapy in women without known ASCVD, with most evidence supporting the use of aspirin for women≥65 years not at increased risk for bleeding. This review article will summarize (1) traditional and non-traditional assessments of ASCVD risk and (2) lifestyle and pharmacologic therapies for the primary prevention of ASCVD in women.
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Affiliation(s)
- Rebeccah A McKibben
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21287
| | - Mahmoud Al Rifai
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21287
| | - Lena M Mathews
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21287
| | - Erin D Michos
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21287
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Abstract
Heart disease is the number one killer of women. Although there are many similarities between men and women, the evolving understanding of ischemic heart disease in women allow us to emphasize the important differences that need to be recognized. These differences, including symptoms at presentation, importance of particular risk factors, pathophysiology of disease, and treatments/outcomes, will be discussed in this review.
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Staff AC, Redman CWG, Williams D, Leeson P, Moe K, Thilaganathan B, Magnus P, Steegers EAP, Tsigas EZ, Ness RB, Myatt L, Poston L, Roberts JM. Pregnancy and Long-Term Maternal Cardiovascular Health: Progress Through Harmonization of Research Cohorts and Biobanks. Hypertension 2015; 67:251-60. [PMID: 26667417 DOI: 10.1161/hypertensionaha.115.06357] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Anne Cathrine Staff
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Christopher W G Redman
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - David Williams
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Paul Leeson
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Kjartan Moe
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Basky Thilaganathan
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Per Magnus
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Eric A P Steegers
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Eleni Z Tsigas
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Roberta B Ness
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Leslie Myatt
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Lucilla Poston
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - James M Roberts
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
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Lee KK, Raja EA, Lee AJ, Bhattacharya S, Bhattacharya S, Norman JE, Reynolds RM. Maternal Obesity During Pregnancy Associates With Premature Mortality and Major Cardiovascular Events in Later Life. Hypertension 2015; 66:938-44. [DOI: 10.1161/hypertensionaha.115.05920] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/21/2015] [Indexed: 01/21/2023]
Abstract
One in 5 pregnant women is obese but the impact on later health is unknown. We aimed to determine whether maternal obesity during pregnancy associates with increased premature mortality and later life major cardiovascular events. Maternity records of women who gave birth to their first child between 1950 and 1976 (n=18 873) from the Aberdeen Maternity and Neonatal databank were linked to the National Register of Deaths, Scotland and Scottish Morbidity Record. The effect of maternal obesity at first antenatal visit on death and hospital admissions for cardiovascular events was tested using time-to-event analysis with Cox proportional hazard regression to compare outcomes of mothers in underweight, overweight, or obese body mass index (BMI) categories compared with normal BMI. Median follow-up was at 73 years. All-cause mortality was increased in women who were obese during pregnancy (BMI>30 kg/m
2
) versus normal BMI after adjustment for socioeconomic status, smoking, gestation at BMI measurement, preeclampsia, and low birth weight (hazard ratio, 1.35; 95% confidence interval, 1.02–1.77). In adjusted models, overweight and obese mothers had increased risk of hospital admission for a cardiovascular event (1.16; 1.06–1.27 and 1.26; 1.01–1.57) compared with normal BMI mothers. Adjustment for parity largely unchanged the hazard ratios (mortality: 1.43, 1.09–1.88; cardiovascular events overweight: 1.17, 1.07–1.29; and obese: 1.30, 1.04–1.62). In conclusion, maternal obesity is associated with increased risk of premature death and cardiovascular disease. Pregnancy and early postpartum could represent an opportunity for interventions to identify obesity and reduce its adverse consequences.
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Affiliation(s)
- Kuan Ken Lee
- From the Endocrinology Unit, BHF/University Centre for Cardiovascular Science (K.K.L., R.M.R.) and Tommy’s Centre for Fetal and Maternal Health, Medical Research Council Centre for Reproductive Health (J.E.N., R.M.R.), Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom (E.A.R., A.J.L., Sohinee Bhattacharya, Siladitya Bhattacharya)
| | - Edwin A. Raja
- From the Endocrinology Unit, BHF/University Centre for Cardiovascular Science (K.K.L., R.M.R.) and Tommy’s Centre for Fetal and Maternal Health, Medical Research Council Centre for Reproductive Health (J.E.N., R.M.R.), Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom (E.A.R., A.J.L., Sohinee Bhattacharya, Siladitya Bhattacharya)
| | - Amanda J. Lee
- From the Endocrinology Unit, BHF/University Centre for Cardiovascular Science (K.K.L., R.M.R.) and Tommy’s Centre for Fetal and Maternal Health, Medical Research Council Centre for Reproductive Health (J.E.N., R.M.R.), Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom (E.A.R., A.J.L., Sohinee Bhattacharya, Siladitya Bhattacharya)
| | - Sohinee Bhattacharya
- From the Endocrinology Unit, BHF/University Centre for Cardiovascular Science (K.K.L., R.M.R.) and Tommy’s Centre for Fetal and Maternal Health, Medical Research Council Centre for Reproductive Health (J.E.N., R.M.R.), Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom (E.A.R., A.J.L., Sohinee Bhattacharya, Siladitya Bhattacharya)
| | - Siladitya Bhattacharya
- From the Endocrinology Unit, BHF/University Centre for Cardiovascular Science (K.K.L., R.M.R.) and Tommy’s Centre for Fetal and Maternal Health, Medical Research Council Centre for Reproductive Health (J.E.N., R.M.R.), Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom (E.A.R., A.J.L., Sohinee Bhattacharya, Siladitya Bhattacharya)
| | - Jane E. Norman
- From the Endocrinology Unit, BHF/University Centre for Cardiovascular Science (K.K.L., R.M.R.) and Tommy’s Centre for Fetal and Maternal Health, Medical Research Council Centre for Reproductive Health (J.E.N., R.M.R.), Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom (E.A.R., A.J.L., Sohinee Bhattacharya, Siladitya Bhattacharya)
| | - Rebecca M. Reynolds
- From the Endocrinology Unit, BHF/University Centre for Cardiovascular Science (K.K.L., R.M.R.) and Tommy’s Centre for Fetal and Maternal Health, Medical Research Council Centre for Reproductive Health (J.E.N., R.M.R.), Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom (E.A.R., A.J.L., Sohinee Bhattacharya, Siladitya Bhattacharya)
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Ngo AD, Roberts CL, Figtree G. Association between interpregnancy interval and future risk of maternal cardiovascular disease-a population-based record linkage study. BJOG 2015; 123:1311-8. [DOI: 10.1111/1471-0528.13729] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2015] [Indexed: 12/01/2022]
Affiliation(s)
- AD Ngo
- Clinical and Population Perinatal Health Research; Kolling Institute; Northern Sydney Local Health District; St Leonards NSW Australia
- Sydney Medical School Northern; University of Sydney; Sydney NSW Australia
| | - CL Roberts
- Clinical and Population Perinatal Health Research; Kolling Institute; Northern Sydney Local Health District; St Leonards NSW Australia
- Sydney Medical School Northern; University of Sydney; Sydney NSW Australia
| | - G Figtree
- Sydney Medical School Northern; University of Sydney; Sydney NSW Australia
- Department of Cardiology; Royal North Shore Hospital; St Leonards NSW Australia
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Câmara SMA, Pirkle C, Moreira MA, Vieira MCA, Vafaei A, Maciel ÁCC. Early maternal age and multiparity are associated to poor physical performance in middle-aged women from Northeast Brazil: a cross-sectional community based study. BMC WOMENS HEALTH 2015; 15:56. [PMID: 26243283 PMCID: PMC4526418 DOI: 10.1186/s12905-015-0214-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 07/23/2015] [Indexed: 11/10/2022]
Abstract
Background Adolescent childbirth and elevated parity are relatively common in middle and low-income countries and they may be related to the higher prevalence and earlier onset of physical decline documented in these settings, especially in women. The aim of this paper is to investigate whether reproductive history is associated with physical function in middle-aged women from Northeast Brazil. Methods The relationship between poor physical performance (grip strength, gait speed and chair stand), early maternal age at first birth (<18 years old), and multiparity (≥3 children) was evaluated in a community sample of 473 women living in Parnamirim (Northeast Brazil). Linear regression models were used to examine the relationship of interest; in addition, mediation analyses were employed to assess indirect effects of obesity and family income. Results Women who gave birth at less than 18 years of age took approximately 0.50 s longer to complete the chair stand test compared to women who gave birth at 18 years or older. Moreover, women who gave birth to < 3 children completed the chair stand test 0.42 s faster compared to those who had ≥ 3 children. The relation between reproductive history and physical performance was mediated by BMI. Reproductive history was not associated with performance in gait speed. Conclusions This study provides evidence that adolescent childbirth and multiparity are related to worse physical performance in middle-aged women from a low income setting. Reproductive history may partially account for earlier physical decline and greater disability in women from lower income settings.
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Affiliation(s)
- Saionara Maria Aires Câmara
- Department of Physiotherapy, Universidade Federal do Rio Grande do Norte, Avenida Senador Salgado Filho, S/N Caixa Postal 1524 - Campus Universitário - Lagoa Nova CEP, Natal, RN, 59072-970, Brazil.
| | - Catherine Pirkle
- Office of Public Health Studies, University of Hawaii-Manoa, 1960 East-West Road, Biomedical D104H, Honolulu, HI, 96822-2319, USA.
| | - Mayle Andrade Moreira
- Department of Physiotherapy, Universidade Federal do Rio Grande do Norte, Avenida Senador Salgado Filho, S/N Caixa Postal 1524 - Campus Universitário - Lagoa Nova CEP, Natal, RN, 59072-970, Brazil.
| | - Mariana Carmem Apolinário Vieira
- Department of Physiotherapy, Universidade Federal do Rio Grande do Norte, Avenida Senador Salgado Filho, S/N Caixa Postal 1524 - Campus Universitário - Lagoa Nova CEP, Natal, RN, 59072-970, Brazil.
| | - Afshin Vafaei
- Department of Public Health Sciences, Carruthers Hall, Queen's University, Kingston, Canada.
| | - Álvaro Campos Cavalcanti Maciel
- Department of Physiotherapy, Universidade Federal do Rio Grande do Norte, Avenida Senador Salgado Filho, S/N Caixa Postal 1524 - Campus Universitário - Lagoa Nova CEP, Natal, RN, 59072-970, Brazil.
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128
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Park K, Wei J, Minissian M, Merz CNB, Pepine CJ. Adverse Pregnancy Conditions, Infertility, and Future Cardiovascular Risk: Implications for Mother and Child. Cardiovasc Drugs Ther 2015; 29:391-401. [PMID: 26037616 PMCID: PMC4758514 DOI: 10.1007/s10557-015-6597-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Adverse pregnancy conditions in women are common and have been associated with adverse cardiovascular and metabolic outcomes such as myocardial infarction and stroke. As risk stratification in women is often suboptimal, recognition of non-traditional risk factors such as hypertensive disorders of pregnancy and premature delivery has become increasingly important. Additionally, such conditions may also increase the risk of cardiovascular disease in the children of afflicted women. In this review, we aim to highlight these conditions, along with infertility, and the association between such conditions and various cardiovascular outcomes and related maternal risk along with potential translation of risk to offspring. We will also discuss proposed mechanisms driving these associations as well as potential opportunities for screening and risk modification.
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Affiliation(s)
- Ki Park
- Division of Cardiovascular Medicine, University of Florida, 1600 SW Archer Rd, P.O. Box 100277, Gainesville, FL 32610-0277, USA
| | - Janet Wei
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Margo Minissian
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - C. Noel Bairey Merz
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Carl J. Pepine
- Division of Cardiovascular Medicine, University of Florida, 1600 SW Archer Rd, P.O. Box 100277, Gainesville, FL 32610-0277, USA
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Zunzunegui MV, Alvarado BE, Guerra R, Gómez JF, Ylli A, Guralnik JM. The mobility gap between older men and women: the embodiment of gender. Arch Gerontol Geriatr 2015; 61:140-8. [PMID: 26113021 DOI: 10.1016/j.archger.2015.06.005] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 03/31/2015] [Accepted: 06/10/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To present the study design and baseline results of the longitudinal International Mobility in Aging Study (IMIAS) on gender differences in physical performance and mobility disability prevalence in five diverse societies. METHODS Data are from surveys on random samples of people aged 65-74 years at Canadian (Kingston, Ontario; Saint-Hyacinthe, Quebec), Mediterranean (Tirana, Albania) and Latin American sites (Natal, Brazil; Manizales, Colombia) (N=1995). Mobility disability was defined as reporting difficulty in walking 400m or climbing stairs. Activities of daily living (ADL) disability was based on any self-reported difficulty in five mobility-related ADLs. The short physical performance battery (SPPB) was used to assess physical performance. Poisson regression models were fitted to estimate prevalence ratios. RESULTS Age-adjusted prevalence of low SPPB, mobility disability and ADL disability were higher in women than in men in all sites except for Kingston. After adjustment for education and income, gender differences in SPPB and ADL disability attenuated or disappeared in Saint-Hyacinthe and Manizales but remained large in Tirana and Natal and mobility disability remained more frequent in women than in men at all sites except Kingston. After further adjustment by chronic conditions and depressive symptoms, gender differences in mobility remained large at all sites except Kingston but only in Tirana did women have significantly poorer physical performance than men. DISCUSSION Results provide evidence for gender as a risk factor to explain poorer physical function in women and suggest that moving toward gender equality could attenuate the gender gap in physical function in old age.
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Affiliation(s)
- M V Zunzunegui
- Research Institute of Public Health of the Université de Montréal (IRSPUM), Canada.
| | - B E Alvarado
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - R Guerra
- School of Physiotherapy, Universidade Federale do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - J F Gómez
- School of Medicine, Universidad de Caldas, Manizales, Caldas, Colombia
| | - A Ylli
- Albanian National Institute of Health, Tirana, Albania
| | - J M Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States
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- Research Institute of Public Health of the Université de Montréal (IRSPUM), Canada; Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada; School of Physiotherapy, Universidade Federale do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil; School of Medicine, Universidad de Caldas, Manizales, Caldas, Colombia; Albanian National Institute of Health, Tirana, Albania; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States
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Sapir-Pichhadze R, Tinckam KJ, Laupacis A, Logan AG, Beyene J, Kim SJ. Immune Sensitization and Mortality in Wait-Listed Kidney Transplant Candidates. J Am Soc Nephrol 2015; 27:570-8. [PMID: 26054537 DOI: 10.1681/asn.2014090894] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 04/27/2015] [Indexed: 11/03/2022] Open
Abstract
Cardiovascular mortality is the leading cause of death in ESRD. Whereas innate and adaptive immunity have established roles in cardiovascular disease, the role of humoral immunity is unknown. We conducted a retrospective cohort study in first-time adult kidney transplant candidates (N=161,308) using data from the Scientific Registry of Transplant Recipients and the Centers for Medicare and Medicaid Services to evaluate whether anti-human leukocyte antigen antibodies, measured as panel reactive antibodies (PRAs), are related to mortality in ESRD. Relationships between time-varying PRAs and all-cause or cardiovascular mortality were assessed using Cox proportional hazards models. The analysis was repeated in subcohorts of candidates at lower risk for significant comorbidities, activated on the waiting list after 2007, or unsensitized at activation. Competing risks analyses were also conducted. Fully adjusted models showed increased hazard ratios (HRs [95% confidence intervals]) for all-cause mortality (HR, 1.02 [95% CI, 0.99 to 1.06]; HR, 1.11 [95% CI,1.07 to 1.16]; and HR,1.21 [95% CI,1.15 to 1.27]) and cardiovascular mortality (HR, 1.05 [95% CI,1.00 to 1.10]; HR,1.11 [95% CI,1.05 to 1.18]; and HR,1.21 [95% CI,1.12 to 1.31]) in PRA 1%-19%, PRA 20%-79%, and PRA 80%-100% categories compared with PRA 0%, respectively. Associations between PRA and the study outcomes were accentuated in competing risks models and in lower-risk patients and persisted in other subcohorts. Our findings suggest that PRA is an independent predictor of mortality in wait-listed kidney transplant candidates. The mechanisms by which PRA confers an incremental mortality risk in sensitized patients, and the role of transplantation in modifying this risk, warrant further study.
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Affiliation(s)
- Ruth Sapir-Pichhadze
- Division of Nephrology and the Kidney Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, and Division of Nephrology, Departments of Medicine and
| | - Kathryn J Tinckam
- Division of Nephrology and the Kidney Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Division of Nephrology, Departments of Medicine and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Andreas Laupacis
- Institute of Health Policy, Management, and Evaluation, and Li Ka Shing Knowledge Institute, and
| | - Alexander G Logan
- Division of Nephrology and the Kidney Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, and Division of Nephrology, Departments of Medicine and
| | - Joseph Beyene
- Institute of Health Policy, Management, and Evaluation, and Population Health Sciences Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - S Joseph Kim
- Division of Nephrology and the Kidney Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, and Division of Nephrology, Departments of Medicine and Division of Nephrology and the Renal Transplant Program, St. Michael's Hospital, Toronto, Ontario, Canada;
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D'Ovidio F, d'Errico A, Scarinzi C, Costa G. Increased incidence of coronary heart disease associated with “double burden” in a cohort of Italian women. Soc Sci Med 2015; 135:40-6. [DOI: 10.1016/j.socscimed.2015.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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132
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Abstract
Cardiovascular disease is the leading cause of morbidity and mortality in females worldwide. Pregnancy is associated with significant physiologic changes that may function as a natural stress test to detect women at future risk. It is established that women who have had a pregnancy complicated by gestational diabetes or a hypertensive disorder of pregnancy are at increased risk of cardiovascular disease later in life, and there is growing evidence that women who deliver infants preterm or growth-restricted infants have an elevated risk as well. Consideration should be given to including these outcomes as indicators of cardiovascular risk. Pregnancy represents a teachable moment when it would be ideal to identify women at risk. Improved integration of women's primary health care and an enhanced knowledge base on the part of clinicians will be necessary to fully incorporate these findings into the clinical care of women.
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Affiliation(s)
- Justin Bohrer
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Deborah B Ehrenthal
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI; Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI.
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133
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Sim JH, Chung D, Lim JS, Lee MY, Chung CH, Shin JY, Huh JH. Maternal age at first delivery is associated with the risk of metabolic syndrome in postmenopausal women: from 2008-2010 Korean National Health and Nutrition Examination Survey. PLoS One 2015; 10:e0127860. [PMID: 26010910 PMCID: PMC4444183 DOI: 10.1371/journal.pone.0127860] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 04/20/2015] [Indexed: 01/20/2023] Open
Abstract
Background Recent cross-sectional studies demonstrated that earlier maternal age at first childbirth is correlated with a higher risk of diabetes in postmenopausal women. In this study, we evaluated whether the age at first delivery is associated with the risk of metabolic syndrome (MetS) in postmenopausal women. Methods A total of 4,261 postmenopausal women aged 45 years or older were analyzed using data generated from Korea National Health and Nutrition Examination Surveys (2008–2010). Subjects were divided into three groups according to the maternal age at first delivery as follows: ≤ 20 years (n=878), 21-25 years (n=2314), and ≥ 26 years (n=1069). Results Approximately 37% of subjects had MetS. The prevalence of MetS showed a gradual increase as maternal age at first delivery decreased (≥ 26 years = 30.9% vs. 21-25 years = 39.9% vs. ≤ 20 years = 50.8%, respectively, p < 0.001). Central obesity indices such as trunk fat mass and waist circumference were significantly higher in the group aged ≤ 20 years than other groups. After adjustments for confounding factors, the odds ratios (ORs) for predicting the presence of MetS increased gradually as first delivery age decreased (≥ 26 years vs. 21-25 years vs. ≤ 20 years: OR [95% CI] = 1 vs. 1.324 [1.118-1.567] vs. 1.641 [1.322-2.036], respectively). Among components of MetS, younger maternal age at first delivery (≤ 20 years) was significantly associated with increased waist circumference (OR [95% CI] = 1.735 [1.41-2.13]), elevated blood pressure (1.261 [1.02-1.57]), high triglyceride (1.333 [1.072-1.659]), and low HDL-cholesterol (1.335[1.084-1.643]). Conclusions Our findings suggest that younger maternal age at first delivery is independently associated with a higher risk of central obesity and MetS in postmenopausal women.
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Affiliation(s)
- Jeong Han Sim
- Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, Gwangwondo, Korea
| | - Dawn Chung
- Department of Obstetrics and Gynecology Yonsei University, Wonju College of Medicine, Wonju, Gwangwondo, Korea
| | - Jung Soo Lim
- Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, Gwangwondo, Korea
| | - Mi Young Lee
- Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, Gwangwondo, Korea
| | - Choon Hee Chung
- Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, Gwangwondo, Korea
| | - Jang Yel Shin
- Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, Gwangwondo, Korea
| | - Ji Hye Huh
- Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, Gwangwondo, Korea
- * E-mail:
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Niemczyk NA, Catov JM, Barinas-Mitchell E, McClure CK, Roberts JM, Tepper PG, Sutton-Tyrrell K. Nulliparity is associated with less healthy markers of subclinical cardiovascular disease in young women with overweight and obesity. Obesity (Silver Spring) 2015; 23:1085-91. [PMID: 25866258 PMCID: PMC4414732 DOI: 10.1002/oby.21044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 01/07/2015] [Indexed: 11/10/2022]
Abstract
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.
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Affiliation(s)
- Nancy Anderson Niemczyk
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pennsylvania, USA; Midwifery Institute of Philadelphia University, Pennsylvania, USA
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135
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Abstract
The aim of this article is to determine whether the age of a woman at first birth is associated with treatment for high blood pressure (HBP) later in life.Baseline data for 62,914 women were sourced from the "45 and Up Study," an observational cohort study of healthy aging in Australia. These women had given first birth between the ages of 18 and 45 years. Odds ratios and 95% confidence intervals for the association between age that a woman gave first birth and treatment for HBP were estimated using logistic regression. Data were stratified by current age (<60 and ≥60 years) and adjusted for demographic and lifestyle factors.There was a significant association between age at first birth and present day HBP. Older age at first birth was associated with a lower likelihood of HBP in women aged 25 to <35 years and 35 to 45 years at first birth (in women currently <60 years) and 35 to 45 years at first birth (in women currently ≥60 years of age), compared with women aged 18 to <25 years at first birth, adjusting for demographic and lifestyle factors.Women who were older when they gave first birth had lower odds of treatment for HBP compared with women who were younger when they gave birth to their first child. The contribution of a woman's pregnancy history, including her age at first birth, should be discussed with a patient when assessing her risk of HBP.
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Affiliation(s)
- Joanne M Lind
- From the University of Western Sydney, School of Medicine, Sydney, New South Wales, Australia
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136
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Sanghavi M, Kulinski J, Ayers CR, Nelson D, Stewart R, Parikh N, de Lemos JA, Khera A. Association between number of live births and markers of subclinical atherosclerosis: The Dallas Heart Study. Eur J Prev Cardiol 2015; 23:391-9. [PMID: 25691547 DOI: 10.1177/2047487315571891] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 01/19/2015] [Indexed: 11/16/2022]
Abstract
AIMS Higher parity has been associated with increased maternal risk of cardiovascular disease, but the mechanism is not well delineated. Whether the number of live births is associated with coronary and aortic subclinical atherosclerosis has not been fully evaluated. METHODS AND RESULTS Women from the Dallas Heart Study, a multiethnic population-based cohort of subjects aged 30-65 years, were included if they had data on self-reported live births and coronary artery calcium (CAC) measured by computed tomography or aortic wall thickness (AWT) by MRI. Coronary artery calcium was positive if >10 Agatston units, and aortic wall thickness if greater than the 75(th) percentile reference point for age and gender. Among the 1644 women included in the study, the mean age was 45 years and 55% were Black. Sequential multivariable models were done adjusting for age, race, traditional cardiovascular risk factors, body mass index, income, education, hormone replacement therapy, oral contraceptives, and physical activity. Using women with 2-3 live births as the reference, those with four or more live births had an increased prevalence of elevated coronary artery calcium (odds ratio (OR) 2.2, 95% confidence interval (CI) 1.28-3.65) and aortic wall thickness (OR 1.6, 95% CI 1.04-2.41). Women with 0-1 live births also had increased coronary artery calcium (OR 1.9, 95% CI 1.16-3.03) and aortic wall thickness (OR 1.5, 95% CI 1.05-2.09) after multivariable adjustment. CONCLUSION The number of live births is associated with subclinical coronary and aortic atherosclerosis, with an apparent U-shaped relationship. Further studies are needed to confirm this association and explore the biological underpinnings of these findings.
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Affiliation(s)
- Monika Sanghavi
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, USA
| | | | - Colby R Ayers
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, USA
| | - David Nelson
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, USA
| | - Robert Stewart
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, USA
| | - Nisha Parikh
- Cardiovascular Division, University of California San Francisco, USA
| | - James A de Lemos
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, USA
| | - Amit Khera
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, USA
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Vaidya D, Bennett WL, Sibley CT, Polak JF, Herrington DM, Ouyang P. Association of parity with carotid diameter and distensibility: multi-ethnic study of atherosclerosis. Hypertension 2014; 64:253-8. [PMID: 24842921 DOI: 10.1161/hypertensionaha.114.03285] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pregnancy and childbirth are associated with hemodynamic changes and vascular remodeling. It is not known whether parity is associated with later adverse vascular properties such as larger arterial diameter, wall thickness, and lower distensibility. We used baseline data from 3283 women free of cardiovascular disease aged 45 to 84 years enrolled in the population-based Multi-Ethnic Study of Atherosclerosis. Participants self-reported parity status. Ultrasound-derived carotid artery lumen diameters and brachial artery blood pressures were measured at peak-systole and end-diastole. Common carotid intima-media thickness was also measured. Regression models to determine the association of carotid distensibility coefficient, lumen diameter, and carotid intima-media thickness with parity were adjusted for age, race, height, weight, diabetes mellitus, current smoking, blood pressure medication use, and total and high-density lipoprotein cholesterol levels. The prevalence of nulliparity was 18%. In adjusted models, carotid distensibility coefficient was 0.09×10−5 Pa−1 lower (P=0.009) in parous versus nulliparous women. Among parous women, there was a nonlinear association with the greatest carotid distensibility coefficient seen in women with 2 live births and significantly lower distensibility seen in primiparas (P=0.04) or with higher parity >2 (P=0.005). No such pattern of association with parity was found for lumen diameter or carotid intima-media thickness. Parity is associated with lower carotid artery distensibility, suggesting arterial remodeling that lasts beyond childbirth. These long-term effects on the vasculature may explain the association of parity with cardiovascular events later in life.
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138
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Pirkle CM, de Albuquerque Sousa ACP, Alvarado B, Zunzunegui MV. Early maternal age at first birth is associated with chronic diseases and poor physical performance in older age: cross-sectional analysis from the International Mobility in Aging Study. BMC Public Health 2014; 14:293. [PMID: 24684705 PMCID: PMC3977880 DOI: 10.1186/1471-2458-14-293] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 03/28/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early maternal age at first birth and elevated parity may have long-term consequences for the health of women as they age. Both are known risk factors for obstetrical complications with lifelong associated morbidities. They may also be related to diabetes and cardiovascular disease development. METHODS We examine the relationship between early maternal age at first birth, defined as ≤18 years of age, multiparity (>2 births), and poor physical performance (Short Physical Performance Battery≤8) in community samples of women between 65 and 74 years of age from Canada, Albania, Colombia, and Brazil (N=1040). Data were collected in 2012 to provide a baseline assessment for a longitudinal cohort called the International Mobility in Aging Study. We used logistic regression and general linear models to analyse the data. RESULTS Early maternal age at first birth is significantly associated with diabetes, chronic lung disease, high blood pressure, and poor physical performance in women at older ages. Parity was not independently associated with chronic conditions and physical performance in older age. After adjustment for study site, age, education, childhood economic adversity and lifetime births, women who gave birth at a young age had 1.75 (95% CI: 1.17-2.64) the odds of poor SPPB compared to women who gave birth>18 years of age. Adjustment for chronic diseases attenuated the association between early first birth and physical performance. Results were weaker in Colombia and Brazil, than Canada and Albania. CONCLUSIONS This study provides evidence that adolescent childbirth may increase the risk of developing chronic diseases and physical limitations in older age. Results likely reflect both the biological and social consequences of early childbearing and if the observed relationship is causal, it reinforces the importance of providing contraception and sex education to young women, as the consequences of early pregnancy may be life-long.
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Affiliation(s)
- Catherine M Pirkle
- Department of Population Health and Environment, Research Center CHUQ, Laval University, 2875, Boulevard Laurier, Édifice Delta II; Bureau 600, 6e étage, Québec, QC G1V 2M2, Canada.
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Knipe DW, Fraser A, Lawlor DA, Howe LD. Is interpregnancy interval associated with cardiovascular risk factors in later life? A cohort study. BMJ Open 2014; 4:e004173. [PMID: 24647446 PMCID: PMC3963084 DOI: 10.1136/bmjopen-2013-004173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Pregnancy represents a metabolic challenge to women; in a normal pregnancy, transient metabolic changes occur that support the needs of the growing fetus. It is possible that repeating this challenge within a relatively short amount of time may result in lasting damage to the woman's cardiovascular health. Conversely, it is also possible that a long interpregnancy interval (IPI) may reflect subfertility, which has been found to be associated with cardiovascular disease (CVD). We examine the associations of short and long IPI with measures of cardiovascular health. DESIGN Prospective cohort. SETTING Mothers of the Avon Longitudinal Study of Parents and Children (ALSPAC). PARTICIPANTS Women with two live births in order to control for confounding by parity. OUTCOME MEASURES Arterial distensibility, common carotid intima, adiposity, blood pressure, lipids, glucose, insulin, proinsulin, triglycerides, C reactive protein. RESULTS 25% (n=3451) of ALSPAC mothers had provided sufficient data to determine full reproductive history-of these, 1477 had two live births, with 54% mothers having non-missing data on all variables required for our analyses. A total of 1268 mothers with IPI (interbirth interval minus 9 months' gestation) had CVD risk factors measured/imputed at mean age 48 years. After adjusting for confounding, we found no association of either short (≤15 months) or long (>27 months) IPI and increased levels of cardiovascular risk factors. There was some suggestion that women with long and short IPIs had a more favourable lipid profile compared with women whose IPI was 16-27 months; however, the differences were small in magnitude and imprecisely estimated. CONCLUSIONS This study does not support the hypothesis that either long or short IPI is a risk factor for later cardiovascular health.
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Affiliation(s)
- Duleeka W Knipe
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Abigail Fraser
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - Debbie A Lawlor
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - Laura D Howe
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
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140
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Stöckl D, Peters A, Thorand B, Heier M, Koenig W, Seissler J, Thiery J, Rathmann W, Meisinger C. Reproductive factors, intima media thickness and carotid plaques in a cross-sectional study of postmenopausal women enrolled in the population-based KORA F4 study. BMC WOMENS HEALTH 2014; 14:17. [PMID: 24456930 PMCID: PMC3904933 DOI: 10.1186/1472-6874-14-17] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 01/18/2014] [Indexed: 11/10/2022]
Abstract
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.
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Affiliation(s)
- Doris Stöckl
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
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141
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Rich-Edwards JW, Fraser A, Lawlor DA, Catov JM. Pregnancy characteristics and women's future cardiovascular health: an underused opportunity to improve women's health? Epidemiol Rev 2013; 36:57-70. [PMID: 24025350 PMCID: PMC3873841 DOI: 10.1093/epirev/mxt006] [Citation(s) in RCA: 280] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2013] [Indexed: 12/12/2022] Open
Abstract
Growing evidence indicates that women with a history of common pregnancy complications, including fetal growth restriction and preterm delivery (often combined as low birth weight), hypertensive disorders of pregnancy, and gestational diabetes, are at increased risk for cardiovascular disease later in life. The purpose of this paper was to review the associations of parity and these 4 pregnancy complications with cardiovascular morbidity and mortality; to review the role of cardiovascular risk factors before, during, and after pregnancy complications in explaining these associations; and to explore the implications of this emerging science for new research and policy. We systematically searched for relevant cohort and case-control studies in Medline through December 2012 and used citation searches for already published reviews to identify new studies. The findings of this review suggest consistent and often strong associations of pregnancy complications with latent and future cardiovascular disease. Many pregnancy complications appear to be preceded by subclinical vascular and metabolic dysfunction, suggesting that the complications may be useful markers of latent high-risk cardiovascular trajectories. With further replication research, these findings would support the utility of these prevalent pregnancy complications in identifying high-risk women for screening, prevention, and treatment of cardiovascular disease, the leading cause of morbidity and mortality among women.
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Affiliation(s)
- Janet W. Rich-Edwards
- Correspondence to Dr. Janet Rich-Edwards, 1620 Tremont Street, OBC-3.34, Boston, MA 02120 (e-mail: )
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142
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Winkvist A, Bertz F, Ellegård L, Bosaeus I, Brekke HK. Metabolic risk profile among overweight and obese lactating women in Sweden. PLoS One 2013; 8:e63629. [PMID: 23667649 PMCID: PMC3646790 DOI: 10.1371/journal.pone.0063629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 04/01/2013] [Indexed: 11/20/2022] Open
Abstract
Background Obesity and cardiovascular diseases are increasing globally and any association between reproduction and these conditions is of concern. Unfortunately, little is known about normal levels of metabolic risk factors in women of different body mass index throughout the reproductive cycle. This study is one of the first to describe the metabolic risk profile of lactating overweight or obese women at 8–12 weeks postpartum. Methods During 2007–2009, 66 overweight or obese Swedish lactating women without known diseases underwent detailed measurements of their metabolic profiles, dietary intake and general health before entering a lifestyle intervention trial. Baseline measurements took place between 8–12 wk postpartum. Almost all women were exclusively breastfeeding their term infants. Results The women were regarded as healthy, as reflected in the absence of diagnosed diseases, their own perceptions and in normal hemoglobin, albumin and fasting plasma glucose values. Four women were diagnosed with metabolic syndrome. In these cases, underlying conditions included large waist circumference, low HDL cholesterol values, high triglyceride values and relatively high blood pressure. The metabolic profile differed between overweight and obese women; obese women had significantly higher levels of fasting insulin (p = 0.017), borderline higher HOMA values (p = 0.057) and significantly higher triglyceride values (p = 0.029), as well as larger waist and hip circumferences (p<0.001 and p<0.001). However, no significant differences between overweight and obese women were detected for LDL or total cholesterol levels. Overweight and obese women reported similar total energy and macronutrient intakes, but obese women tended to be less physically active (p = 0.081). Conclusions Among generally healthy lactating women, obesity as compared to overweight is associated with increased metabolic risk. This cut-off is thus important also in the early postpartum period, and obesity among these women should warrant proper health investigation. Macronutrient intake did not differ between the groups and, hence, cannot explain these differences. Trial registration ClinicalTrials.gov Identifier: NCT01343238
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Affiliation(s)
- Anna Winkvist
- Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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143
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Lupton SJ, Chiu CL, Hodgson LA, Tooher J, Lujic S, Ogle R, Wong TY, Hennessy A, Lind JM. Temporal Changes in Retinal Microvascular Caliber and Blood Pressure During Pregnancy. Hypertension 2013; 61:880-5. [DOI: 10.1161/hypertensionaha.111.00698] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The microvasculature plays an important role in regulating cardiovascular changes in pregnancy, but changes in microvasculature have been difficult to document in vivo. This study objectively quantifies changes in the maternal retinal arteriolar and venular caliber over the course of healthy pregnancy. Healthy pregnant women (n=53) were recruited from Royal Prince Alfred Hospital, Sydney, Australia. Retinal images and mean arterial blood pressures (MAP) were collected at 13, 19, 29, and 38 weeks of gestation and at 6-month postpartum. Retinal vessels were analyzed and summarized as the central retinal arteriolar equivalent and central retinal venular equivalent. Central retinal arteriolar equivalent and central retinal venular equivalent were corrected for MAP. Paired
t
tests were performed comparing consecutive time points, with a significance level of
P
<0.01. There was a decrease in MAP between 13- and 19-week gestation (
P
=0.001) followed by a return to baseline from 19 weeks to delivery. This was correlated by an increase in vessel caliber between 13- and 19-week gestation (central retinal arteriolar equivalent:
P
<0.001, central retinal venular equivalent:
P
=0.007) and a return to baseline from 19 weeks to delivery. There were no differences in the central retinal arteriolar equivalent or central retinal venular equivalent (both uncorrected and corrected for MAP) between nulliparous and parous women. The pattern of dilatation and constriction in the microvasculature mirrored the changes in MAP throughout pregnancy, reflecting changes in peripheral resistance. This study provides insights into physiological changes in the microvasculature throughout a healthy pregnancy. These results can be used as a baseline with which to compare the changes observed in pathological conditions of pregnancy.
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Affiliation(s)
- Samantha J. Lupton
- From the University of Western Sydney, School of Medicine, NSW, Australia (S.J.L., C.L.C., S.L., A.H., J.M.L.); Centre for Eye Research Australia, University of Melbourne, VIC, Australia (L.A.B.H., T.Y.W.); Royal Prince Alfred Hospital, NSW, Australia (J.T., R.O.); and Singapore Eye Research Institute, National University of Singapore, Singapore (T.Y.W.)
| | - Christine L. Chiu
- From the University of Western Sydney, School of Medicine, NSW, Australia (S.J.L., C.L.C., S.L., A.H., J.M.L.); Centre for Eye Research Australia, University of Melbourne, VIC, Australia (L.A.B.H., T.Y.W.); Royal Prince Alfred Hospital, NSW, Australia (J.T., R.O.); and Singapore Eye Research Institute, National University of Singapore, Singapore (T.Y.W.)
| | - Lauren A.B. Hodgson
- From the University of Western Sydney, School of Medicine, NSW, Australia (S.J.L., C.L.C., S.L., A.H., J.M.L.); Centre for Eye Research Australia, University of Melbourne, VIC, Australia (L.A.B.H., T.Y.W.); Royal Prince Alfred Hospital, NSW, Australia (J.T., R.O.); and Singapore Eye Research Institute, National University of Singapore, Singapore (T.Y.W.)
| | - Jane Tooher
- From the University of Western Sydney, School of Medicine, NSW, Australia (S.J.L., C.L.C., S.L., A.H., J.M.L.); Centre for Eye Research Australia, University of Melbourne, VIC, Australia (L.A.B.H., T.Y.W.); Royal Prince Alfred Hospital, NSW, Australia (J.T., R.O.); and Singapore Eye Research Institute, National University of Singapore, Singapore (T.Y.W.)
| | - Sanja Lujic
- From the University of Western Sydney, School of Medicine, NSW, Australia (S.J.L., C.L.C., S.L., A.H., J.M.L.); Centre for Eye Research Australia, University of Melbourne, VIC, Australia (L.A.B.H., T.Y.W.); Royal Prince Alfred Hospital, NSW, Australia (J.T., R.O.); and Singapore Eye Research Institute, National University of Singapore, Singapore (T.Y.W.)
| | - Robert Ogle
- From the University of Western Sydney, School of Medicine, NSW, Australia (S.J.L., C.L.C., S.L., A.H., J.M.L.); Centre for Eye Research Australia, University of Melbourne, VIC, Australia (L.A.B.H., T.Y.W.); Royal Prince Alfred Hospital, NSW, Australia (J.T., R.O.); and Singapore Eye Research Institute, National University of Singapore, Singapore (T.Y.W.)
| | - Tien Yin Wong
- From the University of Western Sydney, School of Medicine, NSW, Australia (S.J.L., C.L.C., S.L., A.H., J.M.L.); Centre for Eye Research Australia, University of Melbourne, VIC, Australia (L.A.B.H., T.Y.W.); Royal Prince Alfred Hospital, NSW, Australia (J.T., R.O.); and Singapore Eye Research Institute, National University of Singapore, Singapore (T.Y.W.)
| | - Annemarie Hennessy
- From the University of Western Sydney, School of Medicine, NSW, Australia (S.J.L., C.L.C., S.L., A.H., J.M.L.); Centre for Eye Research Australia, University of Melbourne, VIC, Australia (L.A.B.H., T.Y.W.); Royal Prince Alfred Hospital, NSW, Australia (J.T., R.O.); and Singapore Eye Research Institute, National University of Singapore, Singapore (T.Y.W.)
| | - Joanne M. Lind
- From the University of Western Sydney, School of Medicine, NSW, Australia (S.J.L., C.L.C., S.L., A.H., J.M.L.); Centre for Eye Research Australia, University of Melbourne, VIC, Australia (L.A.B.H., T.Y.W.); Royal Prince Alfred Hospital, NSW, Australia (J.T., R.O.); and Singapore Eye Research Institute, National University of Singapore, Singapore (T.Y.W.)
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144
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InterLACE: A new International Collaboration for a Life Course Approach to Women's Reproductive Health and Chronic Disease Events. Maturitas 2013; 74:235-40. [DOI: 10.1016/j.maturitas.2012.12.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 12/14/2012] [Indexed: 11/19/2022]
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145
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Association of parity with osteoprotegerin levels and atherosclerosis. Arch Gynecol Obstet 2013; 287:1081-6. [DOI: 10.1007/s00404-012-2703-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 12/21/2012] [Indexed: 11/28/2022]
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146
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Hysterectomy is associated with large artery stiffening in estrogen-deficient postmenopausal women. Menopause 2013; 19:1000-7. [PMID: 22692329 DOI: 10.1097/gme.0b013e31825040f9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Hysterectomy, with or without oophorectomy, is associated with increased cardiovascular disease (CVD) risk due, in part, to an adverse CVD risk factor profile. Large artery stiffening, a biomarker of vascular aging, increases the risk for CVD. We determined whether hysterectomy with or without bilateral oophorectomy (BLO) is associated with arterial stiffening in healthy postmenopausal women. METHODS We conducted a cross-sectional study including estrogen-deficient postmenopausal women who had a hysterectomy with ovarian preservation (n = 24; mean ± SE age, 59 ± 1 y) or with BLO (n = 21; 58 ± 2 y) and had no hysterectomy/no BLO (n = 58; 58 ± 1 y). Arterial stiffness (arterial compliance and β stiffness index) was measured by ultrasonography of the carotid artery. RESULTS Carotid artery compliance was lower in women with hysterectomy alone and in women with hysterectomy with BLO compared with women with no hysterectomy (0.66 ± 0.03 and 0.71 ± 0.06 vs 0.89 ± 0.03 mm/mm Hg × 10, respectively, both P < 0.05). There were no differences in traditional CVD risk factors (ie, adiposity, blood pressure and fasted lipids and lipoproteins, glucose, and insulin) between the groups. After adjustment for age, menopause duration, previous menopausal hormone therapy duration, parity, waist-to-hip ratio, systolic blood pressure, and sex hormone-binding globulin, hysterectomy status remained a significant predictor of arterial compliance. CONCLUSIONS These results indicate that hysterectomy status (with or without BLO) is associated with greater arterial stiffening in estrogen-deficient postmenopausal women. The greater arterial stiffening with hysterectomy was not related to an adverse CVD risk profile. Large artery stiffening may be an important mechanism by which hysterectomy increases the risk of CVD in postmenopausal women.
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147
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Akhter T, Larsson A, Larsson M, Wikström AK, Naessen T. Artery wall layer dimensions during normal pregnancy: a longitudinal study using noninvasive high-frequency ultrasound. Am J Physiol Heart Circ Physiol 2012; 304:H229-34. [PMID: 23125216 DOI: 10.1152/ajpheart.00670.2012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The vascular effects of normal pregnancy were investigated by estimating the intima and media thicknesses of the common carotid artery separately using 22-MHz ultrasound (Collagenoson, Meudt, Germany) in 57 healthy women with normal pregnancies and pregnancy outcomes, in all three trimesters and at 1 yr postpartum. A thick intima, thin media, and high intima-to-media (I/M) ratio are signs of a less healthy artery wall. Mean artery wall layer dimensions remained fairly constant during pregnancy, but the intima thickness and I/M thickness ratio appeared to improve (decrease) postpartum (P < 0.001 for both). The cardiovascular risk parameters of age, body mass index, and blood pressure in the first trimester were associated with higher I/M ratios, especially in the second trimester, whereas higher serum estradiol levels were significantly associated with a lower I/M ratio. Changes from the first to second trimesters in I/M ratio, taking into account differential changes in intima and media thickness, were significantly (P < 0.05-0.001) associated with all risk parameters tested except age, which was associated with increased intima thickness (P = 0.02). Associations with third trimester values and changes from first to third trimesters were similar but less apparent. Thus, fairly constant mean artery wall layer dimensions during pregnancy appeared to improve postpartum. However, higher age, body mass index, or blood pressure and lower serum estradiol levels in the first trimester appeared to negatively affect the artery wall, strongly suggesting that pregnancy has negative vascular effects in some women. A less likely explanation involves possible adaptation to physiological changes during and after pregnancy.
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Affiliation(s)
- Tansim Akhter
- Department of Women's and Children's Health, Section for Obstetrics and Gynecology, Uppsala University, Uppsala, Sweden.
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148
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Stöckl D, Döring A, Thorand B, Heier M, Belcredi P, Meisinger C. Reproductive factors and serum uric acid levels in females from the general population: the KORA F4 study. PLoS One 2012; 7:e32668. [PMID: 22427861 PMCID: PMC3302793 DOI: 10.1371/journal.pone.0032668] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 02/02/2012] [Indexed: 01/18/2023] Open
Abstract
Objective Hyperuricemia is associated with an increased risk of metabolic and cardiovascular diseases. There are pronounced sex differences in the levels of uric acid. It is largely unknown whether or not reproductive parameters which induce hormonal changes are responsible for this. We examined if there are associations between reproductive parameters and uric acid levels in a female population-based sample. Methods In this cross-sectional analysis, data of 1530 women aged 32 to 81 years participating in the KORA F4 study, conducted between 2006 and 2008 in Southern Germany were used. Reproductive parameters were obtained by standardized interviews. Uric acid levels were tested by the uricase method. The whole study sample and stratified in pre- and postmenopausal women was analyzed. Results Menopausal status and earlier age at menarche were associated with higher serum uric acid levels (age-adjusted: p-values 0.003, <0.001 respectively; after multivariable adjustment, including BMI: p-values 0.002, 0.036). A history of oral contraceptive use showed an association with uric acid levels only after multivariable adjustment (p-value 0.009). Hot flushes showed an association with uric acid levels only after age-adjustment (p-value 0.038), but lost significance after adding other confounders. Other reproductive factors, including parity, current or ever use of hormone replacement therapy, current use of oral contraceptives, hysterectomy, bilateral oophorectomy, or depressive mood related to menopausal transition were not associated with uric acid levels. Conclusions Postmenopausal status, earlier age at menarche and a history of oral contraceptive use were independently associated with higher serum uric acid concentrations in women from the general population. Further studies, especially longitudinal population-based studies investigating the relationship of female reproductive parameters with uric acid levels are necessary to confirm our findings.
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Affiliation(s)
- Doris Stöckl
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
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149
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Parikh NI, Lloyd-Jones DM, Ning H, Ouyang P, Polak JF, Lima JA, Bluemke D, Mittleman MA. Association of number of live births with left ventricular structure and function. The Multi-Ethnic Study of Atherosclerosis (MESA). Am Heart J 2012; 163:470-6. [PMID: 22424019 DOI: 10.1016/j.ahj.2011.12.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 12/14/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND Pregnancy is associated with marked maternal cardiovascular/hemodynamic changes. A greater number of pregnancies may be associated with long-term subclinical changes in left ventricular (LV) remodeling. METHODS Among 2,234 white, black, Hispanic, and Chinese women (mean age 62 years) in the MESA, we used linear regression to relate live births and cardiac magnetic resonance imaging LV measures. Covariates included age, ethnicity, height, income, education, birth country, smoking, menopause, and oral contraceptive duration. Models were additionally adjusted for potential mediators: systolic blood pressure, antihypertensive use, total/high-density lipoprotein cholesterol, triglycerides, diabetes, and body mass index. We performed sensitivity analyses excluding 763 women in the lowest socioeconomic group: annual income <$25,000 and lower high school level of education. RESULTS With each live birth, LV mass increased 1.26 g; LV end-diastolic volume, 0.74 mL; and LV end-systolic volume, 0.45 mL; LV ejection fraction decreased 0.18% (P trend <0.05). Changes were most notable for the category of women with ≥5 pregnancies. Upon adjustment for potential biologic mediators, live births remained positively associated with LV mass and end-systolic volume. Live births remained significantly associated with LV end-systolic, end-diastolic volumes, and LV mass (P trend ≤0.02) after excluding women in the lowest socioeconomic group. CONCLUSIONS Number of live births is associated with key LV structural and functional measures in middle to older ages, even after adjustment for sociodemographic factors and cardiovascular disease risk factors. Hemodynamic changes during pregnancy may be associated with cardiac structure/function beyond childbearing years.
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150
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Parikh NI, Cnattingius S, Mittleman MA, Ludvigsson JF, Ingelsson E. Subfertility and risk of later life maternal cardiovascular disease. Hum Reprod 2011; 27:568-75. [PMID: 22131387 DOI: 10.1093/humrep/der400] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Subfertility shares common pathways with cardiovascular disease (CVD), including polycystic ovarian syndrome, obesity and thyroid disorders. Women with prior 0-1 pregnancies are at an increased risk of incident CVD when compared with women with two pregnancies. It is uncertain whether history of subfertility among women eventually giving birth is a risk factor for CVD. METHODS Among Swedish women with self-reported data on subfertility in the Swedish Medical Birth Register (n = 863 324), we used Cox proportional hazards models to relate a history of subfertility to CVD risk after adjustment for age, birth year, highest income, education, birth country, hypertension, diabetes, preterm birth, small for gestational age (SGA), smoking and for BMI in separate models. In additional analyses, we excluded women with: (i) pregnancy-related or non-pregnancy-related hypertension and/or diabetes; and (ii) preterm births and/or SGA babies. RESULTS Among nulliparous women eventually having a childbirth (between 1983 and 2005, the median follow-up time 11.9; 0-23 years and 9 906 621 person-years of follow-up), there was an increased risk of CVD among women reporting ≥ 5 years of subfertility versus 0 years (hazard ratio 1.19, 95% confidence interval 1.02-1.39). There were not significantly elevated CVD risks for women with 1-2 or 3-4 years of subfertility versus 0 years. Accounting for BMI did not change results. Excluding women with hypertension and/or diabetes attenuated associations, whereas exclusion of women with preterm and/or SGA births did not change findings. CONCLUSIONS Subfertility among women eventually having a childbirth is a risk factor for CVD even upon accounting for cardiovascular risk factors and adverse pregnancy outcomes. Future studies should explore the mechanisms underlying this association.
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Affiliation(s)
- Nisha I Parikh
- Division of Cardiology, Queen's Medical Center, John A. Burns School of Medicine, 1301 Punchbowl Street, Honolulu, HI 96813, USA.
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