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Udemgba C, Bravo-Jaimes K, Mejia MO, Oli PR, Shrestha DB, Dawadi S, Kadariya D, Velarde G. Differences in clinical presentation and outcomes in pregnancy-associated Takotsubo Syndrome- A scoping review of the literature: Outcomes in pregnancy-associated Takotsubo. Curr Probl Cardiol 2024; 49:102175. [PMID: 37913927 DOI: 10.1016/j.cpcardiol.2023.102175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 10/28/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Takotsubo syndrome (TS) during pregnancy and postpartum is rare but may lead to significant maternal and fetal morbidity. We compared clinical characteristics and prognosis according to [a] timing of presentation (pregnancy vs post-partum) and [b] modes of delivery (cesarean section vs vaginal delivery). METHODS Systematic review of articles published in PubMed, Scopus, Embase, and Medline databases from inception to July 30, 2023. Patient demographics, obstetric, electrocardiographic, laboratory, echocardiographic characteristics, and prognosis were summarized descriptively. RESULTS An initial database search identified 2162 articles, of which 81 studies were included in this review. TS during pregnancy can have emotional, obstetric, and metabolic triggers and has a higher proportion of adverse fetal outcomes when compared with women who developed TS postpartum. Women with TS after cesarean section had an earlier onset and higher proportion of anesthesia use when compared with those who developed TS after vaginal delivery. There were no differences regarding the degree of systolic dysfunction or the need for advanced therapies, including ventilator support, intra-aortic balloon pump, and extracorporeal membrane oxygenation among groups. CONCLUSIONS TS is associated with various triggers and adverse fetal outcomes when it develops during pregnancy than in the postpartum period. TS occurs more rapidly and with a more aggressive course after cesarean section than after vaginal delivery.
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Affiliation(s)
- Chinelo Udemgba
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL
| | | | - Miluska O Mejia
- Division of Cardiology, Rochester General Hospital, Rochester, NY
| | - Prakash Raj Oli
- Department of Internal Medicine, Province Hospital, Birendranagar, Surkhet, Nepal
| | | | - Sagun Dawadi
- Department of Internal Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Dinesh Kadariya
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL
| | - Gladys Velarde
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL.
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2
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Sarma AA, Paniagua SM, Lau ES, Wang D, Liu EE, Larson MG, Hamburg NM, Mitchell GF, Kizer J, Psaty BM, Allen NB, Lely AT, Gansevoort RT, Rosenberg E, Mukamal K, Benjamin EJ, Vasan RS, Cheng S, Levy D, Boer RADE, Gottdiener JS, Shah SJ, Ho JE. Multiple Prior Live Births Are Associated With Cardiac Remodeling and Heart Failure Risk in Women. J Card Fail 2023; 29:1032-1042. [PMID: 36638956 PMCID: PMC10333450 DOI: 10.1016/j.cardfail.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/15/2022] [Accepted: 12/15/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Greater parity has been associated with cardiovascular disease risk. We sought to find whether the effects on cardiac remodeling and heart failure risk are clear. METHODS We examined the association of number of live births with echocardiographic measures of cardiac structure and function in participants of the Framingham Heart Study (FHS) using multivariable linear regression. We next examined the association of parity with incident heart failure with preserved (HFpEF) or reduced (HFrEF) ejection fraction using a Fine-Gray subdistribution hazards model in a pooled analysis of n = 12,635 participants in the FHS, the Cardiovascular Health Study, the Multi-Ethnic Study of Atherosclerosis, and Prevention of Renal and Vascular Endstage Disease. Secondary analyses included major cardiovascular disease, myocardia infarction and stroke. RESULTS Among n = 3931 FHS participants (mean age 48 ± 13 years), higher numbers of live births were associated with worse left ventricular fractional shortening (multivariable β -1.11 (0.31); P = 0.0005 in ≥ 5 live births vs nulliparous women) and worse cardiac mechanics, including global circumferential strain and longitudinal and radial dyssynchrony (P < 0.01 for all comparing ≥ 5 live births vs nulliparity). When examining HF subtypes, women with ≥ 5 live births were at higher risk of developing future HFrEF compared with nulliparous women (HR 1.93, 95% CI 1.19-3.12; P = 0.008); by contrast, a lower risk of HFpEF was observed (HR 0.58, 95% CI 0.37-0.91; P = 0.02). CONCLUSIONS Greater numbers of live births are associated with worse cardiac structure and function. There was no association with overall HF, but a higher number of live births was associated with greater risk for incident HFrEF.
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Affiliation(s)
- Amy A Sarma
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Samantha M Paniagua
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Emily S Lau
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Dongyu Wang
- CardioVascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Elizabeth E Liu
- CardioVascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Martin G Larson
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA, USA
| | - Naomi M Hamburg
- Department of Medicine, Sections of Cardiology and Vascular Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Gary F Mitchell
- Department of Research, Cardiovascular Engineering, Norwood, MA, USA
| | - Jorge Kizer
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology and Health Services, University of Washington, Seattle, WA, USA; Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Norrina B Allen
- Department of Epidemiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - A Titia Lely
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Ronald T Gansevoort
- Division of Nephrology, Department of Medicine, University Medical Center Groningen, The Netherlands
| | - Emily Rosenberg
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Emelia J Benjamin
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA; Cardiovascular Medicine Section, Department of Medicine and Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA, USA
| | - Ramachandran S Vasan
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA; Cardiovascular Medicine Section, Department of Medicine and Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA, USA; Boston University Center for Computing and Data Sciences, Boston, MA, USA
| | - Susan Cheng
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel Levy
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA, USA
| | - Rudolf A DE Boer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands
| | | | - Sanjiv J Shah
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jennifer E Ho
- CardioVascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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3
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Association of Number of Live Births With Electrocardiographic and Cardiac Structural Changes. J Am Heart Assoc 2022; 11:e025805. [DOI: 10.1161/jaha.122.025805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background
Pregnancy is a major life event unique to women and leads to significant hemodynamic, hormonal, and metabolic changes. The purpose of this study was to use the DHS (Dallas Heart Study), a multiethnic population‐based cohort study of Dallas county adults, to evaluate the association between number of live births and cardiac magnetic resonance imaging and ECG parameters later in life.
Methods and Results
Women were included if they had data on self‐reported live births and ECG or cardiac magnetic resonance imaging measurements. The 3014 women were stratified by number of live births: 0, 1, 2, 3, 4, and ≥5. Higher number of live births was associated with larger left ventricular (LV) end‐diastolic volume (β, 1.31±0.41;
P
<0.01), LV end‐systolic volume (β, 0.83±0.24;
P
<0.01), and LV mass (β, 1.13±0.49;
P
=0.02) and lower LV ejection fraction (β, −0.004±0.0014;
P
<0.01). Increasing parity was associated with longer PR intervals (β, 1.07±0.38;
P
<0.01). Subgroup analysis by race demonstrated that the association between number of live births and magnetic resonance imaging parameters (LV end‐diastolic volume, LV end‐systolic volume, and LV ejection fraction) only remained significant in Black women (
P
value for interaction <0.05).
Conclusions
Increasing number of live births was associated with electrocardiographic and cardiac structural changes in a multiethnic population. When stratified by race and ethnicity, magnetic resonance imaging structural changes only remained significant in Black participants. Whether these changes are pathologic and increase the risk of heart failure or arrhythmias in multiparous women warrants further investigation.
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Pregnancy Complications, Cardiovascular Risk Factors, and Future Heart Disease. Obstet Gynecol Clin North Am 2020; 47:487-495. [PMID: 32762933 DOI: 10.1016/j.ogc.2020.04.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Heart disease is the leading cause of mortality in adult women. Beyond the traditional risk factors of obesity, diabetes, and hypercholesterolemia, women with the pregnancy complications of preeclampsia, gestational diabetes, prematurity, and low birth weight for gestational age (fetal growth restriction) are at higher risk for later development of cardiovascular disease. Education of women and providers about the association of pregnancy complications and cardiovascular disease should begin in the postpartum period. Postpartum cardiovascular risk screening and lifestyle modifications should be considered standard of care and are essential to improving cardiac health as a preventive strategy.
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Oliver-Williams C, Vladutiu CJ, Loehr LR, Rosamond WD, Stuebe AM. The Association Between Parity and Subsequent Cardiovascular Disease in Women: The Atherosclerosis Risk in Communities Study. J Womens Health (Larchmt) 2019; 28:721-727. [PMID: 30481103 PMCID: PMC6537113 DOI: 10.1089/jwh.2018.7161] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Previous studies are inconclusive on the relationship between parity and cardiovascular disease (CVD), with few evaluating multiple cardiovascular outcomes. It is also unclear if any relationship between parity and CVD is independent of breastfeeding. We examined the associations between parity and cardiovascular outcomes, including breastfeeding adjustment. Materials and Methods: Data were from 8,583 White and African American women, 45-64 years of age, in the Atherosclerosis Risk in Communities Study. Coronary heart disease (CHD), myocardial infarction (MI), heart failure, and strokes were ascertained from 1987 to 2016 by annual interviews and hospital surveillance. Parity and breastfeeding were self-reported. Cox proportional hazards regression estimated hazard ratios (HR) for the association between parity and cardiovascular outcomes, adjusting for baseline sociodemographic, clinical and lifestyle factors, and breastfeeding. Results: Women reported no pregnancies (6.0%), or having 0 (1.6%), 1-2 (36.2%), 3-4 (36.4%), or 5+ (19.7%) live births. During 30 years follow-up, there were 1,352 CHDs, 843 MIs, 750 strokes, and 1,618 heart failure events. Compared with women with 1-2 prior births, those with prior pregnancies and no live births had greater incident CHD (HR = 1.64, 95% confidence interval 1.14-2.42) and heart failure risk (1.46, 1.04-2.05), after adjustment for baseline characteristics. Women with 5+ births had greater risk of CHD (1.29, 1.10-1.52) and hospitalized MI (1.38, 1.13-1.69), after adjustment for baseline characteristics and breastfeeding. Conclusions: In a diverse U.S. cohort, a history of 5+ live births is associated with CHD risk, specifically, MI, independent of breastfeeding. Having a prior pregnancy and no live birth is associated with greater CHD and heart failure risk.
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Affiliation(s)
- Clare Oliver-Williams
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Homerton College, Hills Road, University of Cambridge, Cambridge, United Kingdom
| | - Catherine J. Vladutiu
- Department of Obstetrics & Gynecology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Laura R. Loehr
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Wayne D. Rosamond
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Alison M. Stuebe
- Department of Obstetrics & Gynecology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
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6
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Van Waateringe RP, Truyens L, Van Den Berg PP, Lutgers HL, Wolffenbuttel BHR. Skin autofluorescence, a non-invasive biomarker for advanced glycation end products, is not related to the number of pregnancies. J Diabetes 2018; 10:899-901. [PMID: 29774665 DOI: 10.1111/1753-0407.12782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 04/20/2018] [Accepted: 05/15/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Robert P Van Waateringe
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Paul P Van Den Berg
- Department of Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Helen L Lutgers
- Department of Internal Medicine, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Bruce H R Wolffenbuttel
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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7
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Parikh NI, Kapphahn K, Hedlin H, Olgin JE, Allison MA, Magnani JW, Ryckman KR, Waring ME, Perez MV, Howard BV. Effects of reproductive period duration and number of pregnancies on midlife ECG indices: a secondary analysis from the Women's Health Initiative Clinical Trial. BMJ Open 2018; 8:e019129. [PMID: 30121588 PMCID: PMC6104755 DOI: 10.1136/bmjopen-2017-019129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Pregnancy, menses and menopause are related to fluctuations in endogenous sex hormones in women, which cumulatively may alter cardiac electrical conduction. Therefore, we sought to study the association between number of pregnancies and reproductive period duration (RD, time from menarche to menopause) with ECG intervals in the Women's Health Initiative Clinical Trials. DESIGN Secondary analysis of multicentre clinical trial. SETTING USA. PRIMARY OUTCOME MEASURES ECGintervals: PR interval, P-wave duration, P-wave dispersion, QTc interval. PARTICIPANTS n=40 687 women (mean age=62 years) participating in the Women's Health Initiative Clinical Trials. 82.5% were white, 9.3% black, 4% Hispanic and 2.7% Asian. METHODS In primary analysis, we employed multivariable linear regression models relating number of pregnancies and RD with millisecond changes in intervals from enrolment ECG. We studied effect modification by hormone therapy use. RESULTS Among participants, 5+ live births versus 0 prior pregnancies was associated with a 1.32 ms increase in PR interval (95% CI 0.25 to 2.38), with a graded association with longer QTc interval (ms) (none (prior pregnancy, no live births)=0.66 (-0.56 to 1.88), 1=0.15 (-0.71 to 1.02), 2-4=0.25 (-0.43 to 0.94) and 5+ live births=1.15 (0.33 to 1.98), p=0.008). RD was associated with longer PR interval and maximum P-wave duration (but not P-wave dispersion) among never users of hormone therapy: (PR (ms) per additional RD year: 0.10 (0.04 to 0.16); higher P-wave duration (ms): 0.09 (0.06 to 0.12)). For every year increase in reproductive period, QTc decreased by 0.04 ms (-0.07 to -0.01). CONCLUSIONS An increasing number of live births is related to increased and RD to decreased ventricular repolarisation time. Both grand multiparity and longer RD are related to increased atrial conduction time. Reproductive factors that alter midlife cardiac electrical conduction system remodelling in women may modestly influence cardiovascular disease risk in later life. TRIAL REGISTRATION NUMBER NCT00000611; Post-results.
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Affiliation(s)
- Nisha I Parikh
- Division of Cardiology, University of California San Francisco, San Francisco, California, USA
| | - Kristopher Kapphahn
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Haley Hedlin
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jeffrey E Olgin
- Division of Cardiology, University of California San Francisco, San Francisco, California, USA
| | - Matthew A Allison
- Department of Family Medicine, University of California, San Diego, San Diego, California, USA
| | - Jared W Magnani
- Division of Cardiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Kelli R Ryckman
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Molly E Waring
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Marco Valentin Perez
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Barbara V Howard
- MedStar Health Research Institute, Hyattsville, Maryland, USA
- Georgetown and Howard Universities Center for Clinical and Translational Science, Washington, District of Columbia, USA
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8
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Parity, Job Strain, and Cardiovascular Risk in the Women’s Health Study. CURRENT CARDIOVASCULAR RISK REPORTS 2018. [DOI: 10.1007/s12170-018-0571-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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9
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Yang Q, Song C, Jiang J, Chen Y, Liang S, Ma N, Dong K, Nie W, Wang K. Association of reproductive history with hypertension and prehypertension in Chinese postmenopausal women: a population-based cross-sectional study. Hypertens Res 2017; 41:66-74. [DOI: 10.1038/hr.2017.86] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 04/11/2016] [Accepted: 06/07/2017] [Indexed: 11/09/2022]
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10
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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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11
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Aggarwal SR, Herrington DM, Vladutiu CJ, Newman JC, Swett K, Gonzalez F, Kizer JR, Kominiarek MA, Tabb KM, Gallo LC, Talavera GA, Hurwitz BE, Rodriguez CJ. Higher number of live births is associated with left ventricular diastolic dysfunction and adverse cardiac remodelling among US Hispanic/Latina women: results from the Echocardiographic Study of Latinos. Open Heart 2017; 4:e000530. [PMID: 28674618 PMCID: PMC5471863 DOI: 10.1136/openhrt-2016-000530] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 09/06/2016] [Accepted: 11/17/2016] [Indexed: 01/19/2023] Open
Abstract
Introduction Female sex is a risk factor for heart failure with preserved ejection fraction (HFpEF). Previous literature suggests that some diastolic dysfunction (DD) develops during pregnancy and may persist postdelivery. Our objective was to examine the relationship between parity and cardiac structure and function in a population-based cohort. Methods Participants included 1172 Hispanic/Latina women, aged ≥45 years, enrolled in the Echocardiographic Study of Latinos from four US communities (Bronx, Miami, San Diego and Chicago). Standard echocardiographic techniques were used to measure cardiac volumes, left ventricular mass, systolic and diastolic function. Using sampling weights and survey statistics, multivariable linear and logistic regression models were constructed adjusting for age, body mass index, diabetes or prediabetes, systolic blood pressure, use of antihypertensive medications, smoking, total cholesterol and high-density lipoprotein cholesterol. Results In the target population, 5.0% were nulliparous (no live births) and 10.5% were grand multiparous (≥5 live births). Among the nulliparous women, 46% had DD as compared with 51%–58% of women with 1–4 live births and 81% of women with ≥5 live births (p<0.01). In full multivariate models, higher parity was significantly associated with greater left ventricular end-systolic volumes, end-diastolic volumes, left atrial volume indices and presence of DD (all p<0.01) but was not associated with ejection fraction. The log odds for having any grade of DD in grand-multiparous women was over three times that seen in nulliparous women (OR=3.4, 95% CI 1.5 to 7.9, p<0.01) in models further adjusted for income and education. Conclusions Higher parity is associated with increased cardiac mass, volumes and the presence of DD. Further studies are needed to elucidate this apparent deleterious relation and whether parity can help explain the increased risk of HFpEF in women.
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Affiliation(s)
| | | | | | - Jill C Newman
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Katrina Swett
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Jorge R Kizer
- Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Karen M Tabb
- University of Illinois Urbana-Champaign, Urbana, Illinois, USA
| | - Linda C Gallo
- San Diego State University, San Diego, California, USA
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12
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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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13
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Salmoirago-Blotcher E, Dunsiger S, Swales HH, Aurigemma GP, Ockene I, Rosman L, Wittstein IS. Reproductive History of Women With Takotsubo Cardiomyopathy. Am J Cardiol 2016; 118:1922-1928. [PMID: 27742423 DOI: 10.1016/j.amjcard.2016.08.083] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 08/19/2016] [Accepted: 08/19/2016] [Indexed: 10/21/2022]
Abstract
Takotsubo cardiomyopathy (TC) occurs predominantly in postmenopausal women, suggesting a possible role of reproductive and hormonal factors in the pathophysiology of this condition. Yet reproductive characteristics of women with TC have received limited attention. This prospective case-control study sought to explore reproductive characteristics associated with TC. Incident TC cases and myocardial infarction (MI) controls were recruited among consecutive women presenting at the emergency departments of 2 large medical centers in Massachusetts and Connecticut. Female healthy controls were recruited from a registry of research volunteers. Information about reproductive history was collected 1 month after discharge using standardized questionnaires completed during phone interviews. Linear and logistic regression models were used to estimate associations with reproductive factors. From March 2013 to October 2015, 209 women were screened for eligibility and 107 (45 TC, 32 MI, and 30 healthy controls) were enrolled. Conditions uniquely associated with TC were a history of irregular menses (adjusted OR, TC vs MI 8.30; 95% CI 1.01 to 69.18), number of pregnancies (adjusted β coefficient 0.69; SE 0.35, p = 0.05), and use of post-menopausal hormone replacement therapy (OR 5.79; CI 1.20 to 28.02). We did not find associations with history of infertility, breastfeeding, hysterectomy or oophorectomy, oral contraceptive use, and age at menopause. In conclusion, our findings suggest that premenopausal reproductive factors may play an important role in the onset of TC at a later age. These results need to be confirmed in future studies with larger populations.
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Three-Dimensional Rotation, Twist and Torsion Analyses Using Real-Time 3D Speckle Tracking Imaging: Feasibility, Reproducibility, and Normal Ranges in Pediatric Population. PLoS One 2016; 11:e0158679. [PMID: 27427968 PMCID: PMC4948847 DOI: 10.1371/journal.pone.0158679] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 06/20/2016] [Indexed: 01/19/2023] Open
Abstract
Background and Objective The specific aim of this study was to evaluate the feasibility, reproducibility and maturational changes of LV rotation, twist and torsion variables by real-time 3D speckle-tracking echocardiography (RT3DSTE) in children. Methods A prospective study was conducted in 347 consecutive healthy subjects (181 males/156 females, mean age 7.12 ± 5.3 years, and range from birth to 18-years) using RT 3D echocardiography (3DE). The LV rotation, twist and torsion measurements were made off-line using TomTec software. Manual landmark selection and endocardial border editing were performed in 3 planes (apical “2”-, “4”-, and “3”- chamber views) and semi-automated tracking yielded LV rotation, twist and torsion measurements. LV rotation, twist and torsion analysis by RT 3DSTE were feasible in 307 out of 347 subjects (88.5%). Results There was no correlation between rotation or twist and age, height, weight, BSA or heart rate, respectively. However, there was statistically significant, but very modest correlation between LV torsion and age (R2 = 0.036, P< 0.001). The normal ranges were defined for rotation and twist in this cohort, and for torsion for each age group. The intra-observer and inter-observer variabilities for apical and basal rotation, twist and torsion ranged from 7.3% ± 3.8% to 12.3% ± 8.8% and from 8.8% ± 4.6% to 15.7% ± 10.1%, respectively. Conclusions We conclude that analysis of LV rotation, twist and torsion by this new RT3D STE is feasible and reproducible in pediatric population. There is no maturational change in rotation and twist, but torsion decreases with age in this cohort. Further refinement is warranted to validate the utility of this new methodology in more sensitive and quantitative evaluation of congenital and acquired heart diseases in children.
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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: 103] [Impact Index Per Article: 11.4] [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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Jing MJ, Wang JJ, Lin WQ, Lei YX, Wang PX. A community-based cross-sectional study of fatigue in middle-aged and elderly women. J Psychosom Res 2015; 79:288-94. [PMID: 26028605 DOI: 10.1016/j.jpsychores.2015.05.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 05/12/2015] [Accepted: 05/13/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Fatigue has been widely studied in the general population; however, limited studies have investigated it in the female population. The objectives of this community-based study were to (1) investigate the prevalence of fatigue, (2) explore the relationship between gynecological history and experiences of fatigue, and (3) identify risk factors for fatigue in middle-aged and elderly women. METHODS Based on a cross-sectional health study that employed a multi-instrument questionnaire, 1272 women aged 45years or older dwelling in the community were included. The Chinese version of Chalder Fatigue Scale (CFS) was used to assess fatigue, and socio-demographic, health-related, and gynecological data were also collected. Fatigue was defined as a total CFS score≥4. RESULTS The prevalence of fatigue among women aged over 45years was 33.9%. Multivariate logistic regression analysis identified that older age, single marital status, lower education level, the presence of chronic diseases, underweight, hospitalization in the last year, postmenopause, and a higher number of live births were associated with an increased risk of fatigue (P<0.05). CONCLUSIONS Our results indicated that fatigue was common in middle-aged and elderly females. Being postmenopausal and having more than three live births were the particular gynecological factors contributing to fatigue in the general population.
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Affiliation(s)
- Meng-Juan Jing
- Institute of Public Health, School of Nursing, Henan University, Kaifeng, China.
| | - Jia-Ji Wang
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, China.
| | - Wei-Quan Lin
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, China.
| | - Yi-Xiong Lei
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, China.
| | - Pei-Xi Wang
- Institute of Public Health, School of Nursing, Henan University, Kaifeng, China; Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, China.
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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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18
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Mahendru AA, Morris E. Cardiovascular disease in menopause: Does the obstetric history have any bearing? ACTA ACUST UNITED AC 2013; 19:115-20. [DOI: 10.1177/1754045313495675] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cardiovascular disease remains a leading cause of morbidity and mortality in menopausal women in spite of the overall reduction in age-adjusted mortality from the disease in the last few years. It is now clear that mechanisms of cardiovascular disease in menopausal women are similar to men and rather than midlife acceleration of cardiovascular disease in women, the final impact of cardiovascular disease in later life may be a reflection of cardiovascular changes during reproductive years as a result of woman’s obstetric history. A decade after the Women’s Health Initiative trial, there is upcoming evidence to suggest that hormone replacement therapy in young recently menopausal women has a cardioprotective effect. Cardiovascular changes during normal pregnancy or pregnancy complications such as preeclampsia may affect a woman’s long-term cardiovascular health. Therefore, it is plausible that the cardioprotective benefit of hormone replacement therapy depends on occult pre-existing cardiovascular risks in women in relation to their previous obstetric history. In this review, we describe the cardiovascular changes during and after pregnancy in obstetric complications such as recurrent miscarriage, preeclampsia, intrauterine growth restriction, preterm labour and gestational diabetes; existing evidence regarding their association with cardiovascular disease later in life, and hypothesize possible mechanisms. Our aim is to improve the understanding and highlight the importance of including obstetric history in risk assessment in menopausal women and individualizing their risks before prescribing hormone replacement therapy. Future research in risk benefit assessment of hormone replacement therapy should also account for a woman’s background cardiovascular risk in the light of her obstetric history.
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Affiliation(s)
- Amita A Mahendru
- Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Edward Morris
- Norfolk and Norwich University Hospital, Norwich, UK
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Conti E, Zezza L, Ralli E, Caserta D, Musumeci MB, Moscarini M, Autore C, Volpe M. Growth factors in preeclampsia: a vascular disease model. A failed vasodilation and angiogenic challenge from pregnancy onwards? Cytokine Growth Factor Rev 2013; 24:411-25. [PMID: 23800655 DOI: 10.1016/j.cytogfr.2013.05.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 04/30/2013] [Accepted: 05/21/2013] [Indexed: 12/25/2022]
Abstract
Preeclampsia is the major cause of maternofetal and neonatal morbi-mortality including intrauterine growth retardation, miscarriages and stillbirths. Inadequate vascular dilation and angiogenesis represent the crucial underlying defect of gravidic hypertension, denoting a failed response to the vasodilatory and pro-angiogenic challenge imposed by pregnancy, especially if multifetal. A similar pathogenesis appears involved in gestational diabetes. In this review we aimed to provide a hint on understanding the deeply involved angiogenic disorders which eventually culminate in utero-placental failure. The key players in these complex processes may be found in an intricate network of growth factors (GFs) and GF inhibitors, controlled by several vascular risk factors modulated by environment and genes, which eventually impact on early and late cardiovascular outcomes of mother and fetus.
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Affiliation(s)
- E Conti
- Cardiology, Clinical and Molecular Medicine Department, "Sapienza" University of Rome, Italy.
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