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Chen T, Wu J, Pan Q, Dong M. The association of female reproductive factors with history of cardiovascular disease: a large cross-sectional study. BMC Public Health 2024; 24:1616. [PMID: 38886693 PMCID: PMC11181605 DOI: 10.1186/s12889-024-19130-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 06/13/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND This study aimed to explore the association of female reproductive factors (age at first birth (AFB), age at last birth (ALB), number of pregnancies, and live births) with history of cardiovascular disease (CVD). METHODS A total of 15,715 women aged 20 years or over from the National Health and Nutrition Examination Surveys from 1999 to 2018 were included in our analysis. Weighted multivariable logistic regression analysis and restricted cubic spline (RCS) model were used to evaluate the association of AFB and ALB with history of CVD in women. Additionally, the relationship between the number of pregnancies, and live births and history of CVD was also explored. RESULTS After adjusting for potential confounding factors, the RCS plot showed a U-curve relationship between AFB, ALB and history of CVD. Among them, AFB was associated with congestive heart failure (CHF), heart attack, and stroke in a U-shaped curve. Additionally, this U-shaped correlation also exists between ALB and CHF and stroke. However, the number of pregnancies and live births was liner positive associated with history of CVD, including coronary heart disease, CHF, angina pectoris, heart attack, and stroke. CONCLUSIONS Women with younger or later AFB and ALB have higher odds of CVD in later life. Further study is warranted to verify the underlying mechanisms of this association.
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Affiliation(s)
- Tiehan Chen
- Department of Internal Medicine, Lianyungang Maternal and Child Health Hospital, Lianyungang, Jiangsu, 222000, China.
| | - Jingwen Wu
- Department of Cardiology, Lianyungang First People's Hospital, Lianyungang, Jiangsu, 222000, China
| | - Qinyuan Pan
- Department of Intensive Care Unit, Lianyungang First People's Hospital, Lianyungang, Jiangsu, 222000, China
| | - Mingmei Dong
- Department of Internal Medicine, Lianyungang Maternal and Child Health Hospital, Lianyungang, Jiangsu, 222000, China
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Sun W, Shan S, Hou L, Li S, Cao J, Wu J, Yi Q, Luo Z, Song P. Socioeconomic disparities in the association of age at first live birth with incident stroke among Chinese parous women: A prospective cohort study. J Glob Health 2024; 14:04091. [PMID: 38587297 PMCID: PMC11000532 DOI: 10.7189/jogh.14.04091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
Background Stroke has become a significant public health issue in China. Although studies have shown that women's age at first live birth (AFLB) might be associated with incident stroke, there is limited evidence on this relationship among Chinese parous women. Likewise, the nature of this association across urban-rural socioeconomic status (SES) has yet to be explored. In this prospective study, we sought to investigate the associations of women's AFLB with the risk of incident stroke and its subtypes (ischaemic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage) and to explore the differences of these associations as well as the population-level impacts across SES classes. Methods We used data on 290 932 Chinese parous women from the China Kadoorie Biobank who were recruited in the baseline survey between 2004 and 2008 and followed up until 2015. We used latent class analysis to identify urban-rural SES classes and Cox proportional hazard regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for AFLB's association with incident stroke. We then calculated population attributable fraction (PAF) to demonstrate the population-level impact of later AFLB on stroke. Results Around 8.9% of parous women developed stroke after AFLB. Compared with women with AFLB <22 years, those with older AFLB had a higher risk of total stroke, with fully adjusted HRs (95% CI) of 1.71 (95% CI = 1.65-1.77) for 22-24 years and 3.37 (95% CI = 3.24-3.51) for ≥25 years. The associations of AFLB with ischaemic stroke were stronger among rural-low-SES participants. We found the highest PAFs of ischaemic stroke (60.1%; 95% CI = 46.2-70.3) associated with later AFLB for urban-high-SES individuals. Conclusions Older AFLB was associated with higher risks of incident stroke and its subtypes among Chinese parous women, with stronger associations between AFLB and ischaemic stroke among rural-low-SES participants. Targeted medical advice for pregnant women of different ages could have long-term benefits for stroke prevention.
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Appiah D, Kim C, Fuquay T, de Riese C, Ebong IA, Nwabuo CC. Maternal age at birth of last child and cardiovascular disease mortality later in life among a national cohort of postmenopausal women from the United States. Menopause 2023; 30:393-400. [PMID: 36749913 DOI: 10.1097/gme.0000000000002158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Abstract
Maternal age at last birth of child is increasing in the United States, and it has been reported to influence future chronic diseases. In this study of nationally-representative sample of postmenopausal women, there was no conclusive association between maternal age at last birth of child and cardiovascular disease mortality later in life.
Objective
Maternal age at last birth (ALB) of child is increasing in the United States, and it has been reported to influence future chronic diseases. However, the relationship of ALB and cardiovascular disease (CVD) events later in life has not been widely studied. We evaluated the association of ALB with CVD mortality.
Methods
Data were from 7,971 parous postmenopausal women older than 45 years who participated in the US National Health and Nutritional Examination Survey from 1999 to 2018 and had mortality follow-up data through to December 31, 2019. ALB was self-reported, whereas CVD mortality was assessed using International Classification of Diseases codes. Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI).
Results
The mean age of participants was 63 ± 9.8 years, with 9.5% being non-Hispanic Black, 9.7% being Hispanic women, and 21% reporting ALB ≥35 years. During a median follow-up of 8.1 years, 443 participants died from CVD. In age-adjusted models, CVD mortality was elevated for women with ALB of <25 years (HR, 1.68; 95% CI, 1.23-2.29) and ALB of ≥35 years (HR, 1.37; 95% CI, 1.00-1.88). However, after additional adjustment for race and ethnicity, foreign born, education, marital status, poverty income ratio, parity, smoking status, age at menarche, oral contraceptive pills use and family history of myocardial infarction, these estimates were attenuated resulting in no association between ALB and CVD mortality.
Conclusions
In this study of nationally representative sample of postmenopausal women, there was no conclusive association between maternal ALB and CVD mortality later in life.
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Affiliation(s)
- Duke Appiah
- From the Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Catherine Kim
- Department of Obstetrics & Gynecology, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Taylor Fuquay
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Cornelia de Riese
- Departments of Medicine and Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Imo A Ebong
- Division of Cardiovascular Sciences, University of California, Davis, Sacramento, CA
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Barral S, Andersen SL, Perls TT, Bae H, Sebastiani P, Christensen K, Thyagarajan B, Lee J, Schupf N. Association between late maternal age and age-related endophenotypes in the Long Life Family Study. Neurosci Lett 2022; 784:136737. [PMID: 35709880 PMCID: PMC11061875 DOI: 10.1016/j.neulet.2022.136737] [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: 05/06/2022] [Revised: 06/02/2022] [Accepted: 06/10/2022] [Indexed: 11/28/2022]
Abstract
Extended maternal age has been suggested as marker of delayed age-associated disabilities. We use the Long Life Family Study (LLFS) offspring generation to investigate the association between extended maternal age at last childbirth and healthy-aging endophenotypes. We hypothesize that women with extended maternal age at last childbirth will exhibit healthier endophenotype profiles compared to younger mothers. The association between maternal age and age-related endophenotypes previously derived in LLFS was assessed using Generalized Estimating Equations to adjust for relatedness. The quartiles of the maternal age at last childbirth were modeled as the independent variables. Univariate analyses tested the association between maternal age at last childbirth and age at clinical assessment, education, field center, Apolipoprotein E (APOE) genotype, depression, stress, smoking and successful pregnancies. Only the variables significantly associated in the univariate analyses were considered in secondary multivariate analyses. Univariate analyses showed that compared to older mothers (age at last birth ≥35), mothers 30 years old or younger at last childbirth are less educated (12 ± 3 years versus 13 ± 3 years) and have a higher frequency of smoking (9% versus 3% for maternal age ≥35). Results showed that older mothers (age at last birth ≥31-34 or ≥ 35) demonstrated significantly better cognitive profiles (p = 0.017 and p = 0.021 respectively) compared with mothers with last childbirth age ≤30. Later maternal age among women from long-life families is associated with a better cognitive profile, supporting the hypothesis that later age at childbirth may be a marker for healthy aging.
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Affiliation(s)
- Sandra Barral
- The Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA; G.H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA; The Department of Neurology, Columbia University Medical Center, New York, NY, USA.
| | - Stacy L Andersen
- Boston University School of Medicine, Department of Medicine, Boston, MA, USA
| | - Thomas T Perls
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Harold Bae
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University Corvallis, OR, USA
| | - Paola Sebastiani
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Kaare Christensen
- University of Southern Denmark, Odense, Denmark, Department of Epidemiology, Biostatistics and Biodemography, Odense, Denmark
| | - Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Joseph Lee
- The Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA; G.H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA; The Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Nicole Schupf
- The Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA; G.H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA; The Department of Neurology, Columbia University Medical Center, New York, NY, USA; The Department of Epidemiology, Joseph P. Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
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