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Peled T, Weiss A, Hochler H, Sela HY, Lipschuetz M, Karavani G, Grisaru-Granovsky S, Rottenstreich M. Perinatal outcomes in grand multiparous women stratified by parity- A large multicenter study. Eur J Obstet Gynecol Reprod Biol 2024; 300:164-170. [PMID: 39008920 DOI: 10.1016/j.ejogrb.2024.07.021] [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: 03/18/2024] [Revised: 06/18/2024] [Accepted: 07/09/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVE To assess the effect of each additional delivery among grand multiparous (GMP) women on maternal and neonatal outcomes. METHODS A multi-center retrospective cohort study that examined maternal and neonatal outcomes of GMP women (parity 5-10, analyzed separately for each parity level) compared to a reference group of multiparous women (parity 2-4). The study population included grand multiparous women with singleton gestation who delivered in one of four university-affiliated obstetrical centers in a single geographic area, between 2003 and 2021. We excluded nulliparous, those with parity > 10 (due to small sample sizes), women with previous cesarean deliveries (CDs), multifetal gestations, and out-of-hospital deliveries. The primary outcome of this study was postpartum hemorrhage (PPH, estimated blood loss exceeding 1000 ml, and/or requiring blood product transfusion, and/or a hemoglobin drop > 3 g/Dl). Secondary outcomes included unplanned cesarean deliveries, preterm delivery, along with other adverse maternal and neonatal outcomes. Univariate analysis was followed by multivariable logistic regression. RESULTS During the study period, 251,786 deliveries of 120,793 patients met the inclusion and exclusion criteria. Of those, 173,113 (69%) were of parity 2-4 (reference group), 27,894 (11%) were of parity five, 19,146 (8%) were of parity six, 13,115 (5%) were of parity seven, 8903 (4%) were of parity eight, 5802 (2%) were of parity nine and 3813 (2%) were of parity ten. GMP women exhibited significantly higher rates of PPH starting from parity eight. The adjusted odds ratios (aOR) were 1.19 (95 % CI: 1.06-1.34) for parity 8, 1.17 (95 % CI: 1.01-1.36) for parity 9, and 1.39 (95 % CI: 1.18-1.65) for parity 10. Additionally, they showed elevated rates of several maternal and neonatal outcomes, including placental abruption, large-for-gestational age (LGA) neonates, neonatal hypoglycemia, and neonatal seizures. Conversely, they exhibited decreased risk for other adverse maternal outcomes, including preterm deliveries, unplanned cesarean deliveries (CDs), vacuum-assisted delivery, and third- or fourth-degree perineal tears and small-for-gestational age (SGA) neonates. The associations with neonatal hypoglycemia, and neonatal seizure were correlated with the number of deliveries in a dose-dependent manner, demonstrating that each additional delivery was associated with an additional, significant impact on obstetrical complications. CONCLUSION Our study demonstrates that parity 8-10 is associated with a significantly increased risk of PPH. Parity level > 5 correlated with increased odds of placental abruption, LGA neonates, neonatal hypoglycemia, and neonatal seizures. However, GMP women also demonstrated a reduced likelihood of certain adverse maternal outcomes, including unplanned cesarean, preterm deliveries, vacuum-assisted deliveries, SGA neonates, and severe perineal tears. These findings highlight the importance of tailored obstetrical care for GMP women to mitigate the elevated risks associated with higher parity.
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Affiliation(s)
- Tzuria Peled
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Ari Weiss
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Hila Hochler
- Department of Obstetrics and Gynecology, Laniado Medical Center, Netanya, Israel; Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Hen Y Sela
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Michal Lipschuetz
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Henrietta Szold Hadassah Hebrew University School of Nursing in the Faculty of Medicine Jerusalem, Israel
| | - Gilad Karavani
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Misgav Rottenstreich
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel; Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel.
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Berbrier DE, Adler TE, Leone CA, Paidas MJ, Stachenfeld NS, Usselman CW. Blood pressure responses to handgrip exercise but not apnea or mental stress are enhanced in women with a recent history of preeclampsia. Am J Physiol Heart Circ Physiol 2024; 327:H140-H154. [PMID: 38700469 DOI: 10.1152/ajpheart.00020.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/29/2024] [Accepted: 04/29/2024] [Indexed: 05/05/2024]
Abstract
Preeclampsia is a risk factor for future cardiovascular diseases. However, the mechanisms underlying this association remain unclear, limiting effective prevention strategies. Blood pressure responses to acute stimuli may reveal cardiovascular dysfunction not apparent at rest, identifying individuals at elevated cardiovascular risk. Therefore, we compared blood pressure responsiveness with acute stimuli between previously preeclamptic (PPE) women (34 ± 5 yr old, 13 ± 6 mo postpartum) and women following healthy pregnancies (Ctrl; 29 ± 3 yr old, 15 ± 4 mo postpartum). Blood pressure (finger photoplethysmography calibrated to manual sphygmomanometry-derived values; PPE: n = 12, Ctrl: n = 12) was assessed during end-expiratory apnea, mental stress, and isometric handgrip exercise protocols. Integrated muscle sympathetic nerve activity (MSNA) was assessed in a subset of participants (peroneal nerve microneurography; PPE: n = 6, Ctrl: n = 8). Across all protocols, systolic blood pressure (SBP) was higher in PPE than Ctrl (main effects of group all P < 0.05). Peak changes in SBP were stressor specific: peak increases in SBP were not different between PPE and Ctrl during apnea (8 ± 6 vs. 6 ± 5 mmHg, P = 0.32) or mental stress (9 ± 5 vs. 4 ± 7 mmHg, P = 0.06). However, peak exercise-induced increases in SBP were greater in PPE than Ctrl (11 ± 5 vs. 7 ± 7 mmHg, P = 0.04). MSNA was higher in PPE than Ctrl across all protocols (main effects of group all P < 0.05), and increases in peak MSNA were greater in PPE than Ctrl during apnea (44 ± 6 vs. 27 ± 14 burst/100 hb, P = 0.04) and exercise (25 ± 8 vs. 13 ± 11 burst/100 hb, P = 0.01) but not different between groups during mental stress (2 ± 3 vs. 0 ± 5 burst/100 hb, P = 0.41). Exaggerated pressor and sympathetic responses to certain stimuli may contribute to the elevated long-term risk for cardiovascular disease in PPE.NEW & NOTEWORTHY Women with recent histories of preeclampsia demonstrated higher systolic blood pressures across sympathoexcitatory stressors relative to controls. Peak systolic blood pressure reactivity was exacerbated in previously preeclamptic women during small muscle-mass exercises, although not during apneic or mental stress stimuli. These findings underscore the importance of assessing blood pressure control during a variety of experimental conditions in previously preeclamptic women to elucidate mechanisms that may contribute to their elevated cardiovascular disease risk.
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Affiliation(s)
- Danielle E Berbrier
- Cardiovascular Health and Autonomic Regulation Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Tessa E Adler
- Cardiovascular Health and Autonomic Regulation Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
- The John B. Pierce Laboratory, Yale School of Medicine, New Haven, Connecticut, United States
| | - Cheryl A Leone
- The John B. Pierce Laboratory, Yale School of Medicine, New Haven, Connecticut, United States
| | - Michael J Paidas
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, United States
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Nina S Stachenfeld
- The John B. Pierce Laboratory, Yale School of Medicine, New Haven, Connecticut, United States
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, United States
| | - Charlotte W Usselman
- Cardiovascular Health and Autonomic Regulation Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
- The John B. Pierce Laboratory, Yale School of Medicine, New Haven, Connecticut, United States
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Mulder JW, Kusters DM, Roeters van Lennep JE, Hutten BA. Lipid metabolism during pregnancy: consequences for mother and child. Curr Opin Lipidol 2024; 35:133-140. [PMID: 38408036 PMCID: PMC11064913 DOI: 10.1097/mol.0000000000000927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
PURPOSE OF REVIEW Accommodating fetal growth and development, women undergo multiple physiological changes during pregnancy. In recent years, several studies contributed to the accumulating evidence about the impact of gestational hyperlipidemia on cardiovascular risk for mother and child. This review aims to provide a comprehensive overview of the current research on lipid profile alterations during pregnancy and its associated (cardiovascular) outcomes for mother and child from a clinical perspective. RECENT FINDINGS In a normal pregnancy, total and LDL-cholesterol levels increase by approximately 30-50%, HDL-cholesterol by 20-40%, and triglycerides by 50-100%. In some women, for example, with familial hypercholesterolemia (FH), a more atherogenic lipid profile is observed. Dyslipidemia during pregnancy is found to be associated with adverse (cardiovascular) outcomes for the mother (e.g. preeclampsia, gestational diabetes, metabolic syndrome, unfavorable lipid profile) and for the child (e.g. preterm birth, large for gestational age, preatherosclerotic lesions, unfavorable lipid profile). SUMMARY The lipid profile of women during pregnancy provides a unique window of opportunity into the potential future cardiovascular risk for mother and child. Better knowledge about adverse outcomes and specific risk groups could lead to better risk assessment and earlier cardiovascular prevention. Future research should investigate implementation of gestational screening possibilities.
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Affiliation(s)
- Janneke W.C.M. Mulder
- Department of Internal Medicine, Erasmus MC Cardiovascular Institute, University Medical Center Rotterdam, Rotterdam
| | | | - Jeanine E. Roeters van Lennep
- Department of Internal Medicine, Erasmus MC Cardiovascular Institute, University Medical Center Rotterdam, Rotterdam
| | - Barbara A. Hutten
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, University of Amsterdam
- Amsterdam Cardiovascular Sciences Research Institute, Diabetes & Metabolism, Amsterdam, The Netherlands
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Hanna M, Wabnitz A, Grewal P. Sex and stroke risk factors: A review of differences and impact. J Stroke Cerebrovasc Dis 2024; 33:107624. [PMID: 38316283 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107624] [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: 09/01/2023] [Revised: 12/24/2023] [Accepted: 02/02/2024] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVES There is an increase in stroke incidence risk over the lifetime of women, given their longer life expectancy. However, an alarming trend for sex disparities, particularly in certain stroke risk factors, shows a concerning need for focus on sex differences in stroke prevention and treatment for women. In this article, we are addressing sex differences in both traditional and sex-specific stroke risk factors. METHODS We searched PubMed from inception to December 2022 for articles related to sex differences and risk factors for stroke. We reviewed full-text articles for relevance and ultimately included 152 articles for this focused review. RESULTS Women are at increased risk for stroke from both traditional and non-traditional stroke risk factors. As women age, they have a higher disease burden of atrial fibrillation, increased risk of stroke related to diabetes, worsening lipid profiles, and higher prevalence of hypertension and obesity compared to men. Further, women carry sex hormone-specific risk factors for stroke, including the age of menarche, menopause, pregnancy, and its complications, as well as hormonal therapy. Men have a higher prevalence of tobacco use and atrial fibrillation, as well as an increased risk for stroke related to hyperlipidemia. Additionally, men have sex-specific risks related to low testosterone levels. CONCLUSIONS By identifying biological sex-specific risk factors for stroke, developing robust collaborations, researching, and applying the knowledge for risk reduction strategies, we can begin to tailor prevention and reduce the global burden of stroke morbidity and mortality.
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Affiliation(s)
- Mckay Hanna
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Ashley Wabnitz
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Parneet Grewal
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, United States.
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Søndergaard SH, Kamper-Jørgensen M. Pregnancy, cardiovascular health, and microchimerism. Curr Opin Lipidol 2024; 35:7-13. [PMID: 37982290 DOI: 10.1097/mol.0000000000000914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
PURPOSE OF REVIEW To provide an updated review of scientific literature concerning associations between pregnancy and cardiovascular health among women, and to discuss a possible impact of microchimerism on the association. RECENT FINDINGS In most studies, pregnancy and childbirth is associated with increased risk of cardiovascular disease in women. Some ascribe the association mainly to lifestyle, whereas others suggest that pregnancy itself negatively affects women's cardiovascular health. Pregnancy is a natural source of microchimerism, which in turn markedly affects female health. The only study published in the area surprisingly shows that among middle-aged women, male-origin microchimerism (MOM) is associated with half the risk of developing ischemic heart disease (IHD). No similar association is found between MOM and ischemic stroke. SUMMARY The sparse evidence published suggests reduced risk of developing IHD among MOM-positive women. Despite the association being biologically plausible, replication of the findings is warranted to support that this is not a chance finding.
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Affiliation(s)
- Sara Hallum Søndergaard
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen K, Denmark
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d'Errico A, Fontana D, Sacerdote C, Ardito C. Child rearing or childbearing? Risk of cardiovascular diseases associated to parity and number of children. BMC Public Health 2024; 24:272. [PMID: 38263016 PMCID: PMC10804732 DOI: 10.1186/s12889-023-17119-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/31/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND An increased risk of cardiovascular diseases (CVD) has been associated with women's parity, but whether or not this association reflects a direct pregnancy effect, or exposure to factors related to childrearing, still appears unclear. We assessed the CVD risk associated with number of children separately by gender and tested effect modification by socioeconomic position (SEP) and employment status, in order to elucidate the possible mechanisms underlying this association. METHODS The study population was composed of 20,904 men and 25,246 women who were interviewed in one of two National Health Surveys conducted in 2000 and 2005 in Italy. These subjects were followed for CVD incidence up to 2014 through record-linkage with national archives of mortality and hospitalisations. CVD risk was estimated by Cox regression models that were adjusted for socio-demographics, perceived health, lifestyles, biological CVD risk factors and for other potential confounders. RESULTS CVD incidence was significantly increased among men with 3 or more children (HR = 1.26, 95% CI: 1.02-1.56) and among women with 2 and with 3 or more children (HR = 1.42, 95% CI: 1.10-1.83; and HR = 1.39, 95% CI: 1.03-1.87, respectively) compared to subjects without children and no significant gender differences were observed. Subjects with lower SEP displayed stronger associations with parity and a higher number of children for both genders; by contrast, no modifying effect of employment status was observed. CONCLUSIONS Taken together, the significant association between higher parity and CVD risk in both genders, and the higher risk of CVD associated with higher parity among lower SEP parents, suggests that childrearing has a potential effect on the development of CVD that is more pronounced among disadvantaged families, although a concurrent effect of childbearing cannot be completely excluded.
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Affiliation(s)
- Angelo d'Errico
- Epidemiology Unit Piedmont Region ASL TO3, Grugliasco (TO), Italy
| | - Dario Fontana
- Epidemiology Unit Piedmont Region ASL TO3, Grugliasco (TO), Italy
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, University of Turin, Turin, Italy
- Centre for Cancer Epidemiology and Prevention (CPO Piemonte), Turin, Italy
| | - Chiara Ardito
- Competence Centre On Microeconomic Evaluation (CC-ME), European Commission, Joint Research Centre (JRC), Ispra, Italy.
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Seyyed-Mohammadzad M, Kavandi D, Jalili M, Ghodratizadeh S, Mikaeilvand A, Sakha H, Hajizadeh R. Association between parities and duration of breastfeeding and the severity of coronary artery disease in women above 30 years old age (A pilot study). CASPIAN JOURNAL OF INTERNAL MEDICINE 2024; 15:430-438. [PMID: 39011428 PMCID: PMC11246674 DOI: 10.22088/cjim.15.3.430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/22/2023] [Accepted: 09/27/2023] [Indexed: 07/17/2024]
Abstract
Background The prevalence and mortality of CVD in women increase over time. We conducted this research to evaluate the severity of coronary artery disease with the number of live births and breastfeeding duration. Methods Patients aged 30-50 years old with positive exercise tests or evidence of cardiac ischemia who were candidates for coronary angiography were included. All the participants had at least one child. Syntax score was used to evaluate the severity of coronary arteries. Results Mean number of children was 3.72±1.85, in those patients with <2 live births no one had a syntax score≥1, but in the>5 live births group most patients had a syntax score≥1. In patients with zero syntax score, it was estimated as 4.91±39.7; in patients with 1≤ syntax score, it was 4.48±7.29 (P =0.76). Among patients with > 5 birth lives, those with higher syntax scores had older ages (P=0.497). After adjusting age, the association between live births and syntax score became non-significant (P=0.850). Conclusion By increasing the number of live births >5, the severity of coronary artery disease, increases. However, this association was not significant after adjusting the age of patients.
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Affiliation(s)
| | - Dorsa Kavandi
- Student Research Committee, Zanjan University of Medical Sciences, Urmia, Iran
| | - Mohammad Jalili
- Department of Cardiology, Urmia University of Medical Sciences, Urmia, Iran
| | - Sahar Ghodratizadeh
- Department of Anesthesiology, Urmia University of Medical Sciences, Urmia, Iran
| | - Amir Mikaeilvand
- Department of Cardiology, Urmia University of Medical Sciences, Urmia, Iran
| | - Hanieh Sakha
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Hajizadeh
- Department of Cardiology, Urmia University of Medical Sciences, Urmia, Iran
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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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Bonner AN, Jayawickreme S, Malek AM, Vladutiu CJ, Oliver-Williams C, Cortés YI, Tanaka H, Meyer ML. Number of prior live births is associated with higher arterial stiffness but not its change in older women: the atherosclerosis risk in communities study. Front Cardiovasc Med 2023; 10:1172828. [PMID: 37288258 PMCID: PMC10242178 DOI: 10.3389/fcvm.2023.1172828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/27/2023] [Indexed: 06/09/2023] Open
Abstract
Introduction Although studies have demonstrated a J-shaped association between parity and cardiovascular disease (CVD), the association with arterial stiffness is not fully understood. Methods We examined the association between parity and carotid-femoral pulse wave velocity (cfPWV), a measure of central arterial stiffness. We conducted a longitudinal analysis of 1220 women (mean age 73.7 years) who attended the Atherosclerosis Risk in Communities Study visit 5 (2011-2013). At visit 2 (1990-1992), women self-reported parity (number of prior live births), which we categorized as: 0 (never pregnant or pregnant with no live births); 1-2 (referent); 3-4; and 5+ live births. Technicians measured cfPWV at visit 5 (2011-2013) and visit 6 or 7 (2016-2019). Multivariable linear regression modeled the associations of parity with visit 5 cfPWV and cfPWV change between visit 5 and 6/7 adjusted for demographics and potential confounding factors. Results Participants reported 0 (7.7%), 1-2 (38.7%), 3-4 (40.0%), or 5+ (13.6%) prior live births. In adjusted analyses, women with 5+ live births had a higher visit 5 cfPWV (β=50.6 cm/s, 95% confidence interval: 3.6, 97.7 cm/s) than those with 1-2 live births. No statistically significant associations were observed for other parity groups with visit 5 cfPWV or with cfPWV change. Discussion In later life, women with 5+ live births had higher arterial stiffness than those with 1-2 live births, but cfPWV change did not differ by parity, suggesting women with 5+ live births should be targeted for early primary prevention of CVD given their higher arterial stiffness at later-life.
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Affiliation(s)
- Alison N. Bonner
- Medical Doctorate Program, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Shantal Jayawickreme
- Medical Doctorate Program, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Angela M. Malek
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Catherine J. Vladutiu
- Department of Obstetrics & Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Clare Oliver-Williams
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
- Central Bedfordshire Council, Chicksands, Bedfordshire, United Kingdom
| | - Yamnia I. Cortés
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Hirofumi Tanaka
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, United States
| | - Michelle L. Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Ardissino M, Slob EAW, Carter P, Rogne T, Girling J, Burgess S, Ng FS. Sex-Specific Reproductive Factors Augment Cardiovascular Disease Risk in Women: A Mendelian Randomization Study. J Am Heart Assoc 2023; 12:e027933. [PMID: 36846989 PMCID: PMC10111460 DOI: 10.1161/jaha.122.027933] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/23/2022] [Indexed: 03/01/2023]
Abstract
Background Observational studies suggest that reproductive factors are associated with cardiovascular disease, but these are liable to influence by residual confounding. This study explores the causal relevance of reproductive factors on cardiovascular disease in women using Mendelian randomization. Methods and Results Uncorrelated (r2<0.001), genome-wide significant (P<5×10-8) single-nucleotide polymorphisms were extracted from sex-specific genome-wide association studies of age at first birth, number of live births, age at menarche, and age at menopause. Inverse-variance weighted Mendelian randomization was used for primary analyses on outcomes of atrial fibrillation, coronary artery disease, heart failure, ischemic stroke, and stroke. Earlier genetically predicted age at first birth increased risk of coronary artery disease (odds ratio [OR] per year, 1.49 [95% CI, 1.28-1.74], P=3.72×10-7) heart failure (OR, 1.27 [95% CI, 1.06-1.53], P=0.009), and stroke (OR, 1.25 [95% CI, 1.00-1.56], P=0.048), with partial mediation through body mass index, type 2 diabetes, blood pressure, and cholesterol traits. Higher genetically predicted number of live births increased risk of atrial fibrillation (OR for <2, versus 2, versus >2 live births, 2.91 [95% CI, 1.16-7.29], P=0.023), heart failure (OR, 1.90 [95% CI, 1.28-2.82], P=0.001), ischemic stroke (OR, 1.86 [95% CI, 1.03-3.37], P=0.039), and stroke (OR, 2.07 [95% CI, 1.22-3.52], P=0.007). Earlier genetically predicted age at menarche increased risk of coronary artery disease (OR per year, 1.10 [95% CI, 1.06-1.14], P=1.68×10-6) and heart failure (OR, 1.12 [95% CI, 1.07-1.17], P=5.06×10-7); both associations were at least partly mediated by body mass index. Conclusions These results support a causal role of a number of reproductive factors on cardiovascular disease in women and identify multiple modifiable mediators amenable to clinical intervention.
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Affiliation(s)
- Maddalena Ardissino
- National Heart and Lung InstituteImperial College LondonLondonUnited Kingdom
- Nuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
| | - Eric A. W. Slob
- Medical Research Council Biostatistics UnitUniversity of CambridgeCambridgeUnited Kingdom
- Department of Applied Economics, Erasmus School of EconomicsErasmus University RotterdamRotterdamThe Netherlands
- Erasmus University Rotterdam Institute for Behavior and Biology, Erasmus University RotterdamRotterdamThe Netherlands
| | - Paul Carter
- Department of MedicineUniversity of CambridgeCambridgeUnited Kingdom
| | - Tormod Rogne
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenCT
- Department of Circulation and Medical ImagingNorwegian University of Science and TechnologyTrondheimNorway
- Centre for Fertility and HealthNorwegian Institute of Public HealthOsloNorway
| | - Joanna Girling
- Department of Obstetrics and GynaecologyChelsea and Westminster Hospital NHS Foundation TrustLondonUnited Kingdom
| | - Stephen Burgess
- Medical Research Council Biostatistics UnitUniversity of CambridgeCambridgeUnited Kingdom
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUnited Kingdom
| | - Fu Siong Ng
- National Heart and Lung InstituteImperial College LondonLondonUnited Kingdom
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11
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The Link Between Reproductive History, Cardiovascular Disease, and Peripheral Arterial Disease in Women: Implications for Practice. J Nurse Pract 2023. [DOI: 10.1016/j.nurpra.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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12
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Quesada O, Scantlebury DC, Briller JE, Michos ED, Aggarwal NR. Markers of Cardiovascular Risk Associated with Pregnancy. Curr Cardiol Rep 2023; 25:77-87. [PMID: 36745273 PMCID: PMC10278153 DOI: 10.1007/s11886-022-01830-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The purpose of the review is to summarize the unique cardiovascular disease (CVD) risk factors encountered during pregnancy and to provide the reader with a framework for acquiring a comprehensive obstetric history during the cardiovascular (CV) assessment of women. RECENT FINDINGS Individuals with a history of pregnancies complicated by hypertensive disorders of pregnancy (HDP), gestational diabetes (GDM), preterm delivery, low birth weight, and fetal growth restriction during pregnancy are at a higher risk of developing short- and long-term CV complications compared to those without adverse pregnancy outcomes (APOs). Women with a history of APOs can be at increased risk of CVD even after achieving normoglycemia and normal blood pressure control postpartum. Risk assessment and stratification in women must account for these APOs as recommended by the 2019 American College of Cardiology (ACC)/American Heart Association (AHA) guideline on the primary prevention of CVD. Early recognition, monitoring, and treatment of APOs are key to limiting CVD complications late in maternal life. Recognition of APOs as female-specific cardiovascular risk factors is critical for risk stratification for women and birthing persons. Further research is needed to understand the complex interplay between genetics, environmental, behavioral, and maternal vascular health, and the association between APOs and CVD risk.
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Affiliation(s)
- Odayme Quesada
- Women's Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, OH, USA
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH, USA
| | - Dawn C Scantlebury
- Department of Cardiovascular Services, The Queen Elizabeth Hospital, Bridgetown, Barbados
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill, St. Michael, Barbados
| | - Joan E Briller
- Division of Cardiology, University of Illinois Chicago, Chicago, IL, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Niti R Aggarwal
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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13
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Egawa M, Kanda E, Ohtsu H, Nakamura T, Yoshida M. Number of Children and Risk of Cardiovascular Disease in Japanese Women: Findings from the Tohoku Medical Megabank. J Atheroscler Thromb 2023; 30:131-137. [PMID: 35466123 PMCID: PMC9925202 DOI: 10.5551/jat.63527] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/08/2022] [Indexed: 02/04/2023] Open
Abstract
AIM Cardiovascular disease (CVD) is the second largest cause of death in Japanese women. Pregnancy and childbirth are events that put a strain on the cardiovascular system. When postpartum weight retention is insufficient, weight gain due to fat deposition during pregnancy might lead to obesity. Thus, we examined the effects of body mass index (BMI) in middle and older ages and the number of children on CVD and metabolic disorders. METHODS From the Tohoku Medical Megabank database, we used data from 32,000 women aged ≥ 50 years. This database contains obstetrical history, medical history, and laboratory data obtained once from 2013 to 2015. RESULTS The mean age of participants was 64.2 years, and 47.7% of women had two children. Compared with nulliparous women, those who had a higher number of children had higher BMI and systolic blood pressure. The prevalence of CVD was highest in obese class I (30 kg/m2 ≤ BMI) women with three or more children and the prevalence of hypertension was high in pre-obese (25 kg/m2 ≤ BMI <30 kg/m2) and obese class I women with children. Conversely, the prevalence of diabetes and proportion of women whose HbA1c values were >6.5% was highest in obese class I women with no children. CONCLUSION In this study, we found that not only BMI but also the number of children influenced the health status of middle- and older-aged women, suggesting the importance of childbirth history in the health management of women.
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Affiliation(s)
- Makiko Egawa
- Department of Nutrition and Metabolism in Cardiovascular Disease, Graduate School of Medical and Dental Sciences, Tokyo
Medical and Dental University, Tokyo, Japan
| | - Eiichiro Kanda
- Medical Science, Kawasaki Medical School, Okayama, Japan
| | - Hiroshi Ohtsu
- Clinical Pharmacology and Regulatory Science, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Tomohiro Nakamura
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Masayuki Yoshida
- Department of Life Science and Bioethics, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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14
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Gulamhusein N, Dumanski SM, Ahmed SB. Paring It Down: Parity, Sex Hormones, and Cardiovascular Risk. Can J Cardiol 2022; 38:1901-1903. [PMID: 36220497 DOI: 10.1016/j.cjca.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/02/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
- Nabilah Gulamhusein
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Sandra M Dumanski
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Sofia B Ahmed
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
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15
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Madjedi KM, Stuart KV, Chua SYL, Foster PJ, Strouthidis NG, Luben RN, Warwick AN, Kang JH, Wiggs JL, Pasquale LR, Khawaja AP. The Association of Female Reproductive Factors with Glaucoma and Related Traits: A Systematic Review. Ophthalmol Glaucoma 2022; 5:628-647. [PMID: 35691565 PMCID: PMC10051419 DOI: 10.1016/j.ogla.2022.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 05/20/2022] [Accepted: 06/03/2022] [Indexed: 11/25/2022]
Abstract
TOPIC This systematic review summarizes evidence for associations between female reproductive factors (age at menarche, parity, oral contraceptive [OC] use, age at menopause, and postmenopausal hormone [PMH] use) and intraocular pressure (IOP) or open-angle glaucoma (OAG). CLINICAL RELEVANCE Understanding the associations between female reproductive factors and glaucoma may shed light on the disease pathogenesis and aid clinical prediction and personalized treatment strategies. Importantly, some factors are modifiable, which may lead to new therapies. METHODS Two reviewers independently extracted articles in MEDLINE, Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials databases to identify relevant studies. Eligibility criteria included studies with human subjects aged > 18 years; a measured outcome of either IOP or OAG; a cohort, case-control, cross-sectional, or randomized controlled trial design; a reported measure of association, such as the hazard ratio, relative risk, odds ratio, or mean difference, with an associated confidence interval; and a measured exposure of at least 1 of the following variables: age at menarche, parity, OC use, age at menopause, or PMH use. RESULTS We included a total of 27 studies. Substantial differences in study designs, exposure and treatment levels, treatment durations, and variable reporting precluded a meaningful quantitative synthesis of the identified studies. Overall, relatively consistent associations between PMH use and a lower IOP were identified. Estrogen-only PMH use may be associated with lower OAG risk, which may be modified by race. No significant associations were found with combined estrogen-and-progesterone PMH use. No strong associations between parity or age at menarche and glaucoma were found, but a younger age at menopause was associated with an increased glaucoma risk, and adverse associations were identified with a longer duration of OC use, though no overall association with OC use was found. CONCLUSIONS The association between PMH use and lower IOP or OAG risk is a potentially clinically relevant and modifiable risk factor and should be investigated further, although this needs to be interpreted in the context of a high risk of bias across included studies. Future research should examine associations with IOP specifically and how the relationship between genetic factors and OAG risks may be influenced by female reproductive factors.
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Affiliation(s)
- Kian M Madjedi
- National Institute for Health Research, Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust & University College London, Institute of Ophthalmology, London, United Kingdom; Department of Ophthalmology, University of Calgary, Alberta, Canada.
| | - Kelsey V Stuart
- National Institute for Health Research, Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust & University College London, Institute of Ophthalmology, London, United Kingdom
| | - Sharon Y L Chua
- National Institute for Health Research, Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust & University College London, Institute of Ophthalmology, London, United Kingdom
| | - Paul J Foster
- National Institute for Health Research, Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust & University College London, Institute of Ophthalmology, London, United Kingdom
| | - Nicholas G Strouthidis
- National Institute for Health Research, Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust & University College London, Institute of Ophthalmology, London, United Kingdom
| | - Robert N Luben
- National Institute for Health Research, Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust & University College London, Institute of Ophthalmology, London, United Kingdom; Medical Research Council, Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | | | - Jae H Kang
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Janey L Wiggs
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary Boston, Massachusetts
| | - Louis R Pasquale
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anthony P Khawaja
- National Institute for Health Research, Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust & University College London, Institute of Ophthalmology, London, United Kingdom
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16
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CCL2 recruits fetal microchimeric cells and dampens maternal brain damage in post-partum mice. Neurobiol Dis 2022; 174:105892. [DOI: 10.1016/j.nbd.2022.105892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/06/2022] [Accepted: 10/08/2022] [Indexed: 11/19/2022] Open
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17
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Ezeigwe A, Ogunmoroti O, Minhas AS, Rodriguez CP, Kazzi B, Fashanu OE, Osibogun O, Kovell LC, Harrington CM, Michos ED. Association between parity and markers of inflammation: The multi-ethnic study of atherosclerosis. Front Cardiovasc Med 2022; 9:922367. [PMID: 36186982 PMCID: PMC9515387 DOI: 10.3389/fcvm.2022.922367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 08/12/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Multiparity has been associated with increased risk of cardiovascular disease (CVD). Inflammation may be a mechanism linking parity to CVD. We investigated the association between parity and later-life markers of inflammation. Methods We studied 3,454 female MESA participants aged 45-84, free of CVD, who had data on parity and inflammatory markers. Parity was categorized as 0 (reference), 1-2, 3-4, or ≥5. Linear regression was used to evaluate the association between parity and natural log-transformed levels of fibrinogen, D-dimer, GlycA, high sensitivity C-reactive protein (hsCRP), and interleukin-6 (IL-6). Results Mean age was 62 ± 10 years. The proportion of women with nulliparity, 1-2, 3-4, and ≥5 live births were 18, 39, 29, and 14%, respectively. There was no association between parity and fibrinogen. Women with grand multiparity (≥5 live births) had 28, 10, and 18% higher levels of hsCRP, IL-6 and D-dimer, respectively, compared to nulliparous women, after adjustment for demographic factors. After additional adjustment for CVD risk factors, women with 1-2 and 3-4 live births had higher hsCRP and women with 1-2 live births had higher GlycA. Conclusion In this diverse cohort of middle-to-older aged women, we found that higher parity was associated with some inflammatory markers; however, these associations were largely attenuated after adjustment for CVD risk factors. There was no clear dose-response relationship between parity and these inflammatory markers. Future studies are needed to evaluate how inflammation may influence the link between parity and CVD and whether healthy lifestyle/pharmacotherapies targeting inflammation can reduce CVD risk among multiparous women. Clinical trial registration The MESA cohort design is registered at clinicaltrials.gov as follows: https://clinicaltrials.gov/ct2/show/NCT00005487.
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Affiliation(s)
- Angelica Ezeigwe
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Oluseye Ogunmoroti
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Anum S. Minhas
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Carla P. Rodriguez
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Brigitte Kazzi
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Oluwaseun E. Fashanu
- Division of Cardiology, Sands Constellation Heart Institute, Rochester Regional Health, Rochester, NY, United States
| | - Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, United States
| | - Lara C. Kovell
- Division of Cardiology, University of Massachusetts Chan School of Medicine, Worchester, MA, United States
| | - Colleen M. Harrington
- Corrigan's Women's Heart Health Program, Massachusetts General Hospital, Boston, MA, United States
| | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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18
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Association between lower parity and low muscle mass in postmenopausal women: data from KNHANES (2010-2011). Menopause 2022; 29:1137-1144. [PMID: 36067383 DOI: 10.1097/gme.0000000000002036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE This study aimed to investigate whether parity is associated with the prevalence of low muscle mass in postmenopausal women. METHODS This study was performed using data from the 2010-2011 Korean National Health and Nutrition Examination Survey, which included 1,338 postmenopausal women aged 46 to 70 years. The association between parity and low muscle mass was analyzed after adjusting parity, multiparity, age, body mass index, diabetes mellitus, education level, and Homeostatic Model Assessment of Insulin Resistance and using weighted multiple logistic regression analysis. Modifiable risk factors were evaluated in a susceptible population. Low muscle mass was defined as an appendicular skeletal muscle mass index below 2 SDs with a cutoff value of 5.45 kg/m 2 . RESULTS The low muscle mass group ( n = 343) had lower parity, lower body mass index, more frequent previous history of diabetes mellitus, higher Homeostatic Model Assessment of Insulin Resistance, and higher education level compared with the non-low muscle mass group ( n = 995). After adjusting for the confounding factors, parity with three births or more was associated with a significantly lower odds of postmenopausal low muscle mass than nulliparity (model 1: odds ratio, 0.32; 95% confidence interval, 0.12-0.87; P = 0.03; model 2: odds ratio, 0.27; 95% confidence interval, 0.11-0.67; P < 0.05). In the subgroup analysis of the lower parity group, moderate aerobic activity was associated with a lower low muscle mass prevalence. CONCLUSIONS A lower parity is associated with increasing the odds of low muscle mass in postmenopausal Korean women. Moderate aerobic activity may be effective in lowering the odds of low muscle mass in postmenopausal women with lower parity.
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19
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Lau ES, Ho JE. Reply: Previous Pregnancies and Heart Failure Prognosis. J Am Coll Cardiol 2022; 80:e61-e62. [PMID: 35981830 DOI: 10.1016/j.jacc.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 10/15/2022]
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20
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Sun MH, Wen ZY, Wang R, Gao C, Yin JL, Chang YJ, Wu QJ, Zhao YH. Parity and Metabolic Syndrome Risk: A Systematic Review and Meta-Analysis of 15 Observational Studies With 62,095 Women. Front Med (Lausanne) 2022; 9:926944. [PMID: 35903312 PMCID: PMC9314745 DOI: 10.3389/fmed.2022.926944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022] Open
Abstract
Background Epidemiological studies have provided inconsistent evidence of the association between parity and metabolic syndrome (MetS) risk. We conducted this first systematic review and meta-analysis to comprehensively and precisely quantify this topic. Methods Comprehensive searches of PubMed, Embase, and the Web of Science databases were conducted to identify observational studies of the association between parity and MetS risk up to 30 January 2022. Study inclusion, data extraction, and quality assessment were checked and reviewed by two investigators independently. Random-effects models were applied to estimate pooled odds ratios (ORs) and 95% CIs. This study has been registered with PROSPERO. Results Two high-quality cohorts and thirteen medium-quality cross-sectional studies involving 62,095 women were finally included. Compared with the nulliparous, the pooled OR of MetS for the ever parity was 1.31 (95% CI = 0.91–1.88, I2 = 72.6%, n = 3). Compared with the lowest parity number, the pooled OR of MetS for the highest parity number was 1.38 (95% CI = 1.22–1.57, I2 = 60.7%, n = 12). For the dose-response analysis, the pooled OR of MetS for each increment of one live birth was 1.12 (95% CI = 1.05–1.19, I2 = 78.6%, n = 6). These findings were robust across subgroups and sensitivity analyses. No evidence of heterogeneity between subgroups was indicated by meta-regression analyses. Conclusion The findings suggested that parity was associated with an increased risk of MetS. A sufficient number of large prospective cohort studies are required to fully verify our findings. Systematic Review Registration [https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42022307703].
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Affiliation(s)
- Ming-Hui Sun
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
- Key Laboratory of Precision Medical Research on Major Chronic Disease, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhao-Yan Wen
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
- Key Laboratory of Precision Medical Research on Major Chronic Disease, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ran Wang
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
- Key Laboratory of Precision Medical Research on Major Chronic Disease, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chang Gao
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
- Key Laboratory of Precision Medical Research on Major Chronic Disease, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jia-Li Yin
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
- Key Laboratory of Precision Medical Research on Major Chronic Disease, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yu-Jiao Chang
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
- Key Laboratory of Precision Medical Research on Major Chronic Disease, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qi-Jun Wu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
- Key Laboratory of Precision Medical Research on Major Chronic Disease, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Qi-Jun Wu,
| | - Yu-Hong Zhao
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
- Key Laboratory of Precision Medical Research on Major Chronic Disease, Shengjing Hospital of China Medical University, Shenyang, China
- Yu-Hong Zhao,
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Lucà F, Colivicchi F, Rossini R, Riccio C, Gelsomino S, Gulizia MM. Reply to Kielb et al. Untapped Potential for Female Patients? Comment on "Lucà et al. Update on Management of Cardiovascular Diseases in Women. J. Clin. Med. 2022, 11, 1176". J Clin Med 2022; 11:jcm11113086. [PMID: 35683475 PMCID: PMC9181007 DOI: 10.3390/jcm11113086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/24/2022] [Accepted: 05/28/2022] [Indexed: 11/16/2022] Open
Abstract
We would like to thank the authors of this letter for their comments [...].
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Affiliation(s)
- Fabiana Lucà
- Cardiology Department, Big Metropolitano Hospital, AO Bianchi Melacrino Morelli, 89129 Reggio Calabria, Italy
- Correspondence:
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Department, San Filippo Neri Hospital, ASL Roma 1, 00100 Roma, Italy;
| | - Roberta Rossini
- Cardiology Unit, Santa Croce e Carle Hospital, 12100 Cuneo, Italy;
| | - Carmine Riccio
- Cardiovascular Department, Sant’Anna e San Sebastiano Hospital, 81100 Caserta, Italy;
| | - Sandro Gelsomino
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands;
| | - Michele Massimo Gulizia
- Cardiology Department, Garibaldi Nesima Hospital, 95122 Catania, Italy;
- Fondazione per ilTuocuore-Heart Care Foundation, 50121 Firenze, Italy
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Rodriguez CP, Ogunmoroti O, Quispe R, Osibogun O, Ndumele CE, Echouffo Tcheugui J, Minhas AS, Bertoni AG, Allison MA, Michos ED. The Association Between Multiparity and Adipokine Levels: The Multi-Ethnic Study of Atherosclerosis. J Womens Health (Larchmt) 2022; 31:741-749. [PMID: 34747649 PMCID: PMC9133972 DOI: 10.1089/jwh.2021.0091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Background: Multiparity is a risk factor for cardiovascular disease (CVD). However, the mechanisms of this relationship are unknown. Adipokines may predispose multiparous women to certain cardiometabolic complications that can increase their risk of future CVD. Materials and Methods: We studied 973 female participants of the Multi-Ethnic Study of Atherosclerosis free of CVD, who had complete data on parity and adipokines measured at Examination 2 or 3 (randomly assigned). Parity was categorized as nulliparity, 1-2, 3-4, and ≥5 live births. Multivariable linear regression was used to evaluate the association of parity with leptin, resistin, and adiponectin levels. Results: The women had mean age of 65 ± 9 years. After adjustment for age, race/ethnicity, study site, education, menopause status, smoking, physical activity, use of hormone therapy, and waist circumference, a history of grand multiparity (≥5 live births) was associated with 11% higher resistin levels (95% confidence interval [CI] 0-23) and 3-4 live births was associated with 23% higher leptin levels (95% CI 7-42), compared with nulliparity. After adjustment for computed tomography-measured visceral fat, the association of 3-4 live births with leptin remained significant. There were no significant associations of parity with adipokines after further adjustment for additional CVD risk factors. Multigravidity (but not parity) was inversely associated with adiponectin levels. Conclusions: In a multiethnic cohort of women, greater parity was associated with resistin and leptin; however, this association was attenuated after accounting for CVD risk factors. Dysregulation of adipokines could contribute to the excess CVD risk associated with multiparity. Further studies are needed to determine whether adipokines independently mediate the relationship between multiparity and CVD. Clinical trials registration: The MESA cohort is registered at NCT00005487.
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Affiliation(s)
- Carla P. Rodriguez
- Division of Cardiology, The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Oluseye Ogunmoroti
- Division of Cardiology, The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Renato Quispe
- Division of Cardiology, The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, Florida, USA
| | - Chiadi E. Ndumele
- Division of Cardiology, The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Justin Echouffo Tcheugui
- Division of Cardiology, The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anum S. Minhas
- Division of Cardiology, The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alain G. Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Matthew A. Allison
- Department of Family Medicine, University of California San Diego, San Diego, California, USA
| | - Erin D. Michos
- Division of Cardiology, The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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23
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Ashraf S, Batool SH, Sulehri I, Eman S, Rehman AU, Mahmood K. Measuring Everyday Health Information Literacy: A Survey of Pakistani Married Working Women. LIBRI 2022. [DOI: 10.1515/libri-2021-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Health Information Literacy (HIL) influences the decision making of individuals towards the understanding of health-related matters. Married women are the major contributors to family members’ health decisions in a country like Pakistan, where the role of women in family life is very significant. In most families, women are responsible for food selection, cooking, management of the home, including cleanliness etc. Married working women have an integral role both at home and workplace. The current study explores the everyday health information literacy (EHIL) of 213 married working women using a survey research design with a convenient sampling technique from two prominent universities of Lahore, Pakistan. The study’s findings reveal that most of the married working women (3.57 mean value) are well-aware of the sources from where the health-related information can be obtained. Sixty-two percent of the respondents prefer using allopathic healthcare methods for medical treatment. Moreover, 38 percent of women do not understand health-related terminologies. It has been noted that age, education, nature of the job, birthplace, nuclear family system, and educational environment are the significant demographic factors that contribute towards the levels of EHIL.
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Affiliation(s)
- Summaira Ashraf
- Institute of Information Management , University of the Punjab , Lahore , Pakistan
| | - Syeda Hina Batool
- Institute of Information Management , University of the Punjab , Lahore , Pakistan
| | - Imran Sulehri
- Library , Pakistan Institute of Fashion Design , Lahore , Punjab , Pakistan
| | - Saima Eman
- Department of Applied Psychology , Lahore College for Women University , Lahore , Pakistan
| | - Ata ur Rehman
- Scientific Information , National Centre for Physics , Islamabad , Pakistan
| | - Khalid Mahmood
- Institute of Information Management , University of the Punjab , Lahore , Pakistan
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24
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Wong ND, Budoff MJ, Ferdinand K, Graham IM, Michos ED, Reddy T, Shapiro MD, Toth PP. ATHEROSCLEROTIC CARDIOVASCULAR DISEASE RISK ASSESSMENT: An American Society for Preventive Cardiology Clinical Practice Statement. Am J Prev Cardiol 2022; 10:100335. [PMID: 35342890 PMCID: PMC8943256 DOI: 10.1016/j.ajpc.2022.100335] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/17/2022] [Accepted: 03/05/2022] [Indexed: 01/08/2023] Open
Abstract
Risk for atherosclerotic cardiovascular disease (ASCVD) shows considerable heterogeneity both in generally healthy persons and in those with known ASCVD. The foundation of preventive cardiology begins with assessing baseline ASCVD risk using global risk scores based on standard office-based measures. Persons at low risk are generally recommended for lifestyle management only and those at highest risk are recommended for both lifestyle and pharmacologic therapy. Additional “risk enhancing” factors, including both traditional risk factors and novel biomarkers and inflammatory factors can be used to further assess ASCVD risk, especially in those at borderline or intermediate risk. There are also female-specific risk enhancers, social determinants of health, and considerations for high-risk ethnic groups. Screening for subclinical atherosclerosis, especially with the use of coronary calcium screening, can further inform the treatment decision if uncertain based on the above strategies. Persons with pre-existing ASCVD also have variable risk, affected by the number of major ASCVD events, whether recurrent events have occurred recently, and the presence of other major risk factors or high-risk conditions. Current guidelines define high to very high risk ASCVD accordingly. Accurate ASCVD risk assessment is crucial for the appropriate targeting of preventive therapies to reduce ASCVD risk. Finally, the clinician-patient risk discussion focusing on lifestyle management and the risks and benefits of evidence-based pharmacologic therapies to best lower ASCVD risk is central to this process. This clinical practice statement provides the preventive cardiology specialist with guidance and tools for assessment of ASCVD risk with the goal of appropriately targeting treatment approaches for prevention of ASCVD events.
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Affiliation(s)
- Nathan D. Wong
- Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, CA, United States
- Corresponding author.
| | - Matthew J. Budoff
- Division of Cardiology, Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Keith Ferdinand
- Tulane University Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA United States
| | - Ian M. Graham
- Department of Cardiology, Trinity College, Dublin, Ireland
| | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Tina Reddy
- Tulane University Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA United States
| | | | - Peter P. Toth
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- CGH Medical Center, Sterling, IL, United States
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25
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Abstract
Women face a disproportionate burden of stroke mortality and disability. Biologic sex and sociocultural gender both contribute to differences in stroke risk factors, assessment, treatment, and outcomes. There are substantial differences in the strength of association of stroke risk factors, as well as female-specific risk factors. Moreover, there are differences in presentation, response to treatment, and stroke outcomes in women. This review outlines current knowledge of impact of sex and gender on stroke, as well as delineates research gaps and areas for future inquiry.
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Affiliation(s)
- Kathryn M. Rexrode
- Division of Women’s Health, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Tracy E. Madsen
- Division of Sex and Gender in Emergency Medicine, Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI; Department of Epidemiology, Brown University School of Public Health, Providence RI
| | - Amy Y. X. Yu
- Department of Medicine (Neurology), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Cheryl Carcel
- Neurology Program, The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Judith H. Lichtman
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Eliza C. Miller
- Division of Stroke and Cerebrovascular Disease, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
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26
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O’Kelly AC, Michos ED, Shufelt CL, Vermunt JV, Minissian MB, Quesada O, Smith GN, Rich-Edwards JW, Garovic VD, El Khoudary SR, Honigberg MC. Pregnancy and Reproductive Risk Factors for Cardiovascular Disease in Women. Circ Res 2022; 130:652-672. [PMID: 35175837 PMCID: PMC8870397 DOI: 10.1161/circresaha.121.319895] [Citation(s) in RCA: 121] [Impact Index Per Article: 60.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Beyond conventional risk factors for cardiovascular disease, women face an additional burden of sex-specific risk factors. Key stages of a woman's reproductive history may influence or reveal short- and long-term cardiometabolic and cardiovascular trajectories. Early and late menarche, polycystic ovary syndrome, infertility, adverse pregnancy outcomes (eg, hypertensive disorders of pregnancy, gestational diabetes, preterm delivery, and intrauterine growth restriction), and absence of breastfeeding are all associated with increased future cardiovascular disease risk. The menopause transition additionally represents a period of accelerated cardiovascular disease risk, with timing (eg, premature menopause), mechanism, and symptoms of menopause, as well as treatment of menopause symptoms, each contributing to this risk. Differences in conventional cardiovascular disease risk factors appear to explain some, but not all, of the observed associations between reproductive history and later-life cardiovascular disease; further research is needed to elucidate hormonal effects and unique sex-specific disease mechanisms. A history of reproductive risk factors represents an opportunity for comprehensive risk factor screening, refinement of cardiovascular disease risk assessment, and implementation of primordial and primary prevention to optimize long-term cardiometabolic health in women.
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Affiliation(s)
- Anna C. O’Kelly
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Chrisandra L. Shufelt
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jane V. Vermunt
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Margo B. Minissian
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
- Geri and Richard Brawerman Nursing Institute, Cedars-Sinai Medical Center, Los Angeles CA
| | - Odayme Quesada
- Women’s Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, OH
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH
| | - Graeme N. Smith
- Department of Obstetrics and Gynecology, Queen’s University, Kingston, Ontario, Canada
| | - Janet W. Rich-Edwards
- Division of Women’s Health, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Vesna D. Garovic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Samar R. El Khoudary
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Michael C. Honigberg
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA
- Corrigan Women’s Heart Health Program, Massachusetts General Hospital, Boston, MA
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27
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Aleknaviciute J, Evans TE, Aribas E, de Vries MW, Steegers EAP, Ikram MA, Tiemeier H, Kavousi M, Vernooij MW, Kushner SA. Long-term association of pregnancy and maternal brain structure: the Rotterdam Study. Eur J Epidemiol 2022; 37:271-281. [PMID: 34989970 PMCID: PMC9110529 DOI: 10.1007/s10654-021-00818-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 10/29/2021] [Indexed: 02/06/2023]
Abstract
The peripartum period is the highest risk interval for the onset or exacerbation of psychiatric illness in women’s lives. Notably, pregnancy and childbirth have been associated with short-term structural and functional changes in the maternal human brain. Yet the long-term effects of pregnancy on maternal brain structure remain unknown. We investigated a large population-based cohort to examine the association between parity and brain structure. In total, 2,835 women (mean age 65.2 years; all free from dementia, stroke, and cortical brain infarcts) from the Rotterdam Study underwent magnetic resonance imaging (1.5 T) between 2005 and 2015. Associations of parity with global and lobar brain tissue volumes, white matter microstructure, and markers of vascular brain disease were examined using regression models. We found that parity was associated with a larger global gray matter volume (β = 0.14, 95% CI = 0.09–0.19), a finding that persisted following adjustment for sociodemographic factors. A non-significant dose-dependent relationship was observed between a higher number of childbirths and larger gray matter volume. The gray matter volume association with parity was globally proportional across lobes. No associations were found regarding white matter volume or integrity, nor with markers of cerebral small vessel disease. The current findings suggest that pregnancy and childbirth are associated with robust long-term changes in brain structure involving a larger global gray matter volume that persists for decades. Future studies are warranted to further investigate the mechanism and physiological relevance of these differences in brain morphology.
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Affiliation(s)
- Jurate Aleknaviciute
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, 's Gravendijkwal 230, 3000 CA, Rotterdam, The Netherlands
| | - Tavia E Evans
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Wytemaweg 90, 3015 CN, Rotterdam, The Netherlands.,Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Elif Aribas
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Wytemaweg 90, 3015 CN, Rotterdam, The Netherlands
| | - Merel W de Vries
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, 's Gravendijkwal 230, 3000 CA, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Mohammad Arfan Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Wytemaweg 90, 3015 CN, Rotterdam, The Netherlands
| | - Henning Tiemeier
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Child Psychiatry, Sophia Children's Hospital, Erasmus University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Wytemaweg 90, 3015 CN, Rotterdam, The Netherlands
| | - Meike W Vernooij
- Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands. .,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Wytemaweg 90, 3015 CN, Rotterdam, The Netherlands.
| | - Steven A Kushner
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, 's Gravendijkwal 230, 3000 CA, Rotterdam, The Netherlands
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28
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Gemmill A, Weiss J. The relationship between fertility history and incident dementia in the US Health and Retirement Study. J Gerontol B Psychol Sci Soc Sci 2021; 77:1118-1131. [PMID: 34614155 DOI: 10.1093/geronb/gbab183] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES An emerging literature suggests that fertility history, which includes measures of parity and birth timing, may influence cognitive health in older ages, especially among women given their differential exposure to pregnancy and sex hormones. Yet, few studies have examined associations between measures of fertility history and incident dementia in population-based samples. METHODS We examined the associations between parity, younger age at first birth, and older age at last birth with incident dementia over a 16-year period in a prospective sample of 15,361 men and women aged 51-100 years at baseline drawn from the Health and Retirement Study. We used Cox regression and the Fine and Gray model to obtain cause-specific (csHRs) and subdistribution hazard ratios (sdHRs) for incident dementia from gender-stratified models in which we accounted for the semi-competing risk of death. RESULTS During the follow-up period (median 13.0 years), the crude incidence rate for dementia was 16.6 and 19.9 per 1,000 person-years for men and women, respectively. In crude models estimating csHRs, higher parity (vs. parity 2) and younger age at first birth were associated with increased risk of dementia for both genders. These associations did not persist after full covariate adjustment. Across all models in which we estimated sdHRs, we observed a positive relationship between older age at last birth and incident dementia for women only. DISCUSSION In this population-based, multi-ethnic cohort, we observed limited evidence for an association between measures of fertility history and incident dementia among men and women after adjusting for potential confounders.
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Affiliation(s)
- Alison Gemmill
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jordan Weiss
- Department of Demography, University of California, Berkeley, CA, USA
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29
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Smigoc Schweiger D, Battelino T, Groselj U. Sex-Related Differences in Cardiovascular Disease Risk Profile in Children and Adolescents with Type 1 Diabetes. Int J Mol Sci 2021; 22:ijms221910192. [PMID: 34638531 PMCID: PMC8508122 DOI: 10.3390/ijms221910192] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 01/09/2023] Open
Abstract
Cardiovascular disease (CVD) is the primary cause of higher and earlier morbidity and mortality in people with type 1 diabetes (T1D) compared to people without diabetes. In addition, women with T1D are at an even higher relative risk for CVD than men. However, the underlying pathophysiology is not well understood. Atherosclerotic changes are known to progress early in life among people with T1D, yet it is less clear when excess CVD risk begins in females with T1D. This review explores the prevalence of classical CVD risk factors (such as glycemic control, hypertension, dyslipidemia, obesity, albuminuria, smoking, diet, physical inactivity), as well as of novel biomarkers (such as chronic inflammation), in children and adolescents with T1D with particular regard to sex-related differences in risk profile. We also summarize gaps where further research and clearer clinical guidance are needed to better address this issue. Considering that girls with T1D might have a more adverse CVD risk profile than boys, the early identification of and sex-specific intervention in T1D would have the potential to reduce later CVD morbidity and excess mortality in females with T1D. To conclude, based on an extensive review of the existing literature, we found a clear difference between boys and girls with T1D in the presence of individual CVD risk factors as well as in overall CVD risk profiles; the girls were on the whole more impacted.
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Affiliation(s)
- Darja Smigoc Schweiger
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; (D.S.S.); (T.B.)
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, University Medical Centre Ljubljana, Bohoriceva 20, 1000 Ljubljana, Slovenia
| | - Tadej Battelino
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; (D.S.S.); (T.B.)
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, University Medical Centre Ljubljana, Bohoriceva 20, 1000 Ljubljana, Slovenia
| | - Urh Groselj
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; (D.S.S.); (T.B.)
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, University Medical Centre Ljubljana, Bohoriceva 20, 1000 Ljubljana, Slovenia
- Department of Cardiovascular Medicine, School of Medicine, Stanford University, 870 Quarry Road, Stanford, CA 94305, USA
- Correspondence: ; Tel.: +386-1-522-9235; Fax: +386-1-232-0190
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30
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Pérez-Roncero GR, López-Baena MT, Sánchez-Prieto M, Chedraui P, Pérez-López FR. Association of breastfeeding duration with carotid intima-media thickness in later life: a systematic review and meta-analysis. Gynecol Endocrinol 2021; 37:778-784. [PMID: 34030552 DOI: 10.1080/09513590.2021.1925244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To assess the relationship of breastfeeding duration with maternal ultrasound carotid intima-media thickness (CIMT) in later life. METHODS PubMed, Scopus, Web of Science, Embase, and Cochrane Central database searching up to December 15, 2020, for eligible studies that reported on the breastfeeding duration and ultrasound measurement of CIMT in later life. The exposed group corresponded to breastfeeding duration ≥ 6 months whereas the control group was women with breastfeeding of shorter duration or nil breastfeeding. The methodological quality of reviewed articles was appraised using the Newcastle-Ottawa Scale (NOS). Results are reported as the mean difference (MD) or the standardized MD (SMD) and their 95% confidence intervals (CIs). The study was registered in the PROSPERO database. RESULTS Of 532 unique studies, three studies met inclusion criteria including 1721 women with a mean age ranging between 36.6 ± 6.9 and 55.7 ± 5.3 years, comparing breastfeeding duration ≥ 6 months versus 1-5 months (NOS: 7-8). Common CIMT was lower in women who breastfed for a longer duration (SMD = -0.10, 95% CI -0.20 to -0.00). Circulating HDL-cholesterol was higher in women with longer breastfeeding duration (MD = 3.25, 95% CI 0.88-5.61). There were no significant differences for total cholesterol, LDL-cholesterol, triglycerides, glucose, and blood pressure between breastfeeding 6 or more months and the control group. CONCLUSIONS The available studies showed lower CIMT and higher HDL-cholesterol levels in women who breastfed for 6 or more months as compared to controls.
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Affiliation(s)
| | | | - Manuel Sánchez-Prieto
- Department of Obstetrics and Gynecology, Instituto Universitario Dexeus, Barcelona, Spain
| | - Peter Chedraui
- Instituto de Investigación e Innovación en Salud Integral, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
| | - Faustino R Pérez-López
- Department of Obstetrics and Gynecology, University of Zaragoza Faculty of Medicine, Zaragoza, Spain
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31
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Leong D, Tjoe B, Zarrini P, Cook-Wiens G, Wei J, Shufelt CL, Pepine CJ, Handberg EM, Reis SE, Reichek N, Bittner V, Kelsey SF, Marpuri RS, Sopko G, Merz CNB. Risk factors for heart failure in women with ischemia and no obstructive coronary artery disease. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2021; 8:100035. [PMID: 38558849 PMCID: PMC10978133 DOI: 10.1016/j.ahjo.2021.100035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/06/2021] [Indexed: 04/04/2024]
Abstract
Study objective Women with ischemia and no obstructive coronary artery disease (INOCA) are at increased risk for heart failure (HF) hospitalizations, which is predominantly HF with preserved ejection fraction (HFpEF). We aimed to identify predictors for the development of heart failure HF in a deeply phenotyped cohort of women with INOCA and long-term prospective follow-up. Design setting and participants Women enrolled in the NHLBI-sponsored Women's Ischemia Syndrome Evaluation (WISE) were evaluated for baseline characteristics including clinical history, medications, physical exam, laboratory data and angiographic data. Using a multivariate Cox analysis, we assessed the association between baseline characteristics and the occurrence of HF hospitalizations in 493 women with evidence of ischemia but no obstructive coronary disease, no prior history of HF, and available follow-up data. Results During a median follow-up of 6-years, 18 (3.7%) women were hospitalized for HF. Diabetes mellitus and tobacco use were associated with HF hospitalization. In a multivariate analysis adjusting for known HFpEF predictors including age, diabetes, hypertension, tobacco use, and statin use, novel predictive variables included higher resting heart rate, parity and IL-6 levels and lower coronary flow reserve (CFR) and poor functional status. Conclusions There is a considerable incidence of HF hospitalization at longer term follow-up in women with INOCA. In addition to traditional risk factors, novel risk variables that independently predict HF hospitalization include multi-parity, high IL-6, low CFR, and poor functional status. These novel risk factors may be useful to understand mechanistic pathways and future treatment targets for prevention of HFpEF.
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Affiliation(s)
- Derek Leong
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States of America
| | - Benita Tjoe
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States of America
| | - Parham Zarrini
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States of America
| | - Galen Cook-Wiens
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States of America
| | - Janet Wei
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States of America
| | - Chrisandra L. Shufelt
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States of America
| | - Carl J. Pepine
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, United States of America
| | - Eileen M. Handberg
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, United States of America
| | - Steven E. Reis
- Cardiovascular Institute, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Nathaniel Reichek
- Cardiac Imaging and Research Department, Stony Brook University, Roslyn, NY, United States of America
| | - Vera Bittner
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Sheryl F. Kelsey
- Cardiovascular Institute, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Reddy Sailaja Marpuri
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States of America
| | - George Sopko
- National Heart, Lung, and Blood Institute, National Institutes of Health Bethesda, MD, United States of America
| | - C. Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States of America
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32
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Datta BK, Husain MJ, Kostova D. Hypertension in women: the role of adolescent childbearing. BMC Public Health 2021; 21:1481. [PMID: 34325686 PMCID: PMC8323295 DOI: 10.1186/s12889-021-11488-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/09/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Adolescent childbearing is associated with various health risks to the mother and child, and potentially with adverse socioeconomic outcomes. However, little is known about the role of adolescent childbearing in maternal health outcomes in adulthood. This study investigates the link between childbirth in adolescence and later-life risk of hypertension among women in India. METHODS We obtained nationally representative data on demographic and health outcomes for 442,845 women aged 25 to 49 from the India National Family Health Survey (NFHS) 2015-16. We assessed the difference in hypertension prevalence between women who gave birth in adolescence (age 10 to 19) and those who did not, for the full sample and various sub-samples, using linear probability models with controls for individual characteristics, hypertension risk factors, and geographic fixed effects. RESULTS Nearly 40% of the women in the sample gave birth in adolescence. The adjusted probability of being hypertensive in adulthood was 2.3 percentage points higher for this group compared to women who did not give childbirth in adolescence. This added probability was larger for women who gave birth earlier in adolescence (4.8 percentage points) and for women who gave birth more than once in adolescence (3.4 percentage points). CONCLUSIONS Adolescent childbearing was strongly associated with a higher probability of adult female hypertension in India. This finding illustrates the intertemporal relationship between health risk factors during the life cycle, informing the importance of addressing adverse early life events (e.g. child marriage and adolescent childbirth) for hypertension outcomes among women in India.
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Affiliation(s)
- Biplab K Datta
- Global Noncommunicable Diseases Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, 30329, GA, USA
- Present Address: Institute of Public and Preventive Health, Augusta University, 1120 15th Street, Augusta, 30912, GA, USA
| | - Muhammad J Husain
- Global Noncommunicable Diseases Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, 30329, GA, USA.
| | - Deliana Kostova
- Global Noncommunicable Diseases Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, 30329, GA, USA
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Hallum S, Gerds TA, Sehested TSG, Jakobsen MA, Tjønneland A, Kamper-Jørgensen M. Impact of Male-Origin Microchimerism on Cardiovascular Disease in Women: A Prospective Cohort Study. Am J Epidemiol 2021; 190:853-863. [PMID: 33184639 DOI: 10.1093/aje/kwaa250] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 12/17/2022] Open
Abstract
Increasing parity is associated with an increased risk of ischemic heart disease (IHD) and stroke in women. This is probably attributable to biological responses of pregnancy. Male cells of presumed fetal origin are commonly present in women years after pregnancy-a phenomenon termed male-origin microchimerism (MOM). In this study, we investigated whether MOM was associated with risk of IHD and ischemic stroke in women. We evaluated the association between MOM and ischemic events in a cohort of 766 Danish women enrolled in the Diet, Cancer and Health cohort during 1993-1997 when aged 50-64 years. Of these women, 545 (71.2%) tested positive for MOM through targeting of the Y chromosome (DYS14 DNA sequence) in their blood. Multiple Cox regression models were used to calculate hazard ratios with 95% confidence intervals. We found that MOM was associated with a significantly reduced rate of IHD (hazard ratio = 0.44, 95% confidence interval: 0.23, 0.83) but not ischemic stroke (hazard ratio = 0.80, 95% confidence interval: 0.46, 1.41). Our findings show that microchimerism positivity is associated with a lower rate of later IHD development in women. Although the underlying mechanisms are presently unknown, MOM may be relevant in women's cardiovascular health. More studies are needed to confirm these findings.
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Veiga-Lopez A, Sethuraman V, Navasiolava N, Makela B, Olomu I, Long R, van de Wetering K, Martin L, Aranyi T, Szeri F. Plasma Inorganic Pyrophosphate Deficiency Links Multiparity to Cardiovascular Disease Risk. Front Cell Dev Biol 2020; 8:573727. [PMID: 33363139 PMCID: PMC7755719 DOI: 10.3389/fcell.2020.573727] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/18/2020] [Indexed: 12/17/2022] Open
Abstract
Epidemiological studies indicate that elevated alkaline phosphatase activity is associated with increased cardiovascular disease risk. Other epidemiological data demonstrate that mothers giving multiple childbirths (multipara) are also at increased risk of developing late-onset cardiovascular disease. We hypothesized that these two associations stem from a common cause, the insufficient plasma level of the ectopic mineralization inhibitor inorganic pyrophosphate, which is a substrate of alkaline phosphatase. As alkaline phosphatase activity is elevated in pregnancy, we hypothesized that pyrophosphate concentrations decrease gestationally, potentially leading to increased maternal vascular calcification and cardiovascular disease risk in multipara. We investigated plasma pyrophosphate kinetics pre- and postpartum in sheep and at term in humans and demonstrated its shortage in pregnancy, mirroring alkaline phosphatase activity. Next, we tested whether multiparity is associated with increased vascular calcification in pseudoxanthoma elasticum patients, characterized by low intrinsic plasma pyrophosphate levels. We demonstrated that these patients had increased vascular calcification when they give birth multiple times. We propose that transient shortages of pyrophosphate during repeated pregnancies might contribute to vascular calcification and multiparity-associated cardiovascular disease risk threatening hundreds of millions of healthy women worldwide. Future trials are needed to assess if gestational pyrophosphate supplementation might be a suitable prophylactic treatment to mitigate maternal cardiovascular disease risk in multiparous women.
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Affiliation(s)
- Almudena Veiga-Lopez
- Department of Pathology, The University of Illinois at Chicago, Chicago, IL, United States.,Department of Animal Science, Michigan State University, East Lansing, MI, United States
| | - Visalakshi Sethuraman
- Department of Pediatrics and Human Development, Michigan State University, Lansing, MI, United States.,Department of Pediatrics, Texas Tech University Health Sciences Center, Odessa, TX, United States
| | | | - Barbara Makela
- Department of Animal Science, Michigan State University, East Lansing, MI, United States
| | - Isoken Olomu
- Department of Pediatrics and Human Development, Michigan State University, Lansing, MI, United States
| | - Robert Long
- Department of Obstetrics and Gynecology, Sparrow Hospital, Lansing, MI, United States
| | - Koen van de Wetering
- Department of Dermatology and Cutaneous Biology, PXE International Center of Excellence in Research and Clinical Care, Thomas Jefferson University, Philadelphia, PA, United States
| | - Ludovic Martin
- Department of Pediatrics, Texas Tech University Health Sciences Center, Odessa, TX, United States
| | - Tamas Aranyi
- Department of Molecular Biology, Semmelweis University, Budapest, Hungary.,Institute of Enzymology, Research Centre for Natural Sciences, Budapest, Hungary
| | - Flora Szeri
- Department of Dermatology and Cutaneous Biology, PXE International Center of Excellence in Research and Clinical Care, Thomas Jefferson University, Philadelphia, PA, United States.,Institute of Enzymology, Research Centre for Natural Sciences, Budapest, Hungary.,Department of Biochemistry, Semmelweis University, Budapest, Hungary
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35
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O’Kelly AC, Honigberg MC. Sex Differences in Cardiovascular Disease and Unique Pregnancy-Associated Risk Factors in Women. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00860-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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36
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O'Neil A, Russell JD, Thompson K, Martinson ML, Peters SAE. The impact of socioeconomic position (SEP) on women's health over the lifetime. Maturitas 2020; 140:1-7. [PMID: 32972629 PMCID: PMC7273147 DOI: 10.1016/j.maturitas.2020.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 12/18/2022]
Abstract
The "social gradient of health" refers to the steep inverse associations between socioeconomic position (SEP) and the risk of premature mortality and morbidity. In many societies, due to cultural and structural factors, women and girls have reduced access to the socioeconomic resources that ensure good health and wellbeing when compared with their male counterparts. Thus, the objective of this paper is to review how SEP - a construct at the heart of the Social Determinants of Health (SDoH) theory - shapes the health and longevity of women and girls at all stages of the lifespan. Using literature identified from PubMed, Cochrane, CINAHL and EMBASE databases, we first describe the SDoH theory. We then use examples from each stage of the life course to demonstrate how SEP can differentially shape girls' and women's health outcomes compared with boys' and men's, as well as between sub-groups of girls and women when other axes of inequalities are considered, including ethnicity, race and residential setting. We also explore the key consideration of whether conventional SEP markers are appropriate for understanding the social determinants of women's health. We conclude by making key recommendations in the context of clinical, research and policy development.
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Affiliation(s)
- Adrienne O'Neil
- Heart & Mind Research, iMPACT Institute, Deakin University, 3220, VIC, Australia.
| | - Josephine D Russell
- Heart & Mind Research, iMPACT Institute, Deakin University, 3220, VIC, Australia
| | - Kelly Thompson
- Global Women's Health, The George Institute for Global Health, University of New South Wales, Australia
| | | | - Sanne A E 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 University, Utrecht, the Netherlands; The George Institute for Global Health, University of New South Wales, Sydney, Australia
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37
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Freaney PM, Khan SS, Lloyd-Jones DM, Stone NJ. The Role of Sex-Specific Risk Factors in the Risk Assessment of Atherosclerotic Cardiovascular Disease for Primary Prevention in Women. Curr Atheroscler Rep 2020; 22:46. [PMID: 32671475 PMCID: PMC7889439 DOI: 10.1007/s11883-020-00864-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Robust evidence is emerging regarding the contribution of sex-specific risk factors to a woman's unique risk of atherosclerotic cardiovascular disease (ASCVD). This review summarizes the available literature regarding the association of sex-specific risk factors and ASCVD in women. RECENT FINDINGS The American College of Cardiology and American Heart Association Guidelines recommend estimation of 10-year risk of a first ASCVD event using the 2013 Pooled Cohort Equations. This can be further personalized by identifying sex-specific risk factors present in a woman's history. There are multiple vulnerable periods across a woman's life course that are associated with increased risk of ASCVD. Risk factors across the reproductive life course that have been shown to correlate with higher risk for future ASCVD include early menarche, adverse pregnancy outcomes (such as pre-eclampsia or preterm birth), and early natural or surgical menopause. In addition, certain conditions that are more common among women, including autoimmune diseases, history of chest irradiation, and certain chemotherapies, also need to be considered. Finally, risk assessment can be refined with subclinical disease imaging (coronary calcium score) if there remains uncertainty about clinical management with lipid-lowering therapies for primary prevention after inclusion of these risk enhancers. Risk assessment for ASCVD in women requires a personalized approach that incorporates sex-specific risk factors to guide primary prevention measures, such as lipid-lowering therapies. Coronary calcium score imaging may also help further refine risk assessment, but no clinical trials conducted to date have addressed this question.
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Affiliation(s)
- Priya M Freaney
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Sadiya S Khan
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Donald M Lloyd-Jones
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Neil J Stone
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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38
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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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Glisic M, Muka T, Franco OH. Cardiovascular screening and prevention strategies in women with history of preeclampsia: One size does not fit all. Eur J Prev Cardiol 2020; 27:1386-1388. [PMID: 32131625 DOI: 10.1177/2047487320908977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Marija Glisic
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland.,Swiss Paraplegic Research, Switzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
| | - Oscar H Franco
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
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40
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Kanbay M, Ertuglu LA, Afsar B, Ozdogan E, Kucuksumer ZS, Ortiz A, Covic A, Kuwabara M, Cherney DZI, van Raalte DH, de Zeeuw D. Renal hyperfiltration defined by high estimated glomerular filtration rate: A risk factor for cardiovascular disease and mortality. Diabetes Obes Metab 2019; 21:2368-2383. [PMID: 31297976 DOI: 10.1111/dom.13831] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/30/2019] [Accepted: 07/08/2019] [Indexed: 12/22/2022]
Abstract
Renal hyperfiltration, defined as an increased glomerular filtration rate above normal values, is associated with early phases of kidney disease in the setting of various conditions such as obesity and diabetes. Although it is recognized that glomerular hyperfiltration, that is, increased filtration per nephron unit (usually studied at low glomerular filtration levels and often referred to as single nephron hyperfiltration), is a risk factor for the progression of chronic kidney disease, the implications of having renal hyperfiltration for cardiovascular disease and mortality risk are incompletely understood. Recent evidence from diverse populations, including healthy individuals and patients with diabetes or established cardiovascular disease, suggests that renal hyperfiltration is associated with a higher risk of cardiovascular disease and all-cause mortality. In this review, we critically summarize the existing studies, discuss possible mechanisms, and describe the remaining gaps in our knowledge regarding the association of renal hyperfiltration with cardiovascular disease and mortality risk.
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Affiliation(s)
- Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koç University School of Medicine, Istanbul, Turkey
| | - Lale A Ertuglu
- Department of Medicine, School of Medicine, Koç University, Istanbul, Turkey
| | - Baris Afsar
- Department of Medicine, Division of Nephrology, Suleyman Demirel University School of Medicine, Isparta, Turkey
| | - Elif Ozdogan
- Department of Medicine, School of Medicine, Koç University, Istanbul, Turkey
| | - Zeynep S Kucuksumer
- Department of Medicine, School of Medicine, Koç University, Istanbul, Turkey
| | - Alberto Ortiz
- Dialysis Unit, School of Medicine, IIS-Fundacion Jimenez Diaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Adrian Covic
- Nephrology Clinic, Dialysis and Renal Transplant Center, 'C.I. PARHON' University Hospital, and 'Grigore T. Popa' University of Medicine, Iasi, Romania
| | | | - David Z I Cherney
- Department of Medicine, Division of Nephrology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Daniel H van Raalte
- Diabetes Center, Department of Internal Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Dick de Zeeuw
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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41
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Tweet MS. Pregnancy History Is Imperative for Cardiovascular Risk Assessment in Black Women. Circ Cardiovasc Imaging 2019; 12:e009439. [PMID: 31303029 DOI: 10.1161/circimaging.119.009439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Marysia S Tweet
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN
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