Top

BMC Women's Health

Published in:

Open Access 01-12-2024 | Research

Reproductive factors and risk of cardiovascular diseases and all-cause and cardiovascular mortality in American women: NHANES 2003–2018

Authors: Yufeng Yan, Hongjing Lu, Song Lin, Yaguo Zheng

Published in: BMC Women's Health | Issue 1/2024

Abstract

Background

The evidence regarding the association of reproductive factors with cardiovascular diseases (CVDs) is limited.

Aims

To investigate the relationship of reproductive factors with the risk of CVDs, as well as all-cause and cardiovascular mortality.

Methods

This study included 16,404 adults with reproductive factors from the National Health and Nutrition Examination Survey (NHANES) and followed up until 31 December 2019. Logistic models and restricted cubic spline models were used to assess the association of reproductive factors with CVDs. COX proportional hazards models and restricted cubic spline models, with adjustment for potential confounding, were employed to analyze the relation between reproductive factors and cardiovascular and all-cause death.

Results

There is a nonlinear relationship between age at menarche and CVDs. Age at menopause ≤ 11(OR 1.36, 95% CI 1.10–1.69) was associated with an increased risk of CVDs compared to ages 12–13 years. Age at Menopause ≤ 44 (OR 1.69, 95% CI 1.40–2.03) was associated with increased CVDs compared to age 35–49 years. Number of pregnancies ≥ 5(OR 1.26, 95% CI 1.02–1.55) was associated with an increased risk of CVDs compared to one pregnancy. In continuous variable COX regression models, a later age at menopause (HR 0.98, 95% CI 0.97–0.99) and a longer reproductive lifespan (HR 0.98, 95% CI 0.97–0.99) were associated with a decreased risk of all-cause death. A later age at menopause (HR 0.98, 95% CI 0.97–0.99) and a longer reproductive lifespan (HR 0.98, 95% CI 0.97–0.99) were associated with a decreased risk of cardiac death.

Conclusions

Female reproductive factors are significant risk factors for CVDs American women.

Available only for authorised users

Mensah GA, Roth GA, Fuster V. The Global Burden of Cardiovascular diseases and Risk factors: 2020 and Beyond. J Am Coll Cardiol. 2019;74(20):2529–32. https://doi.org/10.1016/j.jacc.2019.10.009.CrossRefPubMed

Vogel B, Acevedo M, Appelman Y, Bairey Merz CN, Chieffo A, Figtree GA, et al. The Lancet women and cardiovascular disease commission: reducing the global burden by 2030. Lancet. 2021;397(10292):2385–438. https://doi.org/10.1016/s0140-6736(21)00684-x.CrossRefPubMed

Lam CSP, Arnott C, Beale AL, Chandramouli C, Hilfiker-Kleiner D, Kaye DM, et al. Sex differences in heart failure. Eur Heart J. 2019;40(47):3859–68. https://doi.org/10.1093/eurheartj/ehz835.CrossRefPubMed

Subramanya V, Zhao D, Ouyang P, Lima JA, Vaidya D, Ndumele CE, et al. Sex hormone levels and change in left ventricular structure among men and post-menopausal women: the multi-ethnic study of atherosclerosis (MESA). Maturitas. 2018;108:37–44. https://doi.org/10.1016/j.maturitas.2017.11.006.CrossRefPubMed

Charalampopoulos D, McLoughlin A, Elks CE, Ong KK. Age at menarche and risks of all-cause and cardiovascular death: a systematic review and meta-analysis. Am J Epidemiol. 2014;180(1):29–40. https://doi.org/10.1093/aje/kwu113.CrossRefPubMedPubMedCentral

Wu X, Cai H, Kallianpur A, Gao YT, Yang G, Chow WH, et al. Age at menarche and natural menopause and number of reproductive years in association with mortality: results from a median follow-up of 11.2 years among 31,955 naturally menopausal Chinese women. PLoS ONE. 2014;9(8):e103673. https://doi.org/10.1371/journal.pone.0103673.CrossRefPubMedPubMedCentral

Jacobsen BK, Oda K, Knutsen SF, Fraser GE. Age at menarche, total mortality and mortality from ischaemic heart disease and stroke: the Adventist Health Study, 1976-88. Int J Epidemiol. 2009;38(1):245–52. https://doi.org/10.1093/ije/dyn251.CrossRefPubMedPubMedCentral

Gallagher LG, Davis LB, Ray RM, Psaty BM, Gao DL, Checkoway H, et al. Reproductive history and mortality from cardiovascular disease among women textile workers in Shanghai, China. Int J Epidemiol. 2011;40(6):1510–8. https://doi.org/10.1093/ije/dyr134.CrossRefPubMedPubMedCentral

!!! INVALID CITATION !!! [9].

10.

Ossewaarde ME, Bots ML, Verbeek AL, Peeters PH, van der Graaf Y, Grobbee DE, et al. Age at menopause, cause-specific mortality and total life expectancy. Epidemiology. 2005;16(4):556–62. https://doi.org/10.1097/01.ede.0000165392.35273.d4.CrossRefPubMed

11.

Ruhl CE, Everhart JE. Fatty liver indices in the multiethnic United States National Health and Nutrition Examination Survey. Aliment Pharmacol Ther. 2015;41(1):65–76. https://doi.org/10.1111/apt.13012.CrossRefPubMed

12.

Patel CJ, Pho N, McDuffie M, Easton-Marks J, Kothari C, Kohane IS, et al. A database of human exposomes and phenomes from the US National Health and Nutrition Examination Survey. Sci Data. 2016;3:160096. https://doi.org/10.1038/sdata.2016.96.CrossRefPubMedPubMedCentral

13.

Zipf G, Chiappa M, Porter KS, Ostchega Y, Lewis BG, Dostal J. National health and nutrition examination survey: plan and operations, 1999–2010. Vital Health Stat. 2013;1(56):1–37.

14.

Richardson AM, Joshy G, D’Este CA. Understanding statistical principles in linear and logistic regression. Med J Aust. 2018;208(8):332–4. https://doi.org/10.5694/mja17.00222.CrossRefPubMed

15.

McLernon DJ, Giardiello D, Van Calster B, Wynants L, van Geloven N, van Smeden M, et al. Assessing performance and clinical usefulness in Prediction Models with Survival outcomes: practical Guidance for Cox Proportional hazards models. Ann Intern Med. 2023;176(1):105–14. https://doi.org/10.7326/m22-0844.CrossRefPubMed

16.

Gauthier J, Wu QV, Gooley TA. Cubic splines to model relationships between continuous variables and outcomes: a guide for clinicians. Bone Marrow Transpl. 2020;55(4):675–80. https://doi.org/10.1038/s41409-019-0679-x.CrossRef

17.

Canoy D, Beral V, Balkwill A, Wright FL, Kroll ME, Reeves GK, et al. Age at menarche and risks of coronary heart and other vascular diseases in a large UK cohort. Circulation. 2015;131(3):237–44. https://doi.org/10.1161/circulationaha.114.010070.CrossRefPubMed

18.

Jeong SM, Yoo JE, Jeon KH, Han K, Lee H, Lee DY, et al. Associations of reproductive factors with incidence of myocardial infarction and ischemic stroke in postmenopausal women: a cohort study. BMC Med. 2023;21(1):64. https://doi.org/10.1186/s12916-023-02757-2.CrossRefPubMedPubMedCentral

19.

Zhu F, Qi H, Bos M, Boersma E, Kavousi M. Female Reproductive factors and risk of New-Onset Heart failure: findings from UK Biobank. JACC Heart Fail. 2023. https://doi.org/10.1016/j.jchf.2023.02.019.CrossRefPubMed

20.

Lakshman R, Forouhi NG, Sharp SJ, Luben R, Bingham SA, Khaw KT, et al. Early age at menarche associated with cardiovascular disease and mortality. J Clin Endocrinol Metab. 2009;94(12):4953–60. https://doi.org/10.1210/jc.2009-1789.CrossRefPubMed

21.

Ley SH, Li Y, Tobias DK, Manson JE, Rosner B, Hu FB, et al. Duration of Reproductive Life Span, Age at Menarche, and age at Menopause are Associated with Risk of Cardiovascular Disease in Women. J Am Heart Assoc. 2017;6(11). https://doi.org/10.1161/jaha.117.006713.

22.

Peters SA, Woodward M. Women’s reproductive factors and incident cardiovascular disease in the UK Biobank. Heart. 2018;104(13):1069–75. https://doi.org/10.1136/heartjnl-2017-312289.CrossRefPubMed

23.

Jeong SM, Jeon KH, Jung W, Yoo JE, Yoo J, Han K, et al. Association of reproductive factors with cardiovascular disease risk in pre-menopausal women: nationwide population-based cohort study. Eur J Prev Cardiol. 2023;30(3):264–73. https://doi.org/10.1093/eurjpc/zwac265.CrossRefPubMed

24.

Chen X, Liu Y, Sun X, Yin Z, Li H, Liu X, et al. Age at menarche and risk of all-cause and cardiovascular mortality: a systematic review and dose–response meta-analysis. Menopause. 2019;26(6):670–6. https://doi.org/10.1097/gme.0000000000001289.CrossRef

25.

Honigberg MC, Zekavat SM, Aragam K, Finneran P, Klarin D, Bhatt DL, et al. Association of Premature Natural and Surgical Menopause With Incident Cardiovascular Disease. JAMA. 2019;322(24):2411–21. https://doi.org/10.1001/jama.2019.19191.CrossRefPubMedPubMedCentral

26.

Barrett-Connor E, Bush TL. Estrogen and coronary heart disease in women. JAMA. 1991;265(14):1861–7.CrossRefPubMed

27.

Bairey Merz CN, Johnson BD, Sharaf BL, Bittner V, Berga SL, Braunstein GD, et al. Hypoestrogenemia of hypothalamic origin and coronary artery disease in premenopausal women: a report from the NHLBI-sponsored WISE study. J Am Coll Cardiol. 2003;41(3):413–9. https://doi.org/10.1016/s0735-1097(02)02763-8.CrossRefPubMed

28.

Woo D, Jae S, Park S. U-shaped association between age at first childbirth and mortality: a prospective cohort study. Maturitas. 2022;161:33–9. https://doi.org/10.1016/j.maturitas.2022.01.015.CrossRefPubMed

29.

Täufer Cederlöf E, Lundgren M, Lindahl B, Christersson C. Pregnancy complications and risk of Cardiovascular Disease later in life: a Nationwide Cohort Study. J Am Heart Assoc. 2022;11(2):e023079. https://doi.org/10.1161/jaha.121.023079.CrossRefPubMedPubMedCentral

30.

Rosendaal NTA, Pirkle CM. Age at first birth and risk of later-life cardiovascular disease: a systematic review of the literature, its limitation, and recommendations for future research. BMC Public Health. 2017;17(1):627. https://doi.org/10.1186/s12889-017-4519-x.CrossRefPubMedPubMedCentral

31.

Gunderson EP, Jacobs DR Jr., Chiang V, Lewis CE, Tsai A, Quesenberry CP Jr., et al. Childbearing is associated with higher incidence of the metabolic syndrome among women of reproductive age controlling for measurements before pregnancy: the CARDIA study. Am J Obstet Gynecol. 2009;201(2):177. https://doi.org/10.1016/j.ajog.2009.03.031.CrossRefPubMedCentral

32.

Wong JA, Rexrode KM, Sandhu RK, Conen D, Albert CM. Number of pregnancies and Atrial Fibrillation Risk: the women’s Health Study. Circulation. 2017;135(6):622–4. https://doi.org/10.1161/circulationaha.116.026629.CrossRefPubMedPubMedCentral

33.

Li W, Wang Y, Shen L, Song L, Li H, Liu B, et al. Association between parity and obesity patterns in a middle-aged and older Chinese population: a cross-sectional analysis in the Tongji-Dongfeng cohort study. Nutr Metab (Lond). 2016;13:72doi. https://doi.org/10.1186/s12986-016-0133-7.CrossRef

34.

Lacey RE, Kumari M, Sacker A, McMunn A. Age at first birth and cardiovascular risk factors in the 1958 British birth cohort. J Epidemiol Community Health. 2017;71(7):691–8. https://doi.org/10.1136/jech-2016-208196.CrossRefPubMed

35.

Li W, Ruan W, Lu Z, Wang D. Parity and risk of maternal cardiovascular disease: a dose-response meta-analysis of cohort studies. Eur J Prev Cardiol. 2019;26(6):592–602. https://doi.org/10.1177/2047487318818265.CrossRefPubMed

36.

Jaffe DH, Neumark YD, Eisenbach Z, Manor O. Parity-related mortality: shape of association among middle-aged and elderly men and women. Eur J Epidemiol. 2009;24(1):9–16. https://doi.org/10.1007/s10654-008-9310-y.CrossRefPubMed

37.

Spence NJ, Eberstein IW. Age at first birth, parity, and post-reproductive mortality among white and black women in the US, 1982–2002. Soc Sci Med. 2009;68(9):1625–32. https://doi.org/10.1016/j.socscimed.2009.02.018.CrossRefPubMedPubMedCentral

Title: Reproductive factors and risk of cardiovascular diseases and all-cause and cardiovascular mortality in American women: NHANES 2003–2018
Authors: Yufeng Yan
Hongjing Lu
Song Lin
Yaguo Zheng
Publication date: 01-12-2024
Publisher: BioMed Central
Published in: BMC Women's Health / Issue 1/2024
Electronic ISSN: 1472-6874
DOI: https://doi.org/10.1186/s12905-024-03055-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Reproductive factors and risk of cardiovascular diseases and all-cause and cardiovascular mortality in American women: NHANES 2003–2018

Abstract

Background

Aims

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Aims

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2024

Maternal and perinatal outcomes of oligohydramnios in late term and post term pregnancies at public hospitals in Ethiopia: a cross-sectional study

“Counteract the gaslighting” – a thematic analysis of open-ended responses about what women survivors of intimate partner sexual violence need from service providers

Measurement of luteinizing hormone surge in vaginal discharge: a potential biomarker that enables simple, non-invasive prediction of the periovulatory period

Pelvic floor function after third and fourth degree perineal lacerations: a case-control study on quality of life

CGRP neuropeptide levels in patients with endometriosis-related pain treated with dienogest: a comparative study

The effectiveness of educational intervention based on the Health Action Model (HAM) in improving breast cancer screening behaviors