Reproductive Factors and Incidence of Heart Failure Hospitalization in the Women's Health Initiative
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Authors
Hall, Philip S.Nah, Gregory
Howard, Barbara V.
Lewis, Cora E.
Allison, Matthew A.
Sarto, Gloria E.
Waring, Molly E.
Jacobson, Lisette T.
Manson, Joann E.
Klein, Liviu
Parikh, Nisha I.
UMass Chan Affiliations
Department of Quantitative Health SciencesDocument Type
Journal ArticlePublication Date
2017-05-23Keywords
cardiovascular diseasemenarche
menopause
pregnancy
women
Cardiology
Cardiovascular Diseases
Clinical Epidemiology
Epidemiology
Reproductive and Urinary Physiology
Women's Health
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BACKGROUND: Reproductive factors reflective of endogenous sex hormone exposure might have an effect on cardiac remodeling and the development of heart failure (HF). OBJECTIVES: This study examined the association between key reproductive factors and the incidence of HF. METHODS: Women from a cohort of the Women's Health Initiative were systematically evaluated for the incidence of HF hospitalization from study enrollment through 2014. Reproductive factors (number of live births, age at first pregnancy, and total reproductive duration [time from menarche to menopause]) were self-reported at study baseline in 1993 to 1998. We employed Cox proportional hazards regression analysis in age- and multivariable-adjusted models. RESULTS: Among 28,516 women, with an average age of 62.7 +/- 7.1 years at baseline, 1,494 (5.2%) had an adjudicated incident HF hospitalization during an average follow-up of 13.1 years. After adjusting for covariates, total reproductive duration in years was inversely associated with incident HF: hazard ratios (HRs) of 0.99 per year (95% confidence interval [CI]: 0.98 to 0.99 per year) and 0.95 per 5 years (95% CI: 0.91 to 0.99 per 5 years). Conversely, early age at first pregnancy and nulliparity were significantly associated with incident HF in age-adjusted models, but not after multivariable adjustment. Notably, nulliparity was associated with incident HF with preserved ejection fraction in the fully adjusted model (HR: 2.75; 95% CI: 1.16 to 6.52). CONCLUSIONS: In post-menopausal women, shorter total reproductive duration was associated with higher risk of incident HF, and nulliparity was associated with higher risk for incident HF with preserved ejection fraction. Whether exposure to endogenous sex hormones underlies this relationship should be investigated in future studies.Source
J Am Coll Cardiol. 2017 May 23;69(20):2517-2526. doi: 10.1016/j.jacc.2017.03.557. Link to article on publisher's siteDOI
10.1016/j.jacc.2017.03.557Permanent Link to this Item
http://hdl.handle.net/20.500.14038/29077PubMed ID
28521890Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1016/j.jacc.2017.03.557