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Certain Reproductive Factors Signal Increased Risk of Coronary Artery Disease in Women

Having 3 or more pregnancies, a shorter reproductive life span, or early age at menopause onset were linked to increased risk of CAD in a recent study.

Results of a recent study into coronary artery disease in postmenopausal women is offering clinicians an overview of reproductive risk factors, which investigators hope can lead to earlier identification and treatment of the cardiovascular condition.

One of the largest studies to examine reproductive risk factors, results indicated having 3 or more pregnancies, early menopause, and having a shorter reproductive life were all independent risk factors for obstructive coronary artery disease in women.

"This study expands our knowledge about the link between reproductive factors such as early menopause and shorter reproductive life span and increased cardiovascular risk. Indeed, there is a growing body of evidence suggesting that early loss of ovarian function results in accelerated aging. Future research should be directed toward identifying ways to delay ovarian aging," commented Stephanie Faubion, MD, clinician at Women's Health Clinic at Mayo Clinic and medical director of the North American Menopause Society, in a statement.

While previous research has suggested reproductive factors, there is much about the relationship between reproductive factors and subsequent cardiovascular risk. To learn more about how these factors may influence risk of coronary artery disease, a team of investigators from the Tongji Medical College designed the current study to compare reproductive factors among postmenopausal women with no apparent coronary artery disease, nonobstructive coronary artery disease, and obstructive coronary artery disease.

Using women admitted to the cardiovascular department of the Tongji Hospital from between April 2013 and October 2018, investigators were able to identify 2,511 postmenopausal women admitted for chest pain and referred for invasive coronary angiography for possible inclusion in the their study. Of these 974 were excluded due to prior coronary artery disease and 63 were excluded due to missing data. In total, 1474 women were included in the analysis.

Among the 1474 women included, coronary angiography resulted indicated 251 had no apparent coronary artery disease, 342 women had nonobstructive coronary artery disease, and 881 women had obstructive coronary artery disease. For the subsequent analyses, investigators used the those with no coronary artery disease and those with non obstructive coronary artery disease were used as controls.

In adjusted analyses, investigators identified multiple reproductive risk factors associated with an increased risk of obstructive coronary artery disease. Those who entered menopause at 40 years of age or younger were at an increased risk compared to those who entered menopause later in life (aOR, 1.77; 95% CI, 1.14-2.76; P=.011), those with a reproductive life span of 30 or fewer years were at an increased risk compared to those with a reproductive life span of more than 30 years (aOR, 1.72; 95% CI, 1.26-2.35; P=.011), and those with multigravidity, which was defined 3 pregnancies or more, were at an increased risk for obstructive coronary artery disease compared to those who were never pregnant (aOR, 1.81; 95% CI, 1.03-3.17; P=.011).

Further analysis indicated each additional year in age at menopause or reproductive life span was associated with a 4% reduction in obstructive coronary artery disease (OR, 0.96; 95% CI, 0.94-0.99; P=.011). Factors not associated with increased risk of obstructive coronary artery disease included parity, age at first birth, spontaneous abortion, induced abortion, stillbirth, hypertensive disorders of pregnancy, gestational diabetes mellitus, and age at menarche.

“These results provide a new direction for the pathophysiological study of obstructive CAD. The prognosis of women with obstructive CAD is usually worse than that of women with no apparent CAD and nonobstructive CAD, and early intervention is necessary,” wrote study investigators. “Therefore, women with these reproductive risk factors should take precautions as early as possible.”

This study, “Reproductive risk factors for angiographic obstructive coronary artery disease among postmenopausal women,” was published in Menopause.