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    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.
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    UMass Chan Affiliations
    Department of Quantitative Health Sciences
    Document Type
    Journal Article
    Publication Date
    2017-05-23
    Keywords
    cardiovascular disease
    menarche
    menopause
    pregnancy
    women
    Cardiology
    Cardiovascular Diseases
    Clinical Epidemiology
    Epidemiology
    Reproductive and Urinary Physiology
    Women's Health
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    Link to Full Text
    https://doi.org/10.1016/j.jacc.2017.03.557
    Abstract
    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 site
    DOI
    10.1016/j.jacc.2017.03.557
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/29077
    PubMed ID
    28521890
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.jacc.2017.03.557
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