Infertility linked to an increased risk of heart failure

Infertility is linked to a higher risk of an incident cardiac arrestespecially heart failure with preserved ejection fraction (HFpEF), suggests a prospective cohort study.

The data show that infertile women were at higher risk of having heart failure in the future, primarily due to an increased risk of HFpEF rather than heart failure with reduced ejection fraction (HFrEF). Coronary artery disease, conventional cardiovascular risk factorsand other infertility-related disorders do not explain these findings, report Emily S. Lau, MD, MPH, Massachusetts General Hospital, Boston, and colleagues.

The conclusions were published in the April 26 issue of Journal of the American College of Cardiology.

Discussion of what happened when patients were trying to get pregnant if they had unfavorable outcomes of pregnancy or a history of infertility, and experience with menopause are all important, Lau noted.

“All of these reproductive factors are incredibly important windows into a woman’s future cardiovascular risk, and yet they’re not routinely asked during primary care office visits or even cardiology office visits, but that’s something that we doctors should start asking our patients,” she said. | Medscape Cardiology in an interview.

Previous research does not provide a robust data set on the relationship between cardiovascular disease and infertility, especially heart failure,” notes M. Ersilia DEFILIPPIS, MD, Columbia University Irving Medical Center, New York, in a accompanying editorial. A review involving the Swedish Medical Birth Registry has indicated that women with a history of infertility who eventually became pregnant were at high risk of cardiovascular disease, but he did not specifically at risk of heart failure.

The Women’s Health Initiative (WHI) has been helpful in helping the medical community assess reproductive health and its relationship to cancer, osteoporosis, and cardiovascular risk, she writes. To honor research participants, efforts should be made to engage in early assessment, to improve history taking, and to do risk assessment of young women of childbearing age in trials. clinics and in clinical practice, she writes.

“This should include an assessment of traditional cardiovascular risk factors, but also ask about age at menarche, difficulty conceiving, number of pregnancies and adverse pregnancy outcomes, breastfeeding, and timing of pregnancy. menopause,” the editorial notes.

“This risk assessment should be an iterative process as new information about a woman’s reproductive health becomes available. This longitudinal knowledge can enable patients and physicians to optimize women’s cardiovascular health throughout their lifetime. life,” concludes DeFilippis.

For this report, Lau and her colleagues analyzed 38,528 postmenopausal women, 14% of whom reported having a history of infertility. The average age was 63 years old.

Using WHI data, the study team prospectively assessed postmenopausal women to determine if they were developing heart failure. Using cause-based multivariate Cox models, researchers assessed the relationship between infertility and heart failure subtypes, which included HFrEF, HFpEF, as well as congestive heart failure.

Over a median follow-up of 15 years, 2373 developed incident HF, including 1133 with HFpEF and 807 with HFrEF.

Infertility was independently related to risk of congestive heart failure in the future (relative risk [HR]1.16; P = 0.006).

Additional data on heart failure subtypes showed that infertility was not related to HFrEF (HR, 0.97; 95% CI, 0.80, 1.18), but was was associated with a future risk of HFpEF (HR, 1.27; P= .002).

The study is observational in nature, which limits the researchers’ ability to assess causality, participants self-reported their infertility status, which may have been misclassified, postmenopausal women were enrolled in the WHI between 1993 and 1998, before the use of modern fertility therapies like in vitro fertilization and the lack of information on the period of infertility before pregnancy were the limitations of the study, note the authors.

Other limitations include that the research did not focus specifically on microvascular disease, although coronary disease did not take into account the relationship between heart failure and infertility, and the fact that baseline covariates – such as traditional cardiovascular risk factors, such as waist circumference, blood pressure and body mass index – were assessed at registration.

“Our results highlight the need for rigorous studies on the mechanisms by which infertility can lead to a future HFPEF and a comprehensive CV risk,” the researchers conclude.

The WHI program is supported by the US Department of Health and Human Services and the National Heart, Lung, and Blood Institute, National Institutes of Health. Lau has received support from the American Heart Association. DeFilippis reports no relevant financial relationships.

J Am Coll Cardiol. 2022;79:1594-1603, 1604-1605. Full Text, Editorial

Ashley Lyles is an award-winning medical journalist. She is a graduate of New York University’s Science, Health and Environmental Information Program. Previously, she studied professional writing at Michigan State University, where she took premedical courses. His work has taken him to Honduras, Cambodia, France and Ghana and has appeared in outlets like The New York Times Daily 360, PBS NewsHour, The Huffington Post, Undark, The Root, Psychology Today, Insider and Tonic (Health by vice), among other publications.

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