Infertility may predict HF risk in women
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Women reporting a history of infertility had an almost 20% increased risk for developing HF during 15 years of follow-up, particularly HF with preserved ejection fraction, according to an analysis of Women’s Health Initiative data.
“Infertility is a reproductive factor that is consistently underrecognized with respect to CV risk, in part because of the paucity of rigorous data examining CV risk in women with a history of infertility,” Emily S. Lau, MD, MPH, a cardiologist and investigator at Massachusetts General Hospital and instructor in medicine at Harvard Medical School, and colleagues wrote in the study background. “The risk of infertility should not be overlooked because it affects more than 14% of women in the United States and has been linked to higher risk of overall CVD risk in some studies, although the available data are conflicting. In the Swedish Medical Birth Register, women who reported at least 5 years of infertility before a successful pregnancy had a 19% higher incidence of CVD compared with women without a history of infertility.”
Risk by HF subtype
In a prospective study, Lau and colleagues followed 38,528 postmenopausal women who participated in the Women’s Health Initiative for development of HF; women self-reported infertility at study baseline (mean age, 63 years). Researchers evaluated the association of infertility with incident overall HF and HF subtypes.
Within the cohort, 14% of participants reported infertility at baseline.
During a median follow-up of 15 years, 2,373 women developed incident HF, including 807 with HF with reduced ejection fraction and 1,133 with HFpEF. Infertility was independently associated with risk for overall HF (HR = 1.16; 95% CI, 1.04-1.3; P = .006). However, in analyses stratified by HF subtype, the association persisted only for HFpEF, with an HR of 1.27 (95% CI, 1.09-1.48; P = .002).
The relationship between infertility and risk for HF and HFpEF persisted even after further adjustment for irregular menses, early menopause and thyroid disease, with HRs for overall HF of 1.15 (95% CI, 1.03-1.29; P = .01) and for HFpEF of 1.26 (95% CI, 1.08-1.47; P = .003).
The researchers also found that systolic BP, hypertension treatment, diabetes and hyperlipidemia were not associated with infertility (P > .05 for all). Additionally, researchers found no association between infertility and traditional CV risk factors as captured by 10-year estimated ASCVD risk.
“The association between infertility and HF did not appear to be explained by established CV risk factors or infertility-related risk factors, highlighting the need for further investigation into the underlying mechanistic drivers,” the researchers wrote.
Improve assessment of women’s health
In a related editorial, Ersilia M. DeFilippis, MD, advanced HF and transplant fellow at Columbia University Irving Medical Center, wrote that the findings highlight the need for developing sex-specific risk scores that incorporate reproductive factors, such as history of preeclampsia, gestational hypertension and infertility, which can incur risk independent of traditional CV risk factors.
“One of the best ways to honor these research participants is to improve our history taking, early evaluation and risk assessment of young women of reproductive age, both in clinical practice and as part of clinical trials,” DeFilippis wrote. “This should include an assessment of traditional cardiovascular risk factors but also inquire about age of menarche, difficulty conceiving, number of pregnancies and any adverse pregnancy outcomes, breastfeeding and timing of menopause. Furthermore, this risk assessment should be an iterative process as new information about a woman's reproductive health becomes available. This longitudinal knowledge can empower patients and physicians to optimize cardiovascular health for women throughout their lifespan.”
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