Menstrual cycle disorders tied to increasing CVD risk in young women, teens
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Key takeaways:
- CVD is the leading cause of death in women.
- Dysmenorrhea and polycystic ovary syndrome may impact women’s long-term CVD risk.
PHILADELPHIA — Two common reproductive health conditions, dysmenorrhea and polycystic ovary syndrome, are associated with increasing CVD risk in women, according to research presented at the American Heart Association Scientific Sessions.
In one study, women aged younger than 50 years with dysmenorrhea had a higher risk for ischemic heart disease compared with women without painful menstrual periods. Another study that focused on adolescents aged 13 to 17 years found risk for high BP was higher among girls with PCOS compared with girls without PCOS.
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“Finding new markers of CV risk in young women is required to improve screening and preventive measures,” Eugenia Alleva, MD, MSc, postdoctoral research fellow at the Windreich Department of Artificial Intelligence and Human Health and the Hasso Plattner Institute for Digital Health at Mount Sinai, told Healio. “OB/GYNs are becoming increasingly involved in their patients’ long-term health beyond reproductive health. In particular, the American College of Cardiology and AHA have already called for close collaboration between OB/GYNs and cardiologists to optimize primary preventive screening for CVD through the assessment of reproductive risk factors, such as early age at menarche and pregnancy-related hypertensive complications.”
CVD risk and dysmenorrhea
“Dysmenorrhea is a very common menstrual disorder associated with chronic stress, release of inflammatory molecules and autonomic nervous system dysfunction — and, therefore, with the potential to affect CV health. However, it remains a highly understudied condition. On the other hand, young women are experiencing a stagnation, or even an increase, in ischemic heart disorders in the last 10 to 20 years. In this regard, studying dysmenorrhea as a potential CV risk marker is particularly interesting,” Alleva told Healio.
Alleva and colleagues assessed risk for ischemic heart disease among 30,554 women with dysmenorrhea and 25,350 without dysmenorrhea. The researchers looked at diagnoses of ischemic heart disease overall before age 50 years, as well as angina, MI and related complications, and chronic heart disease. They also evaluated women’s menstrual abnormalities, including irregular menstrual cycles, heavy menstrual bleeding and endometriosis, to assess the risk associated with dysmenorrhea independently from these other menstrual conditions, according to a press release.
“The use of AI-based technologies such as large language models, coupled with the large electronic health record dataset at mount Sinai, enabled us to study this condition and its associated risks more precisely than before,” Alleva said.
Women with dysmenorrhea were twice as likely to have overall ischemic heart disease, twice as likely to have chronic or ongoing ischemic heart disease and more than three times more likely to have angina compared with women without dysmenorrhea.
“When performing secondary analyses, we saw that the effect of dysmenorrhea on CV risk is more prominent in non-white population. While this is a very preliminary result, it is surprising to see such a difference and this finding opens up many more questions with respect to the mechanisms that link dysmenorrhea and cardiovascular disease,” Alleva told Healio.
The researchers noted that future studies are needed to confirm these findings and investigate causal mechanisms.
“This is one of very few studies describing a link between dysmenorrhea and ischemic heart disease, and we still need to confirm the findings further and have a long but exciting way ahead of us,” Alleva said.
Hypertension risk and PCOS
For the other study, Sherry Zhang, MD, resident physician in internal medicine at Kaiser Permanente Oakland Medical Center, and colleagues focused on risk associated with PCOS in adolescents.
“Polycystic ovary syndrome in adult women is associated with hypertension and other CV risk factors, but population studies in children are limited,” Zhang told Healio.
Zhang and colleagues analyzed data from about 170,000 teen girls who had a well-child visit at Kaiser Permanente Northern California from 2012 to 2018. One-third were non-Hispanic white, 30.5% Hispanic, 19.9% Asian/Pacific Islander, 9.7% Black and 6.3% other or unknown race/ethnicity. Two-thirds had normal weight, 19% had overweight and 16% had obesity. Based on available BP data, 75% were normotensive, 17.5% had elevated BP and 7% had hypertension (6.1% stage 1; 0.9% stage 2).
In the overall cohort, 1,142 girls had PCOS. The researchers compared differences in BP between those with and without PCOS.
The prevalence of high BP was 18.6% among girls with PCOS compared with 6.9% among girls without PCOS, according to the findings.
PCOS was associated with a 1.3-fold higher risk for BP greater than 130/80 mm Hg. The researchers reported similar findings among girls with obesity.
“These findings emphasize the importance of routine high BP screening in adolescents with polycystic ovary syndrome,” Zhang told Healio.
The researchers plan to examine the persistence of elevated BP and other cardiometabolic risk factors in this high-risk population, Zhang said.
“We recognize that BP can be more variable during childhood, which is why it is important to conduct future studies that include follow-up blood pressure measurements,” Zhang told Healio.
Reference:
- Zhang S, et al. Abstract 176. Presented at: American Heart Association Scientific Sessions; Nov. 11-13, 2023; Philadelphia.
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Alleva E, et al. Abstract 177. Presented at: American Heart Association Scientific Sessions; Nov. 11-13, 2023; Philadelphia.
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