Miscarriage linked to increased risk for heart disease, but not CVD or stroke

Takeaway

• Early menarche (<12 years) and/or menopause (<47 years), young age at first birth, adverse pregnancy outcomes and hysterectomy are associated with increased cardiovascular risk.

Why this matters

• More frequent cardiovascular screening may be appropriate in women with certain reproductive factors.
• Cardiovascular risk stratification which takes account of reproductive factors should be considered.

Key results

• Adjusted HRs (aHRs) for coronary heart disease (CHD) and stroke after early menarche were 1.05 (95% CI, 0.93-1.18) and 1.17 (95% CI, 1.03-1.32).
• Having children significantly increased the risk for CHD in women (aHR, 1.21; 95% CI, 1.05-1.40) and men (aHR, 1.13; 95% CI, 1.04-1.23), but did not increase the risk for cardiovascular disease (CVD) or stroke.
• Each child was associated with increased risk for CVD in women (aHR, 1.03; 95% CI, 1.00-1.06) and men (aHR, 1.03; 95% CI, 1.02-1.05).
• Inverse relationship between age at first birth and risk for CVD, CHD and stroke, after adjustment for socioeconomic status and lifestyle factors.
• Miscarriage associated with higher risk for CHD (aHR, 1.14; 95% CI, 1.01-1.29), but not CVD or stroke.
• Hysterectomy associated with risk for CVD (aHR, 1.12; 95% CI, 1.03-1.22) and CHD (aHR, 1.20; 95% CI, 1.07-1.34), but not stroke.
• Early menopause associated with greater risk for CVD (aHR, 1.33; 95% CI, 1.19-1.49), CHD (aHR, 1.29; 95% CI, 1.10-1.51) and stroke (aHR, 1.42; 95% CI, 1.21-1.66).

Study design

• Prospective, population-based cohort study of UK Biobank data from 267,440 women and 215,088 men aged 40-69 years without a history of CVD at baseline.
• Funding: None disclosed. 

Limitations

• Information on reproductive factors was self-reported.
• Potential for reverse causality.
• Number of events was limited in some of the analyses.