Women's College Research Institute and Cardiovascular Division, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
J Am Coll Cardiol. 2013 Oct 29;62(18):1704-1712. doi: 10.1016/j.jacc.2013.05.085. Epub 2013 Jul 31.
The purpose of the study was to investigate whether fertility therapy might contribute to subsequent cardiovascular disease.
Fertility medications are used for 1% of births yet may also lead to endothelial injury with long-term adverse consequences for the mother.
A population-based cohort analysis was performed of women who gave birth in Ontario, Canada, between July 1, 1993, and March 31, 2010, distinguishing those who did and did not receive fertility therapy in the 2 years before delivery. Cox proportional models were derived to estimate hazard ratios with and without adjustment for baseline characteristics. The primary outcome was a composite cardiovascular endpoint of death, nonfatal coronary ischemia, stroke, transient ischemic attack, thromboembolism, or heart failure.
Among 1,186,753 women who delivered during the study period, 6,979 gave birth after fertility therapy. After 9.7 years of median follow-up, women who delivered after fertility therapy had fewer cardiovascular events than controls (103 vs. 117 events per 100,000 person-years), equivalent to an unadjusted hazard ratio of 0.96 (95% confidence interval: 0.72 to 1.29, p = 0.79) and an adjusted hazard ratio of 0.55 (95% confidence interval: 0.41 to 0.74, p < 0.0001). An apparent relative lower risk was observed across all age and income groups. Women who received fertility therapy also had lower risk-adjusted all-cause mortality, thromboembolic events, subsequent depression, alcoholism, and self-harm (p < 0.01 for each).
Successful fertility therapy was not associated with an increased risk of cardiovascular disease later in life.
本研究旨在探讨生育治疗是否会导致后续心血管疾病。
生育药物仅用于 1%的分娩，但也可能导致内皮损伤，对母亲产生长期不良后果。
对 1993 年 7 月 1 日至 2010 年 3 月 31 日期间在加拿大安大略省分娩的妇女进行了基于人群的队列分析，区分了在分娩前 2 年内接受和未接受生育治疗的妇女。采用 Cox 比例风险模型估计调整和未调整基线特征后的风险比。主要结局是死亡、非致死性冠状动脉缺血、卒中等心血管复合终点事件。
在研究期间分娩的 1186753 名妇女中，有 6979 名妇女在接受生育治疗后分娩。中位随访 9.7 年后，接受生育治疗后分娩的妇女心血管事件少于对照组（每 10 万人年分别为 103 例和 117 例），未经调整的风险比为 0.96（95%置信区间：0.72 至 1.29，p=0.79），调整后的风险比为 0.55（95%置信区间：0.41 至 0.74，p<0.0001）。在所有年龄和收入组中均观察到相对较低的风险。接受生育治疗的妇女也有较低的风险调整全因死亡率、血栓栓塞事件、随后的抑郁、酗酒和自残（p<0.01）。
生育治疗的成功与晚年心血管疾病风险的增加无关。
