Hall Philip S, Nah Gregory, Howard Barbara V, Lewis Cora E, Allison Matthew A, Sarto Gloria E, Waring Molly E, Jacobson Lisette T, Manson JoAnn E, Klein Liviu, Parikh Nisha I
Division of Cardiology, University of California, San Francisco, San Francisco, California.
MedStar Health Research Institute and Georgetown/Howard Universities Center for Clinical and Translational Research, Hyattsville, Maryland.
J Am Coll Cardiol. 2017 May 23;69(20):2517-2526. doi: 10.1016/j.jacc.2017.03.557.
Reproductive factors reflective of endogenous sex hormone exposure might have an effect on cardiac remodeling and the development of heart failure (HF).
This study examined the association between key reproductive factors and the incidence of HF.
Women from a cohort of the Women's Health Initiative were systematically evaluated for the incidence of HF hospitalization from study enrollment through 2014. Reproductive factors (number of live births, age at first pregnancy, and total reproductive duration [time from menarche to menopause]) were self-reported at study baseline in 1993 to 1998. We employed Cox proportional hazards regression analysis in age- and multivariable-adjusted models.
Among 28,516 women, with an average age of 62.7 ± 7.1 years at baseline, 1,494 (5.2%) had an adjudicated incident HF hospitalization during an average follow-up of 13.1 years. After adjusting for covariates, total reproductive duration in years was inversely associated with incident HF: hazard ratios (HRs) of 0.99 per year (95% confidence interval [CI]: 0.98 to 0.99 per year) and 0.95 per 5 years (95% CI: 0.91 to 0.99 per 5 years). Conversely, early age at first pregnancy and nulliparity were significantly associated with incident HF in age-adjusted models, but not after multivariable adjustment. Notably, nulliparity was associated with incident HF with preserved ejection fraction in the fully adjusted model (HR: 2.75; 95% CI: 1.16 to 6.52).
In post-menopausal women, shorter total reproductive duration was associated with higher risk of incident HF, and nulliparity was associated with higher risk for incident HF with preserved ejection fraction. Whether exposure to endogenous sex hormones underlies this relationship should be investigated in future studies.
反映内源性性激素暴露情况的生殖因素可能会影响心脏重塑和心力衰竭（HF）的发生发展。
本研究探讨关键生殖因素与HF发病率之间的关联。
对来自女性健康倡议队列研究的女性进行系统评估，自研究入组至2014年期间HF住院的发生率。生殖因素（活产数、首次怀孕年龄和总生殖持续时间[从月经初潮至绝经的时间]）于1993年至1998年研究基线时通过自我报告获得。我们在年龄调整模型和多变量调整模型中采用Cox比例风险回归分析。
在28516名女性中，基线时平均年龄为62.7±7.1岁，在平均13.1年的随访期间，1494名（5.2%）有经判定的HF住院事件。在对协变量进行调整后，以年计算的总生殖持续时间与HF发病呈负相关：每年的风险比（HR）为0.99（95%置信区间[CI]：每年0.98至0.99），每5年的HR为0.95（95%CI：每5年0.91至0.99）。相反，在年龄调整模型中，首次怀孕年龄早和未生育与HF发病显著相关，但在多变量调整后则不然。值得注意的是，在完全调整模型中，未生育与射血分数保留的HF发病相关（HR：2.75；95%CI：1.16至6.52）。
在绝经后女性中，较短的总生殖持续时间与HF发病风险较高相关，未生育与射血分数保留的HF发病风险较高相关。内源性性激素暴露是否是这种关系的基础应在未来研究中进行调查。
