Cairncross Zoe F, Ahmed Sofia B, Dumanski Sandra M, Nerenberg Kara A, Metcalfe Amy
Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada.
Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
CJC Open. 2020 Nov 24;3(4):400-408. doi: 10.1016/j.cjco.2020.11.011. eCollection 2021 Apr.
Cardiovascular disease (CVD) is the leading cause of death in women globally. In recent years, attention has turned to infertility and pregnancy-related events as potential markers for early mortality and future CVD.
The Study of Women's Health Across the Nation (SWAN) is an ongoing longitudinal cohort study of women's health. Women aged 42-52 years with a uterus and ≤ 1 intact ovary, a menstrual period, and no hormone medications within 3 months before enrollment were eligible. Infertility was self-reported and defined as the inability to achieve pregnancy after 12 months of trying to conceive, or use of fertility medications for > 1 month. Outcomes included development of metabolic syndrome over a 7-year follow-up, and any atherosclerotic CVD event (ie, stroke, angina, myocardial infarction) over a 10-year follow-up. Cox proportional hazards models were used to calculate hazard ratios (HRs) for metabolic syndrome and CVD events in participants with infertility, with adjustment for relevant covariates. Participants without infertility were used as the comparison group.
We included 2370 participants in the analysis of metabolic syndrome risk, and 2809 participants were included in the analysis of CVD event risk. Participants with self-reported infertility did not have a higher risk of developing metabolic syndrome (HR, 0.91; 95% confidence interval, 0.71-1.15) or experiencing CVD events (HR, 0.79; 95% confidence interval, 0.52-1.21) after adjusting for relevant covariates.
Infertility was not associated with development of metabolic syndrome or CVD events in women; further research is required to investigate the effects of specific causes of infertility and fertility treatments on CVD outcomes.
心血管疾病（CVD）是全球女性死亡的主要原因。近年来，人们开始关注不孕症和与妊娠相关的事件，将其作为早期死亡和未来心血管疾病的潜在标志物。
全国女性健康研究（SWAN）是一项正在进行的关于女性健康的纵向队列研究。纳入年龄在42 - 52岁、有子宫且卵巢≤1个完整、有月经周期且在入组前3个月内未使用激素药物的女性。不孕症通过自我报告确定，定义为尝试受孕12个月后仍未怀孕，或使用生育药物超过1个月。结局包括7年随访期间代谢综合征的发生情况，以及10年随访期间任何动脉粥样硬化性心血管疾病事件（即中风、心绞痛、心肌梗死）。使用Cox比例风险模型计算不孕症参与者发生代谢综合征和心血管疾病事件的风险比（HRs），并对相关协变量进行调整。以无不孕症的参与者作为对照组。
在代谢综合征风险分析中纳入了2370名参与者，在心血管疾病事件风险分析中纳入了2809名参与者。在对相关协变量进行调整后，自我报告有不孕症的参与者发生代谢综合征（HR，0.91；95%置信区间，0.71 - 1.15）或心血管疾病事件（HR，0.79；95%置信区间，0.52 - 1.21）的风险并不更高。
不孕症与女性代谢综合征或心血管疾病事件的发生无关；需要进一步研究以调查不孕症的特定原因和生育治疗对心血管疾病结局的影响。
