Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.
Aalborg University School of Medicine and Health, Aalborg, Denmark.
JAMA Netw Open. 2021 Dec 1;4(12):e2138071. doi: 10.1001/jamanetworkopen.2021.38071.
Some prior evidence suggests that adverse pregnancy outcomes (APOs) may be associated with heart failure (HF). Identifying unique factors associated with the risk of HF and studying HF subtypes are important next steps.
To investigate the association of APOs with incident HF overall and stratified by HF subtype (preserved vs reduced ejection fraction) among postmenopausal women in the Women's Health Initiative (WHI).
DESIGN, SETTING, AND PARTICIPANTS: In 2017, an APO history survey was administered in the WHI study, a large multiethnic cohort of postmenopausal women. The associations of 5 APOs (gestational diabetes, hypertensive disorders of pregnancy [HDP], low birth weight, high birth weight, and preterm delivery) with incident adjudicated HF were analyzed. In this cohort study, the association of each APO with HF was assessed using logistic regression models and with HF subtypes using multinomial regression, adjusting for age, sociodemographic characteristics, smoking, randomization status, reproductive history, and other APOs. Data analysis was performed from January 2020 to September 2021.
APOs (gestational diabetes, HDP, low birth weight, high birth weight, and preterm delivery).
All confirmed cases of women hospitalized with HF and HF subtype were adjudicated by trained physicians using standardized methods.
Of 10 292 women (median [IQR] age, 60 [55-64] years), 3185 (31.0%) reported 1 or more APO and 336 (3.3%) had a diagnosis of HF. Women with a history of any APO had a higher prevalence of hypertension, diabetes, coronary heart disease, or smoking. Of the APOs studied, only HDP was significantly associated with HF with a fully adjusted odds ratio (OR) of 1.75 (95% CI, 1.22-2.50), and with HF with preserved ejection fraction in fully adjusted models (OR, 2.06; 95% CI, 1.29-3.27). In mediation analyses, hypertension explained 24% (95% CI, 12%-73%), coronary heart disease 23% (95% CI, 11%-68%), and body mass index 20% (95% CI, 10%-64%) of the association between HDP and HF.
In this large cohort of postmenopausal women, HDP was independently associated with incident HF, particularly HF with preserved ejection fraction, and this association was mediated by subsequent hypertension, coronary heart disease, and obesity. These findings suggest that monitoring and modifying these factors early in women presenting with HDP may be associated with reduced long-term risk of HF.
一些先前的证据表明，不良妊娠结局（APOs）可能与心力衰竭（HF）有关。确定与 HF 风险相关的独特因素并研究 HF 亚型是下一步的重要步骤。
在妇女健康倡议（WHI）的绝经后妇女中，调查 APO 史与总体 HF 以及 HF 亚型（射血分数保留与射血分数降低）的相关性。
设计、地点和参与者：在 2017 年，WHI 研究进行了 APO 史调查，这是一项大型多民族绝经后妇女队列研究。使用逻辑回归模型分析了 5 种 APO（妊娠糖尿病、妊娠高血压疾病[HDP]、低出生体重、高出生体重和早产）与新确诊 HF 的关系。在这项队列研究中，使用多变量回归模型评估了每种 APO 与 HF 亚型的关联，调整了年龄、社会人口特征、吸烟、随机分组状态、生殖史和其他 APO。数据分析于 2020 年 1 月至 2021 年 9 月进行。
APO（妊娠糖尿病、HDP、低出生体重、高出生体重和早产）。
所有经培训的医生使用标准化方法对因 HF 住院的女性的所有确诊病例和 HF 亚型进行了裁决。
在 10292 名女性中（中位数[IQR]年龄，60[55-64]岁），3185 名（31.0%）报告了 1 种或多种 APO，336 名（3.3%）患有 HF。有 APO 史的女性高血压、糖尿病、冠心病或吸烟的患病率更高。在所研究的 APO 中，只有 HDP 与 HF 显著相关，完全调整后的优势比（OR）为 1.75（95%CI，1.22-2.50），与完全调整模型中的射血分数保留 HF 相关（OR，2.06；95%CI，1.29-3.27）。在中介分析中，高血压解释了 HDP 与 HF 之间关联的 24%（95%CI，12%-73%），冠心病解释了 23%（95%CI，11%-68%），体重指数解释了 20%（95%CI，10%-64%）。
在这项大型绝经后妇女队列研究中，HDP 与 HF 的发生独立相关，特别是射血分数保留的 HF，并且这种相关性是由随后的高血压、冠心病和肥胖引起的。这些发现表明，在患有 HDP 的女性中早期监测和改变这些因素可能与 HF 的长期风险降低有关。
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