Murugappan Gayathree, Leonard Stephanie A, Farland Leslie V, Lau Emily S, Shadyab Aladdin H, Wild Robert A, Schnatz Peter, Carmichael Suzan L, Stefanick Marcia L, Parikh Nisha I
Department of Obstetrics and Gynecology, Stanford University Medical Center, Stanford, California.
Department of Obstetrics and Gynecology, Stanford University Medical Center, Stanford, California.
Fertil Steril. 2022 May;117(5):1038-1046. doi: 10.1016/j.fertnstert.2022.02.005. Epub 2022 Mar 16.
To investigate the association of infertility with atherosclerotic cardiovascular disease (ASCVD) among postmenopausal participants in the Women's Health Initiative (WHI). We hypothesized that nulliparity and pregnancy loss may reveal more extreme phenotypes of infertility, enabling further understanding of the association of infertility with ASCVD.
Prospective cohort study.
Forty clinical centers in the United States.
PATIENT(S): A total of 158,787 postmenopausal participants in the Women's Health Initiative cohort.
INTERVENTION(S): Infertility, parity, and pregnancy loss.
MAIN OUTCOME MEASURE(S): The primary outcome was risk of ASCVD among women with and without a history of infertility, stratified by history of live birth and pregnancy loss. Cox proportional-hazards models were adjusted for demographics and risk factors for ASCVD.
RESULT(S): Among 158,787 women, 25,933 (16.3%) reported a history of infertility; 20,427 (80%) had at least 1 live birth; and 9,062 (35%) had at least 1 pregnancy loss. There was a moderate overall association between infertility and ASCVD (adjusted hazard ratio, 1.02; 95% confidence interval [CI], 0.99-1.06) over 19 years of follow-up. Among nulliparous women, infertility was associated with a 13% higher risk of ASCVD (95% CI, 1.04-1.23). Among nulliparous women who had a pregnancy loss, infertility was associated with a 36% higher risk of ASCVD (95% CI, 1.09-1.71).
CONCLUSION(S): Women with a history of infertility overall had a moderately higher risk of ASCVD compared with women without a history of infertility. Atherosclerotic cardiovascular disease risk was much higher among nulliparous infertile women and among nulliparous infertile women who also had a pregnancy loss, suggesting that in these more extreme phenotypes, infertility may be associated with ASCVD risk.
研究女性健康倡议（WHI）中绝经后参与者的不孕症与动脉粥样硬化性心血管疾病（ASCVD）之间的关联。我们假设未生育和流产可能揭示不孕症更极端的表型，从而有助于进一步了解不孕症与ASCVD之间的关联。
前瞻性队列研究。
美国40个临床中心。
女性健康倡议队列中共有158,787名绝经后参与者。
不孕症、生育情况和流产情况。
主要结局是有无不孕症病史的女性发生ASCVD的风险，按活产史和流产史分层。Cox比例风险模型针对人口统计学和ASCVD风险因素进行了调整。
在158,787名女性中，25,933名（16.3%）报告有不孕症病史；20,427名（80%）至少有1次活产；9,062名（35%）至少有1次流产。在19年的随访中，不孕症与ASCVD之间存在中度总体关联（调整后的风险比为1.02；95%置信区间[CI]为0.99 - 1.06）。在未生育的女性中，不孕症与ASCVD风险高13%相关（95%CI为1.04 - 1.23）。在有过流产的未生育女性中，不孕症与ASCVD风险高36%相关（95%CI为1.09 - 1.71）。
有不孕症病史的女性总体上发生ASCVD的风险略高于无不孕症病史的女性。未生育的不孕女性以及有过流产的未生育不孕女性发生动脉粥样硬化性心血管疾病的风险要高得多，这表明在这些更极端的表型中，不孕症可能与ASCVD风险相关。
