Kazzi Brigitte, Ogunmoroti Oluseye, Rodriguez Carla P, Zhao Di, Minhas Anum S, Osibogun Olatokunbo, Subramanya Vinita, Allison Matthew A, Ouyang Pamela, Michos Erin D
Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA.
Can J Cardiol. 2022 Dec;38(12):1893-1900. doi: 10.1016/j.cjca.2022.09.004. Epub 2022 Sep 8.
Multiparity is a risk factor for cardiovascular disease (CVD). A more androgenic sex hormone profile, with a higher testosterone (T)/estradiol (E2) ratio, is associated with worse CVD outcomes in women and might be one mechanism linking multiparity to increased CVD risk. We investigated the relationship between parity and sex hormones at mid-to-older age.
We performed a cross-sectional analysis of 2979 women with data on parity and endogenous sex hormone levels from the Multi-Ethnic Study of Atherosclerosis (MESA), a community-based cohort. Parity and gravidity (our exposures) were categorized as 0 (reference), 1-2, 3-4, or ≥ 5. Our outcome measures were T, E2, sex hormone binding globulin, dehydroepiandrosterone, and T/E2 ratio. Progressively adjusted linear regression was used to evaluate the association of parity/gravidity with sex hormones.
In multivariable adjusted models, there were no significant associations of parity with E2, dehydroepiandrosterone, and sex hormone binding globulin. Compared with nulliparity, after adjustment for CVD risk factors, women with 1-2 and 3-4 live births had higher T, but this was not significant for grand multiparity (≥ 5 live births). However, grand multigravidity (≥ 5 pregnancies) was associated with 10% (95% confidence interval [CI], 1%-20%) higher T and 14% (95% CI, 1%-29%) higher T/E2, compared with null gravidity. Grand multiparity was associated with an 18% (95% CI, 4%-34%) higher T/E2 ratio compared with nulliparity, after adjustment for CVD risk factors.
In this multiethnic cohort, women with grand multigravidity and grand multiparity had higher T/E2 levels, reflecting a more androgenic sex hormone profile. Longitudinal studies on sex hormones' influence on the relationship between multiparity and CVD are warranted.
多产是心血管疾病（CVD）的一个危险因素。雄激素性更强的性激素谱，即更高的睾酮（T）/雌二醇（E2）比值，与女性更差的CVD结局相关，可能是将多产与CVD风险增加联系起来的一种机制。我们研究了中年至老年女性的产次与性激素之间的关系。
我们对来自社区队列动脉粥样硬化多族裔研究（MESA）的2979名有产次和内源性性激素水平数据的女性进行了横断面分析。产次和妊娠次数（我们的暴露因素）分为0（参照）、1 - 2、3 - 4或≥5。我们的结局指标是T、E2、性激素结合球蛋白、脱氢表雄酮和T/E2比值。采用逐步调整的线性回归来评估产次/妊娠次数与性激素的关联。
在多变量调整模型中，产次与E2、脱氢表雄酮和性激素结合球蛋白之间无显著关联。与未生育相比，在调整心血管疾病危险因素后，有1 - 2次和3 - 4次活产的女性T水平较高，但多产（≥5次活产）时不显著。然而，与未妊娠相比多妊娠（≥5次妊娠）与T水平高10%（95%置信区间[CI]，1% - 20%）和T/E2高14%（95% CI，1% - 29%）相关。在调整心血管疾病危险因素后，与未生育相比多产与T/E2比值高18%（95% CI，4% - 34%）相关。
在这个多族裔队列中，多妊娠和多产的女性T/E2水平较高，反映出雄激素性更强的性激素谱。有必要对性激素对多产与心血管疾病关系的影响进行纵向研究。
