Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health University of Arizona Tucson AZ.
Department of Obstetrics and Gynecology, College of Medicine-Tucson University of Arizona Tucson AZ.
J Am Heart Assoc. 2023 Mar 7;12(5):e027755. doi: 10.1161/JAHA.122.027755. Epub 2023 Feb 27.
Background Certain symptoms associated with infertility are associated with cardiovascular disease, including menstrual cycle irregularity, early menopause, and obesity; however, few studies have investigated the association between infertility and cardiovascular disease risk. Methods and Results Participants in the NHSII (Nurses' Health Study II) who reported infertility (12 months of trying to conceive without success, including women who subsequently conceived) or who were gravid, with no infertility were followed from 1989 until 2017 for development of incident, physician-diagnosed coronary heart disease (CHD) (myocardial infarction, coronary artery bypass grafting, angioplasty, stent) and stroke. Time-varying Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% CIs and were adjusted a priori for potential confounding variables. Among 103 729 participants, 27.6% reported having ever experienced infertility. Compared with gravid women who had not reported infertility, women with a history of infertility had greater risk of CHD (HR, 1.13 [95% CI, 1.01-1.26]) but not stroke (HR, 0.91 [95% CI, 0.77-1.07]). The association between history of infertility and CHD was strongest among women who reported infertility at an earlier age (HR for infertility first reported at ≤25 years, 1.26 [95% CI, 1.09-1.46]; HR at 26-30 years, 1.08 [95% CI, 0.93-1.25]; HR at >30 years, 0.91 [95% CI, 0.70-1.19]). When we investigated specific infertility diagnoses, elevated risk of CHD was observed among women whose infertility was attributed to an ovulatory disorder (HR, 1.28 [95% CI, 1.05-1.55]) or endometriosis (HR, 1.42 [95% CI, 1.09-1.85]). Conclusions Women with infertility may be at an increased risk of CHD. Risk differed by age at first infertility diagnosis and was restricted to ovulatory- and endometriosis-related infertility.
一些与不孕相关的症状与心血管疾病有关，包括月经周期不规律、早绝经和肥胖；然而，很少有研究调查不孕与心血管疾病风险之间的关系。
NHSII（护士健康研究 II）中的参与者报告了不孕（12 个月未能成功受孕，包括随后受孕的女性）或怀孕但没有不孕，从 1989 年开始随访至 2017 年，以确定是否发生了新发的、经医生诊断的冠心病（CHD）（心肌梗死、冠状动脉旁路移植术、血管成形术、支架）和中风。采用时变 Cox 比例风险模型计算危险比（HR）和 95%置信区间（CI），并根据潜在混杂变量进行了预先调整。在 103729 名参与者中，27.6%报告曾经历过不孕。与未报告不孕的怀孕女性相比，有不孕史的女性患 CHD 的风险更高（HR，1.13[95%CI，1.01-1.26]），但中风风险无差异（HR，0.91[95%CI，0.77-1.07]）。不孕史与 CHD 之间的关联在报告较早年龄不孕的女性中最强（首次报告不孕年龄≤25 岁的 HR，1.26[95%CI，1.09-1.46]；报告年龄为 26-30 岁的 HR，1.08[95%CI，0.93-1.25]；报告年龄>30 岁的 HR，0.91[95%CI，0.70-1.19]）。当我们调查特定的不孕诊断时，观察到因排卵障碍（HR，1.28[95%CI，1.05-1.55]）或子宫内膜异位症（HR，1.42[95%CI，1.09-1.85]）导致不孕的女性患 CHD 的风险升高。
不孕女性患 CHD 的风险可能增加。风险因首次不孕诊断的年龄而异，仅限于排卵障碍和子宫内膜异位症相关的不孕。
