Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA.
Biostatistics and Epidemiology Consulting Lab, Office of Research, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA.
BMC Med. 2024 May 23;22(1):208. doi: 10.1186/s12916-024-03426-8.
Heavy menstrual bleeding (HMB) is a common menstrual disorder associated with multiple risk factors of cardiovascular disease (CVD) in women. In addition, HMB is often present with irregular menstruation (IM) which is a risk factor for CVD outcomes. However, the relationship between HMB and CVD outcomes is unexplored in the presence or absence of IM. We determined the association of HMB with multiple CVD outcomes using a nationally representative sample of female hospitalizations in the US.
All hospitalizations of females with HMB diagnosis and normal menstrual cycles from ages of 18 to 70 years were extracted from the National Inpatient Sample Database, 2017. The HMB was defined using the International Classification of Diseases (ICD)-10 for excessive and frequent menstruation bleeding and included any current or history of HMB diagnosis. Outcomes including major adverse cardiovascular events (MACE), coronary heart disease (CHD), stroke, heart failure (HF), atrial fibrillation (AF) or arrhythmia, myocardial infarction (MI), and diabetes (DM) were defined using ICD-10 codes. Adjusted logistic regression and prosperity scores-matched logistic regression analyses were conducted to summarize adjusted associations with an odds ratio (OR) and a 95% confidence interval (CI).
Among 2,430,851 hospitalizations, HMB was observed in 7762 (0.68%) females with age ≤ 40 years and 11,164 (0.86%) females with age > 40 years. Among hospitalizations with age ≤ 40 years, HMB was significantly associated with increased odds of CVD outcomes including MACE (OR = 1.61; 95% CI: 1.25, 2.08), CHD (OR = 1.72; 95% CI: 1.10, 2.71), stroke (OR = 1.95; 95% CI: 1.12, 3.40), HF (OR = 1.53; 95% CI: 1.15, 2.03), and AF/arrhythmia (OR = 1.84; 95% CI: 1.34, 2.54). These associations were confirmed in multiple sensitivity analyses. In contrast, HMB was not robustly associated with CVD events among hospitalizations of women with age > 40 years. HMB without IM was strongly associated with DM, HF, AF, and MACE outcomes while HMB with IM was strongly associated with CHD and AF outcomes in hospitalizations of young women.
HMB is associated with CVD events among US hospitalizations of young women. A routine investigation and screening of menstrual disorders, especially HMB, is useful for CVD risk stratification and management in young women.
重度月经出血 (HMB) 是一种常见的月经紊乱，与女性心血管疾病 (CVD) 的多种危险因素有关。此外，HMB 常伴有不规则月经 (IM)，这也是 CVD 结局的一个危险因素。然而，在存在或不存在 IM 的情况下，HMB 与 CVD 结局之间的关系尚未得到探索。我们使用美国全国代表性的女性住院患者样本，确定了 HMB 与多种 CVD 结局之间的关联。
从 2017 年国家住院患者样本数据库中提取了年龄在 18 至 70 岁之间、患有 HMB 诊断和正常月经周期的所有女性的住院数据。HMB 是使用国际疾病分类 (ICD)-10 定义的，用于过度和频繁的月经出血，并包括任何当前或既往的 HMB 诊断。使用 ICD-10 代码定义了主要不良心血管事件 (MACE)、冠心病 (CHD)、中风、心力衰竭 (HF)、心房颤动 (AF) 或心律失常、心肌梗死 (MI) 和糖尿病 (DM) 等结局。使用调整后的逻辑回归和繁荣分数匹配的逻辑回归分析来总结调整后的关联，得出比值比 (OR) 和 95%置信区间 (CI)。
在 2430851 例住院患者中，年龄≤40 岁的女性中有 7762 例 (0.68%) 和年龄>40 岁的女性中有 11164 例 (0.86%) 患有 HMB。在年龄≤40 岁的住院患者中，HMB 与 CVD 结局的发生风险显著增加有关，包括 MACE（OR=1.61；95%CI：1.25，2.08）、CHD（OR=1.72；95%CI：1.10，2.71）、中风（OR=1.95；95%CI：1.12，3.40）、HF（OR=1.53；95%CI：1.15，2.03）和 AF/心律失常（OR=1.84；95%CI：1.34，2.54）。这些关联在多项敏感性分析中得到了证实。相比之下，HMB 与年龄>40 岁女性的 CVD 事件之间没有明显的关联。无 IM 的 HMB 与糖尿病、HF、AF 和 MACE 结局强烈相关，而有 IM 的 HMB 与年轻女性的 CHD 和 AF 结局强烈相关。
HMB 与美国年轻女性的 CVD 事件有关。对月经紊乱，特别是 HMB 的常规检查和筛查，对年轻女性的 CVD 风险分层和管理是有用的。
