Kim Catherine, Appiah Duke, Yin Zhe, Schreiner Pamela J, Lewis Cora E, McLaughlin Megan M, Dula Adrienne N, Siscovick David S, Huddleston Heather
Departments of Medicine, Obstetrics & Gynecology, and Epidemiology, Ann Arbor, MI.
Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX.
medRxiv. 2025 Jan 9:2025.01.08.25320210. doi: 10.1101/2025.01.08.25320210.
INTRODUCTION: Previous reports have noted associations between subfertility in women and increased risk of cardiovascular disease (CVD) events in later life. However, reports conflict regarding the associations between subfertility and CVD risk factors. Using data from a population-based cohort of Black and White women, we examined the association between longitudinal assessments of CVD risk factors and subfertility. METHODS: The Coronary Artery Risk Development in Young Adults (CARDIA) study is a prospective cohort of Black and White women who have undergone repeated assessment of CVD risk factors beginning at study baseline (1985-1986). Risk factors included cigarette smoking, body mass index (BMI), blood pressure, lipid levels, glucose, and C-reactive protein. At approximately 40 years of age, an ancillary study assessed histories of subfertility. We used generalized estimating equations with a logit link model to examine associations between subfertility (dependent variable) and repeated CVD risk factors (independent variables), with adjustment for age, race, center, and education level in 1107 women. RESULTS: Cigarette use and higher levels of BMI, glucose, and triglycerides and lower levels of high-density lipoprotein cholesterol (HDL) were associated with subfertility after adjustment for age, race, and education. In multivariable models which included all of these risk factors, cigarette use (odds ratio [OR] 1.004, 95% confidence interval [CI] 1.002, 1.006, p<0.0001) and HDL (OR 0.99, 95% CI 0.99, 0.995, p=0.046) were still associated with subfertility, but associations with BMI, glucose, and triglycerides were no longer significant. CONCLUSIONS: Women with subfertility histories have adverse CVD risk factors across the reproductive lifespan. Cigarette use is a strong risk factor for infertility.
引言:既往报告指出,女性生育力低下与晚年心血管疾病(CVD)事件风险增加之间存在关联。然而,关于生育力低下与CVD危险因素之间的关联,报告结果存在冲突。我们利用基于人群的黑人和白人女性队列数据,研究了CVD危险因素的纵向评估与生育力低下之间的关联。 方法:青年成人冠状动脉风险发展(CARDIA)研究是一个黑人和白人女性的前瞻性队列,自研究基线(1985 - 1986年)起对CVD危险因素进行了反复评估。危险因素包括吸烟、体重指数(BMI)、血压、血脂水平、血糖和C反应蛋白。在大约40岁时,一项辅助研究评估了生育力低下的病史。我们使用带有logit链接模型的广义估计方程,在1107名女性中,调整年龄、种族、中心和教育水平后,研究生育力低下(因变量)与反复测量的CVD危险因素(自变量)之间的关联。 结果:在调整年龄、种族和教育因素后,吸烟、较高的BMI、血糖和甘油三酯水平以及较低的高密度脂蛋白胆固醇(HDL)水平与生育力低下相关。在包含所有这些危险因素的多变量模型中,吸烟(比值比[OR]1.004,95%置信区间[CI]1.002,1.006,p<0.0001)和HDL(OR 0.99,95%CI 0.99,0.995,p = 0.046)仍与生育力低下相关,但与BMI、血糖和甘油三酯的关联不再显著。 结论:有生育力低下病史的女性在整个生殖寿命期都存在不良的CVD危险因素。吸烟是不孕的一个重要危险因素。
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