Study finds infertility history linked with increased risk of heart
failure
The future risk of heart failure is not related to other known factors
Date:
April 18, 2022
Source:
Massachusetts General Hospital
Summary:
A woman's reproductive history can help predict her future risk
of heart disease.
FULL STORY ==========================================================================
A new study finds that a history of infertility is associated with
increased risk of heart failure. Published in the Journal of the American College of Cardiology, researchers from Massachusetts General Hospital
(MGH) revealed that women who had experienced infertility had a 16%
increased risk of heart failure compared with women who did not have an infertility history.
==========================================================================
"We are beginning to recognize that a woman's reproductive history tells
a lot about her future risk of heart disease," says first author Emily
Lau, MD, MPH, cardiologist and director of the Menopause, Hormones & Cardiovascular Clinic at MGH. "Whether a woman has difficulty becoming pregnant, what happens during her pregnancies, when she transitions
through menopause all influence her risk of heart disease later in life." Infertility affects about 1 in 5 US women and includes a spectrum
of conception difficulties, but its link with heart failure has not
been well-studied until recently. Partnering with the Women's Health
Initiative (WHI), which was designed in the early 1990s and queried a
woman's reproductive history, Lau and colleagues studied postmenopausal
women from the WHI and examined whether infertility was associated with development of heart failure.
There are two types of heart failure: heart failure with preserved
ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF).
Ejection fraction is a measurement related to the volume percentage of
blood that is pumped from the left ventricle of the heart during each
beat. An ejection fraction less than 50% is commonly viewed as abnormal
or reduced.
The team found an association between infertility and overall heart
failure, specifically with HFpEF, a form of heart failure that is far
more common in women regardless of fertility history. Among the 38,528 postmenopausal women studied, 14% of the participants reported a history
of infertility. Over a 15- year follow up period, the researchers noted
that infertility was associated with 16% future risk of overall heart
failure. When they examined heart failure subtypes, they found that
infertility was associated with a 27% increased future risk of HFpEF.
Over the past decade, HFpEF (where the heart muscle does not relax well)
as opposed to HFrEF (where the left ventricle does not pump well), has
become the dominant form of heart failure in both men and women. But
it remains more common in women. "It's a challenging condition because
we still do not completely understand how HFpEF develops and we do not
have very good therapies to treat HFpEF," says Lau.
"I think our findings are particularly noteworthy because heart
failure with preserved ejection fraction is more prevalent in women,"
says Lau. "We don't understand why we see HFpEF more in women. Looking
back in a woman's early reproductive life may give us some clues as to
why." Of note, the team observed that the link persisted regardless of
whether an individual eventually conceived or had a live birth.
The increased risk was independent of traditional cardiovascular risk
factors and other infertility-related conditions. "There has been some suggestion in previous studies that women with infertility do have more cardiometabolic risk factors," says Lau, but the team did not find that cardiometabolic risk factors explained the link between infertility
with heart failure in this study. They also looked to see if other infertility-related conditions like thyroid disease, irregular menses,
and early menopause explained the association between infertility and
heart failure but did not evidence to support that hypothesis either.
"So it really begs the question: what are the mechanisms driving
the association between infertility and heart failure," says Lau. Is
it shared risk factors, or is infertility on the causal pathway? She
mentions vascular and endothelial dysfunction may be involved and plans
on eventually clarifying the mechanism underlying the link between
infertility and heart failure. In the future, Lau hopes to conduct a prospective study of women with an infertility history involving exercise parameters, vascular measures, and more, to solve the mystery.
"We as scientists and doctors are beginning to recognize how important
a woman's reproductive history is for their future risk of heart disease.
Infertility is one of many cardiovascular risk factors, such as
hypertension and high blood pressure, but reproductive history is not
routinely considered as part of the cardiovascular risk assessment,"
says Lau. Since people do not tend to develop heart failure until well in
their 60s and beyond, and infertility is mostly experienced in the 20s,
30s, and 40s, many physicians are not thinking about the connection. "We
cannot change a woman's history of infertility, but if we know a woman has
had a history of infertility, we can be more aggressive about counseling
her about other modifiable risk factors including high blood pressure,
high cholesterol, smoking, and beyond." This research was supported in
part by the National Institutes of Health and American Heart Association.
========================================================================== Story Source: Materials provided by Massachusetts_General_Hospital. Note: Content may be edited for style and length.
========================================================================== Journal Reference:
1. Emily S. Lau, Dongyu Wang, Mary Roberts, Christy N. Taylor,
Gayathree
Murugappan, Aladdin H. Shadyab, Peter F. Schnatz, Leslie V. Farland,
Malissa J. Wood, Nandita S. Scott, Charles B. Eaton, Jennifer E. Ho.
Infertility and Risk of Heart Failure in the Women's Health
Initiative.
Journal of the American College of Cardiology, 2022; 79 (16):
1594 DOI: 10.1016/j.jacc.2022.02.020 ==========================================================================
Link to news story:
https://www.sciencedaily.com/releases/2022/04/220418164934.htm
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