TY - JOUR
T1 - Association of infertility with atherosclerotic cardiovascular disease among postmenopausal participants in the Women's Health Initiative
AU - Murugappan, Gayathree
AU - Leonard, Stephanie A.
AU - Farland, Leslie V.
AU - Lau, Emily S.
AU - Shadyab, Aladdin H.
AU - Wild, Robert A.
AU - Schnatz, Peter
AU - Carmichael, Suzan L.
AU - Stefanick, Marcia L.
AU - Parikh, Nisha I.
N1 - Funding Information:
Supported by a grant from the Stanford Maternal and Child Health Research Institute (MCHRI) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health (NIH) (no. 1K12HD103084). The Women’s Health Initiative (WHI) program is funded by the National Heart, Lung, and Blood Institute (NHLBI), NIH , and the US Department of Health and Human Services (DHHS) through contracts HHSN268201600018C, HHSN268201600001C, HHSN268201600002C, HHSN268201600003C, and HHSN268201600004C.
Funding Information:
G.M. is a Scientific Advisor to Hannah Life and reports grants from the Stanford Maternal and Child Health Research Institute (MCHRI) and the Eunice Kennedy Shriver NICHD (no. 1K12HD103084) of the National Institutes of Health for the submitted work. S.A.L. reports a grant from the Eunice Kennedy Shriver NICHD (no. 1K12HD103084) to Principal Investigator Dr. Gayathree Murugappan for the submitted work. L.V.F. reports a grant from the National Institutes of Health (no. R21HD099623) and travel support from the Pacific Coast Reproductive Society outside the submitted work. E.S.L. reports a grant from the American Heart Association (no. 853922) outside the submitted work. A.H.S. has nothing to disclose. R.A.W. reports grants from the Eunice Kennedy Shriver NICHD, Quest Diagnostics, and Ablacare outside the submitted work. P.S. has nothing to disclose. S.L.C. has nothing to disclose. M.L.S. has nothing to disclose. N.I.P. has nothing to disclose.
Publisher Copyright:
© 2022 American Society for Reproductive Medicine
PY - 2022
Y1 - 2022
N2 - Objective: To investigate the association of infertility with atherosclerotic cardiovascular disease (ASCVD) among postmenopausal participants in the Women's Health Initiative (WHI). We hypothesized that nulliparity and pregnancy loss may reveal more extreme phenotypes of infertility, enabling further understanding of the association of infertility with ASCVD. Design: Prospective cohort study. Setting: Forty clinical centers in the United States. Patient(s): A total of 158,787 postmenopausal participants in the Women's Health Initiative cohort. Intervention(s): Infertility, parity, and pregnancy loss. Main Outcome Measure(s): The primary outcome was risk of ASCVD among women with and without a history of infertility, stratified by history of live birth and pregnancy loss. Cox proportional-hazards models were adjusted for demographics and risk factors for ASCVD. Result(s): Among 158,787 women, 25,933 (16.3%) reported a history of infertility; 20,427 (80%) had at least 1 live birth; and 9,062 (35%) had at least 1 pregnancy loss. There was a moderate overall association between infertility and ASCVD (adjusted hazard ratio, 1.02; 95% confidence interval [CI], 0.99–1.06) over 19 years of follow-up. Among nulliparous women, infertility was associated with a 13% higher risk of ASCVD (95% CI, 1.04–1.23). Among nulliparous women who had a pregnancy loss, infertility was associated with a 36% higher risk of ASCVD (95% CI, 1.09–1.71). Conclusion(s): Women with a history of infertility overall had a moderately higher risk of ASCVD compared with women without a history of infertility. Atherosclerotic cardiovascular disease risk was much higher among nulliparous infertile women and among nulliparous infertile women who also had a pregnancy loss, suggesting that in these more extreme phenotypes, infertility may be associated with ASCVD risk.
AB - Objective: To investigate the association of infertility with atherosclerotic cardiovascular disease (ASCVD) among postmenopausal participants in the Women's Health Initiative (WHI). We hypothesized that nulliparity and pregnancy loss may reveal more extreme phenotypes of infertility, enabling further understanding of the association of infertility with ASCVD. Design: Prospective cohort study. Setting: Forty clinical centers in the United States. Patient(s): A total of 158,787 postmenopausal participants in the Women's Health Initiative cohort. Intervention(s): Infertility, parity, and pregnancy loss. Main Outcome Measure(s): The primary outcome was risk of ASCVD among women with and without a history of infertility, stratified by history of live birth and pregnancy loss. Cox proportional-hazards models were adjusted for demographics and risk factors for ASCVD. Result(s): Among 158,787 women, 25,933 (16.3%) reported a history of infertility; 20,427 (80%) had at least 1 live birth; and 9,062 (35%) had at least 1 pregnancy loss. There was a moderate overall association between infertility and ASCVD (adjusted hazard ratio, 1.02; 95% confidence interval [CI], 0.99–1.06) over 19 years of follow-up. Among nulliparous women, infertility was associated with a 13% higher risk of ASCVD (95% CI, 1.04–1.23). Among nulliparous women who had a pregnancy loss, infertility was associated with a 36% higher risk of ASCVD (95% CI, 1.09–1.71). Conclusion(s): Women with a history of infertility overall had a moderately higher risk of ASCVD compared with women without a history of infertility. Atherosclerotic cardiovascular disease risk was much higher among nulliparous infertile women and among nulliparous infertile women who also had a pregnancy loss, suggesting that in these more extreme phenotypes, infertility may be associated with ASCVD risk.
KW - Cardiovascular disease
KW - gravidity
KW - infertility
KW - parity
KW - pregnancy
UR - http://www.scopus.com/inward/record.url?scp=85126515657&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85126515657&partnerID=8YFLogxK
U2 - 10.1016/j.fertnstert.2022.02.005
DO - 10.1016/j.fertnstert.2022.02.005
M3 - Article
C2 - 35305814
AN - SCOPUS:85126515657
JO - Fertility and Sterility
JF - Fertility and Sterility
SN - 0015-0282
ER -