Infertility and Risk of Heart Failure in the Women's Health Initiative

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

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


Background: There is growing recognition that reproductive factors are associated with increased risk of future cardiovascular disease. Infertility has been less well studied, although emerging data support its association with increased risk of cardiovascular disease. Whether infertility is associated with future risk of heart failure (HF) is not known. Objectives: This study sought to examine the development of HF and HF subtypes in women with and without history of infertility. Methods: We followed postmenopausal women from the Women's Health Initiative prospectively for the development of HF. Infertility was self-reported at study baseline. Multivariable cause-specific Cox models were used to evaluate the association of infertility with incident overall HF and HF subtypes (heart failure with preserved ejection fraction [HFpEF]: left ventricular ejection fraction of ≥50% vs heart failure with reduced ejection fraction [HFrEF]: left ventricular ejection fraction of <50%]). Results: Among 38,528 postmenopausal women (mean age: 63 ± 7 years), 5,399 (14%) participants reported a history of infertility. Over a median follow-up of 15 years, 2,373 developed incident HF, including 807 with HFrEF and 1,133 with HFpEF. Infertility was independently associated with future risk of overall HF (HR: 1.16; 95% CI: 1.04-1.30; P = 0.006). Notably, when examining HF subtypes, infertility was associated with future risk of HFpEF (HR: 1.27; 95% CI: 1.09-1.48; P = 0.002) but not HFrEF (HR: 0.97; 95% CI: 0.80-1.18). Conclusions: Infertility was significantly associated with incident HF. This was driven by increased risk of HFpEF, but not HFrEF, and appeared independent of traditional cardiovascular risk factors and other infertility-related conditions. Future research should investigate mechanisms that underlie the link between infertility and HFpEF.

Original languageEnglish (US)
Pages (from-to)1594-1603
Number of pages10
JournalJournal of the American College of Cardiology
Issue number16
StatePublished - Apr 26 2022


  • heart failure
  • infertility
  • women

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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