Multiple Prior Live Births Are Associated With Cardiac Remodeling and Heart Failure Risk in Women

https://doi.org/10.1016/j.cardfail.2022.12.014Get rights and content

Highlights

  • Greater numbers of live births were associated with worse left ventricular systolic function and cardiac mechanics.

  • Further research is required to understand better the mechanism by which higher levels of live births are associated with LV systolic dysfunction in order to improve the long-term cardiovascular health of multiparous women.

  • Contemporary cardiovascular datasets should routinely capture pregnancy and reproductive histories of participants.

ABSTRACT

Objective

Greater parity has been associated with cardiovascular disease risk. We sought to find whether the effects on cardiac remodeling and heart failure risk are clear.

Methods

We examined the association of number of live births with echocardiographic measures of cardiac structure and function in participants of the Framingham Heart Study (FHS) using multivariable linear regression. We next examined the association of parity with incident heart failure with preserved (HFpEF) or reduced (HFrEF) ejection fraction using a Fine-Gray subdistribution hazards model in a pooled analysis of n = 12,635 participants in the FHS, the Cardiovascular Health Study, the Multi-Ethnic Study of Atherosclerosis, and Prevention of Renal and Vascular Endstage Disease. Secondary analyses included major cardiovascular disease, myocardia infarction and stroke.

Results

Among n = 3931 FHS participants (mean age 48 ± 13 years), higher numbers of live births were associated with worse left ventricular fractional shortening (multivariable β -1.11 (0.31); P = 0.0005 in ≥ 5 live births vs nulliparous women) and worse cardiac mechanics, including global circumferential strain and longitudinal and radial dyssynchrony (P < 0.01 for all comparing ≥ 5 live births vs nulliparity). When examining HF subtypes, women with ≥ 5 live births were at higher risk of developing future HFrEF compared with nulliparous women (HR 1.93, 95% CI 1.19–3.12; P = 0.008); by contrast, a lower risk of HFpEF was observed (HR 0.58, 95% CI 0.37–0.91; P = 0.02).

Conclusions

Greater numbers of live births are associated with worse cardiac structure and function. There was no association with overall HF, but a higher number of live births was associated with greater risk for incident HFrEF.

Section snippets

Brief Lay Summary

Among 3931 participants in the Framingham Heart Study, there was an association of greater number of live births with lower cardiac function among women. In a larger group of patients across 4 cohorts (with a total of 12,635 participants), more live births were associated with a higher risk of developing heart failure with lower cardiac function as compared with patients who had never experienced a live birth.

Study Sample

We examined the association of number of live births and subclinical cardiovascular disease in a retrospective analysis of women enrolled in the Framingham Heart Study (FHS) who attended the FHS Offspring examination 6 (1995–1998) or the third-generation examination 1 (2002–2005) and for whom data regarding number of live births were available. Details of the cohorts have been published previously.7,8 In brief, the FHS Offspring cohort was recruited in 1971 and included adult children and

Results

The clinical characteristics of FHS participants (n = 3931) by number of live births are reported in Table 1. In the overall sample, the average participant age was 48 ± 13 years, with older ages in groups with greater number of live births. Of the total cohort, 15% were receiving hypertension therapy, 4% had DM, and 16% were current smokers.

Discussion

We studied the association of number of live births with cardiac structure and function in a rigorously phenotyped community-based sample of women and further examined the association of parity with incident cardiovascular events in a pooled analysis across 4 longitudinal cohorts. Our findings are as follows. First, greater numbers of live births were associated with lower measures of LV systolic function. Importantly, this finding was further associated with impaired cardiac mechanics.

Conclusion

Compared to nulliparous women, those who experienced greater numbers of live births were at higher risk for later-life LV systolic dysfunction and worse cardiac mechanics, as reflected by worse fractional shortening, global circumferential strain and greater mechanical dyssynchrony. We also observed that although overall risk of HF is not associated with number of live births, women with histories of multiple live births (≥ 5) are at higher risk for HFrEF but may be at lower risk for HFpEF.

Proposed Tweet

A greater number of live births is associated with (1) worse cardiac structure and function vs nulliparity in participants in the Framingham Heart Study and (2) increased risk of HFrEF @JCardFail.

@sarma_amy

@JenHoCardiology

Disclosures

AAS has received research funding from an Institutional CRICO Patient Safety Grant; GFM is the president of Cardiovascular Engineering, Inc. and reports serving as a consultant to and receiving honoraria and grant support from Novartis, Servier, Merck, Bayer, and the National Institutes of Health; NMH has consulted for Merck and Sanifit; the UMCG, which employs RAdB, has received research grants and/or fees from AstraZeneca, Abbott, Bristol-Myers Squibb, Novartis, Novo Nordisk, and Roche, and

Sources of Funding

This work was partially supported by the National Heart, Lung, and Blood Institute (Framingham Heart Study, contract N01-HC25195, HHSN268201500001I and 75N92019D00031; Cardiovascular Health Study, contracts HHSN268201200036C, HHSN268200800007C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086, and grants U01HL130114, U01HL080295, HL076784, AG028321, HL070100, HL060040, HL080124, HL071039, HL077447, HL107385, HL126136 and HL142983). The Multi-Ethnic Study of

References (26)

  • X Cao et al.

    Cumulative effect of reproductive factors on ideal cardiovascular health in postmenopausal women: a cross-sectional study in central south China

    BMC Cardiovasc Disord

    (2015)
  • WB Kannel et al.

    An investigation of coronary heart disease in families: the Framingham offspring study

    Am J Epidemiol

    (1979)
  • GL Splansky et al.

    The third generation cohort of the National Heart, Lung, and Blood Institute's Framingham Heart Study: design, recruitment, and initial examination

    Am J Epidemiol

    (2007)
  • Cited by (0)

    View full text