Multiple Prior Live Births Are Associated With Cardiac Remodeling and Heart Failure Risk in Women
Graphical Abstract
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.
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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.
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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)
- et al.
Effectiveness-based guidelines for the prevention of cardiovascular disease in women–2011 update: a guideline from the American Heart Association
J Am Coll Cardiol
(2011) - et al.
Methods of assessing prevalent cardiovascular disease in the Cardiovascular Health Study
Ann Epidemiol
(1995) - et al.
Rationale, design, and baseline characteristics of a trial of prevention of cardiovascular and renal disease with fosinopril and pravastatin in nonhypertensive, nonhypercholesterolemic subjects with microalbuminuria (the Prevention of REnal and Vascular ENdstage Disease Intervention Trial [PREVEND IT])
Am J Cardiol
(2000) - et al.
Association of number of live births with left ventricular structure and function. The Multi-Ethnic Study of Atherosclerosis (MESA)
Am Heart J
(2012) - et al.
Geometry as a confounder when assessing ventricular systolic function: comparison between ejection fraction and strain
J Am Coll Cardiol
(2017) - et al.
Relation of the number of parity to left ventricular diastolic function in pregnancy
Am J Cardiol
(2017) - et al.
AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
Circulation
(2019) - et al.
Number of pregnancies and the subsequent risk of cardiovascular disease
N Engl J Med
(1993) - et al.
The association between parity and subsequent cardiovascular disease in women: the Atherosclerosis Risk in Communities Study
J Womens Health (Larchmt)
(2019) - et al.
Number of pregnancies and atrial fibrillation risk: the Women's Health Study
Circulation
(2017)