Elsevier

JACC: Heart Failure

Volume 11, Issue 9, September 2023, Pages 1203-1212
JACC: Heart Failure

Clinical Research
Female Reproductive Factors and Risk of New-Onset Heart Failure: Findings From UK Biobank

https://doi.org/10.1016/j.jchf.2023.02.019Get rights and content
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open access

Abstract

Background

A comprehensive evaluation of woman-specific risk factors in relation to incident heart failure (HF) is limited.

Objectives

This study sought to investigate the association of multiple female reproductive factors with the risk of HF.

Methods

Between 2007 and 2010, 229,026 women (mean age: 56.5 years) without prevalent HF from the UK Biobank cohort were included and followed until December 2020. The relation between (self-reported) reproductive factors and HF was analyzed using Cox proportional hazards models with adjustment for potential confounding.

Results

Menarche at age <12 years, compared to age 12-13 years, carried a 9% larger risk of HF (HR: 1.09 [95% CI: 1.01-1.18]). Younger age at menopause was associated with a higher risk of HF (HRage <45 y vs 50-51 y: 1.15 [95% CI: 1.03-1.28]; HRage 45-49 y vs 50-51 y: 1.11 [95% CI: 1.01-1.23]). Younger maternal age at first live birth (HRage <21 y vs 24-26 y: 1.42 [95% CI: 1.28-1.59]; HRage 21-23 y vs 24-26 y: 1.14 [95% CI: 1.03-1.26]) and at last live birth (HRage <26 y vs 29-31 y: 1.19 [95% CI: 1.07-1.33]) were associated with higher risk of HF. Compared to women with 1 or 2 children, having 3 or 4 children (HR: 1.09 [95% CI: 1.02-1.17]) or >4 children (HR: 1.24 [95% CI: 1.05-1.47]) was associated with higher HF risk. Experiencing miscarriages or abortions was not significantly associated with incident HF, whereas experiencing 1 stillbirth and recurrent stillbirths conferred a 20% and 43% larger risk of HF, respectively, compared to no stillbirth.

Conclusions

The findings emphasize the importance of female reproductive history in the assessment of HF risk.

Key Words

heart failure
menopause
pregnancy
reproductive factors
women

Abbreviations and Acronyms

CHD
coronary heart disease
CVD
cardiovascular disease
HF
heart failure

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The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.

Drs Zhu and Qi contributed equally to this work.