Mid and Later Life Reproductive Factors Are Not Associated with Physical Frailty Among Women with Heart Failure

Abstract

Background In heart failure (HF), the prevalence of physical frailty is high, and women are more likely to be frail than men; however, the reasons for gender differences in physical frailty in HF are unknown. Frailty has been associated with younger age at menopause and a history of hysterectomy, possibly reflecting accelerated aging. The relationship between physical frailty and later life reproductive factors might elucidate mechanisms of physical frailty among women with HF. Hypothesis : We hypothesized that, among women with HF, physical frailty will be associated with history of hysterectomy, post-menopause, and reproductive cancer. Methods : This was an analysis of data collected from a study of gender differences in physical frailty in HF. We examined reproductive factors of hysterectomy, post-menopause, and reproductive cancer history among women in the sample. Physical frailty was measured using the Frailty Phenotype Criteria: unintentional weight loss, weakness, slowness, physical exhaustion, and low physical activity. Comparative statistics were used to compare reproductive factors with physical frailty. Logistic regression was used to quantify associations between reproductive factors and physical frailty, accounting for age, etiology, HF type (reduced or preserved ejection fraction), and Charlson Comorbidity Index. Results The average age of women in our sample (n = 56) was 65.0±16.3 years and 83.9% had non-ischemic etiology of HF. The majority (82%) were in menopause transition or post-menopause. Physical frailty was identified in 58.9% of women. There was no significant association between physical frailty and history of a hysterectomy (χ2 = 1.52, p = 0.22), post-menopause (χ2 = 0.87, p = 0.65), or reproductive cancer (χ2 = 0.19, p = 0.67). In separate multivariate logistic regression models, history of hysterectomy (OR 1.75, 95% CI [0.48, 6.34]), post-menopause (OR 0.38, 95% CI [0.03, 5.07]), or reproductive cancer (OR 0.35, 95% CI [0.04, 2.95]) were not significantly associated with physical frailty in women. Conclusions Mid and later life reproductive factors, as well as age, do not appear to be significantly associated with physical frailty among women with HF, indicating that physical frailty affects women across the lifespan. However, future studies should explore a comprehensive reproductive history, including age of menarche, pregnancy, breastfeeding, and other reproductive life events, as variables that may impact physical frailty among women with HF.