Cardiovascular Morbidity In Women Research Articles

Endometriosis is associated with an increased whole-blood thrombogenicity detected by a novel automated microchip flow-chamber system (T-TAS®).

Potential thrombotic and antifibrinolytic influence of endometriosis on haemostasis has been recently reported in the literature, as well as increased cardiovascular morbidity in women suffering from the disease. We performed a pilot study to assess the influence of endometriosis on the thrombus formation process under in vitro flow conditions. This study compared women with confirmed endometriosis (n = 23) surgically and control healthy subjects (n = 10). In both groups, the same exclusion criteria were used: a prior episode of thrombosis diagnosed as acquired or inherited thrombophilia, neoplasm, and an uncertain family history of thrombosis. We evaluated the whole blood thrombogenicity using T-TAS® at a shear rate of 240 s-1 (Total-Thrombus Analysis System, Zacros, Japan). The blood clot formation initiation time (T10) and occlusion time (OT) were significantly shortened in the endometriosis group (p < 0.05). The area under the curve (AUC30) of blood clot time formation values (BCTF) was substantially higher in the patients suffering from a disease (p = 0.03). An increase in AUC (TTAS) values by 100 increases the risk of developing endometriosis by 1.56-fold [adjusted OR = 1.56 (p = 0.01); (95% CI: 1.10-2.18)]. Inflammatory markers (neutrophil-to-lymphocyte ratio (NLR), and the leucocyte, neutrophil, basophil, and neutrophil concentrations) were also substantially higher in the endometriosis group (p < 0.05). The alteration of the T-TAS® and NLR values supports the thesis of a shift of the equilibrium towards thrombosis in women who have endometriosis. This phenomenon links to a state of chronic inflammation. It is detectable using a novel system for the quantitative assessment of the platelet thrombus formation process under flow conditions in vitro.

Impact of reproductive factors on major cardiovascular disease risk in women: a Mendelian randomization study

Abstract Background Cardiovascular disease is a major cause of morbidity and mortality in women. Multiple observational studies have explored the role of female reproductive history on the risk of cardiovascular disease and suggested that factors such as high parity and early menarche are associated with higher rates of cardiovascular disease later in life. However, effect estimates derived from observational studies are liable to influence by residual confounding and bias in study design. We utilise Mendelian randomisation to explore causal pathways underlying this association by leveraging genetic variability in reproductive factors using instrumental variable analysis. Methods Uncorrelated single nucleotide polymorphisms (r2&amp;lt;0.001) were extracted from summary statistics of published sex-specific genome wide association studies (GWAS) for the exposures of age at first birth (n=131,987, unit = years), number of live births (n=193,953, coded into three categories of &amp;lt;2, 2 or &amp;gt;2 live births), age at menarche (n=329,345, unit = years) and age at menopause (n=106,048, unit = years). Genetic association estimates for the outcomes of coronary artery disease, ischaemic stroke, stroke of any type, heart failure and atrial fibrillation were extracted from GWAS analyses on respectively 122,733 cases, 34,217 cases, 40,585 cases, 47,309 cases and 60,620 cases. All GWAS studies were on populations of predominantly European ancestry. Inverse-variance weighted MR was utilised for primary analyses; sensitivity analyses using MR-Egger and weighted median MR were carried out. Results Earlier age at first birth was associated with increased risk of coronary artery disease (OR per 1-year lower age = 1.49, 95% CI 1.28–1.74, p&amp;lt;0.001). Lower age at menarche was also associated with increased risk of coronary artery disease (OR per 1-year lower age = 1.10, 95% CI 1.06–1.14, p&amp;lt;0.001) and increased risk of heart failure (OR 1.12, 95% CI 1.07–1.17, p&amp;lt;0.001). Finally, higher number of live births was associated with increased risk of atrial fibrillation (OR per increase in category of &amp;lt;2, 2 or &amp;gt;2 live births = 2.91, 95% CI 1.16–7.29, p=0.023), increased risk of heart failure (OR 1.90, 95% CI 1.28–2.82, p=0.001), increased risk of ischaemic stroke (OR 2.07, 95% CI 1.22–3.52, p=0.007) and of stroke of any type (OR 1.86, 95% CI 1.03–3.37, p=0.039). Conclusion The results of this study support the emerging evidence of female-specific risk factors for cardiovascular disease, by demonstrating that that earlier age at first birth, higher number of live births, and earlier menarche are all associated with increased cardiovascular morbidity in women. The results notably highlight parity as a major sex-specific risk factor of likely causal relevance. These findings support the inclusion of reproductive history in the routine evaluation of cardiovascular risk in females and identify key markers of risk that may be used to target primary prevention measures. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Research Council GEPSI 946647 for EAWSBritish Heart Foundation RG/16/3/32175 for FSN

Cocaine and the Long-Term Risk of Cardiovascular Disease in Women

BackgroundCocaine is associated with acute cardiovascular complications, but the long-term cardiovascular risks of cocaine use are poorly understood. We examined the association between cocaine use disorders and long-term cardiovascular morbidity in women. MethodsWe analyzed a longitudinal cohort of 1,296,463 women in Quebec, Canada between 1989 and 2020. The exposure included cocaine use disorders prior to or during pregnancy. The outcome was cardiovascular hospitalization up to 31 years later. We used adjusted Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association of cocaine use disorders with cardiovascular hospitalization. ResultsThe cohort included 2954 women with cocaine use disorders. Compared with women without an identified cocaine disorder, women with cocaine use disorders had 1.55 times greater risk of future cardiovascular hospitalization during 3 decades of follow-up (95% CI, 1.37-1.75). Cocaine use disorders were strongly associated with inflammatory heart disease (HR 4.82; 95% CI, 2.97-7.83), cardiac arrest (HR 2.93; 95% CI, 1.46-5.88), valve disease (HR 3.09; 95% CI, 2.11-4.51), and arterial embolism (HR 2.22; 95% CI, 1.19-4.14). The association between cocaine use disorder and cardiovascular hospitalization was most marked after 5 to 10 years of follow-up (HR 2.15; 95% CI, 1.70-2.72). ConclusionsWomen with cocaine use disorders have a high risk of cardiovascular hospitalization up to 3 decades later. Substance use reduction and cardiovascular risk surveillance may help reduce the burden of cardiovascular disease in women with cocaine use disorders.

Physical Activity and Diet Quality: Effects on Cardiovascular Morbidity in Women with Turner Syndrome-Results from an Online Patient Survey.

Turner syndrome (TS) is a rare chromosomal disease with increased cardiovascular morbidity and mortality. The aim of this study was to investigate the influence of physical activity and diet quality on cardiovascular morbidity in German TS women. An anonymous online questionnaire was established. The questionnaire was based on the 2020 WHO recommendations on physical activity and sedentary behaviour and included the 14-Item Mediterranean Diet Assessment Tool. In addition, TS patients were asked about existing cardiovascular conditions. In total, 83 TS women were included in the final analysis. The achievement of <600 Metabolic Equivalent-minutes per week for recreational activities was significantly associated with the presence of arterial hypertension (p = 0.006). High adherence to the Mediterranean diet was achieved by only 20.5% of TS subjects and tended to be inversely associated with the presence of lipid metabolism disorders (p = 0.063). Only 37.3% of TS participants received nutritional counselling. Given the increased cardiovascular risk, specific counselling for lifestyle optimisation may play an important role in the management of TS. Further studies are required to evaluate the effects of regular aerobic physical training and different nutritional programs on cardiovascular morbidity in TS.

Severe Cardiovascular Morbidity in Women With Hypertensive Diseases During Delivery Hospitalization

(Am J Obstet Gynecol. 2019;220:582.e1–582.e11) The pregnancy-related mortality ratio in the United States has tripled between 1987 and 2014. Some studies have estimated 35% to 44% of cases of maternal mortality or severe maternal morbidity are preventable. Hypertensive disorders of pregnancy (HDP) affect 10% of pregnancies worldwide and are one of the main causes of maternal and perinatal morbidity. Cardiovascular (CV) disease is the leading cause of death in women in the United States and the leading cause of pregnancy-related death. HDP have been associated with an increased risk of CV disease 10 to 30 years after delivery, but there is a lack of data on the relationship between HDP and CV morbidity during hospitalization for delivery. This study aimed to identify the risk of CV morbidity during delivery hospitalization in pregnancies complicated by HDP.

Severe cardiovascular morbidity in women with hypertensive diseases during delivery hospitalization

Cardiovascular disease is the leading cause of pregnancy-related death in the United States. Identification of short-term indicators of cardiovascular morbidity has the potential to alter the course of this devastating disease among women. It has been established that hypertensive disorders of pregnancy are associated with increased risk of cardiovascular disease 10-30 years after delivery; however, little is known about the association of hypertensive disorders of pregnancy with cardiovascular morbidity during the delivery hospitalization. We aimed to identify the immediate risk of cardiovascular morbidity during the delivery hospitalization among women who experienced a hypertensive disorder of pregnancy. This retrospective cohort study of women, 15-55 years old with a singleton gestation between 2008 and 2012 in New York City, examined the risk of severe cardiovascular morbidity in women with hypertensive disorders of pregnancy compared with normotensive women during their delivery hospitalization. Women with a history of chronic hypertension, diabetes mellitus, or cardiovascular disease were excluded. Mortality and severe cardiovascular morbidity (myocardial infarction, cerebrovascular disease, acute heart failure, heart failure or arrest during labor or procedure, cardiomyopathy, cardiac arrest and ventricular fibrillation, or conversion of cardiac rhythm) during the delivery hospitalization were identified using birth certificates and discharge record coding. Using multivariable logistic regression, we assessed the association between hypertensive disorders of pregnancy and severe cardiovascular morbidity, adjusting for relevant sociodemographic and pregnancy-specific clinical risk factors. A total of 569,900 women met inclusion criteria. Of those women, 39,624 (6.9%) had a hypertensive disorder of pregnancy: 11,301 (1.9%) gestational hypertension; 16,117 (2.8%) preeclampsia without severe features; and 12,206 (2.1%) preeclampsia with severe features, of whom 319 (0.06%) had eclampsia. Among women with a hypertensive disorder of pregnancy, 431 experienced severe cardiovascular morbidity (10.9 per 1000 deliveries; 95% confidence interval, 9.9-11.9). Among normotensive women, 1780 women experienced severe cardiovascular morbidity (3.4 per 1000 deliveries; 95% confidence interval, 3.2-3.5). Compared with normotensive women, there was a progressively increased risk of cardiovascular morbidity with gestational hypertension (adjusted odds ratio, 1.18; 95% confidence interval, 0.92-1.52), preeclampsia without severe features (adjusted odds ratio, 1.96; 95% confidence interval, 1.66-2.32), preeclampsia with severe features (adjusted odds ratio, 3.46; 95% confidence interval, 2.99-4.00), and eclampsia (adjusted odds ratio, 12.46; 95% confidence interval, 7.69-20.22). Of the 39,624 women with hypertensive disorders of pregnancy, there were 15 maternal deaths, 14 of which involved 1 or more cases of severe cardiovascular morbidity. Hypertensive disorders of pregnancy, particularly preeclampsia with severe features and eclampsia, are significantly associated with cardiovascular morbidity during the delivery hospitalization. Increased vigilance, including diligent screening for cardiac pathology in patients with hypertensive disorders of pregnancy, may lead to decreased morbidity for mothers.

Is There Really Increased Cardiovascular Morbidity in Women with Polycystic Ovary Syndrome?

For some time, it has been assumed that women with polycystic ovary syndrome (PCOS) are at increased risk of developing cardiovascular disease (CVD). This has largely been on the basis of having many risk factors, including abnormal lipid profile, insulin resistance, and markers of inflammation. However, despite having these and other risk factors, we argue here, in the view of the authors, that there is no credible evidence that there is greater CVD morbidity in all women with PCOS. We analyze the existing data and discuss that overall CVD risk decreases with age when more CVD events are likely to occur, and introduce the possibility that there may be some unknown inherent protective factor(s) in women with PCOS. It appears that only obesity and/or diabetes mellitus significantly increase CVD risk in women with PCOS, and that most of the data showing an increased rate of CVD are reported in younger women with PCOS where the absolute risk is small. It is also suggested that the CVD risk is predominantly in women with the "classic" features of PCOS, including menstrual irregularity and hyperandrogenism, particularly in the presence of obesity and diabetes, and should not be generalized to all women with PCOS using Rotterdam criteria. Strategies for a healthy lifestyle, which should be a lifelong goal for all women with PCOS, become particularly important to prevent obesity and diabetes.

Fertility Treatments in Women Who Become Pregnant and Carried to Viability, and the Risk for Long-Term Maternal Cardiovascular Morbidity.

Objective The objective of this study was to investigate whether patients who undergo fertility treatments (ovulation induction or in vitro fertilization) have an increased risk for future maternal cardiovascular morbidity. Design A population-based study compared the incidence of long-term cardiovascular morbidity in a cohort of women with and without a previous exposure to fertility treatments. Deliveries occurred during a 25-year period, with a mean follow-up of 11.7 years. Women with known cardiovascular disease and congenital cardiovascular malformations diagnosed before the index pregnancy and multiple pregnancies were excluded. Results During the study period, 99,291 patients met the inclusion criteria; 4.1% (n = 4,153) occurred in patients with exposure to fertility treatments. Patients with exposure to fertility treatments did not have higher rates of cardiovascular morbidity. Using a Kaplan-Meier survival curve, patients with an exposure to fertility treatments had no higher cumulative incidence of cardiovascular hospitalizations. Using a Cox proportional hazards model, adjusted for confounders such as preeclampsia, diabetes mellitus, and obesity, exposure to fertility treatments remained unassociated with cardiovascular hospitalizations (adjusted hazard ratio = 1.1; 95% confidence interval, 0.9-1.3; p = 0.441). Conclusion In our population, during a mean follow-up period of 11.7, results showed no increased risk for cardiovascular morbidity in women undergoing fertility treatments.

The effect of hormone therapy on all-cause and cardiovascular mortality in women with chronic kidney disease: protocol for a systematic review and meta-analysis.

BackgroundChronic kidney disease affects approximately one in ten North Americans and is associated with a high risk of cardiovascular disease. Chronic kidney disease in women is characterized by an abnormal sex hormone profile and low estradiol levels. Since low estradiol levels are associated with an increased cardiovascular risk in healthy women, our objective is to determine the effect of hormone therapy on all-cause mortality, cardiovascular mortality, and cardiovascular morbidity in women with chronic kidney disease.Methods/designStudies examining hormone therapy for adult women with chronic kidney disease will be included. The primary outcome is all-cause or cardiovascular mortality and morbidity. We will search electronic bibliographic databases (MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL)) along with relevant conference proceedings, table of contents of journals, and review articles. Two investigators will independently screen identified abstracts and select observational cohort studies, case–control studies, and randomized controlled trials examining hormone therapy in women with chronic kidney disease. These investigators will also independently abstract data from relevant full-text journal articles and assess risk of bias. Where possible, these data will be summarized using pooled or combined estimates for the risk ratio or hazard ratio of all-cause mortality, cardiovascular mortality, and cardiovascular morbidity in women with chronic kidney disease with and without hormone therapy. A random effects model will be used, and meta-regression and subgroup analyses will be used to explore potential source of heterogeneity.DiscussionGiven the high burden of cardiovascular disease in women with chronic kidney disease, this study will help guide clinical practice by summarizing current evidence on the use of hormone therapy for prevention of all-cause mortality, cardiovascular mortality, and cardiovascular morbidity in this population.Systematic review registrationThe final protocol was registered with PROSPERO (CRD42014014566).

Reproductive history in relation to relative weight and fat distribution

Department of Primary Health Care, Sahlgrenska University Hospital, Goteborg University, Gothenburg, Sweden. OBJECTIVE: To investigate the relationship between reproductive history and body composition. DESIGN: Prospective population study in Sweden. SUBJECTS: 1462 randomly selected women representing five separate age cohorts (38, 46, 50, 54 and 60 at the 1968-1969 baseline examination) have been followed longitudinally. MEASUREMENTS: Relative weight, fat distribution, and fat cellularity were related to menarche, parity, lactation, menopause and oestrogen medication. RESULTS: Age of menarche did not show any association with subsequent fat distribution, nor did length of lactation time. On the other hand parity was positively associated to total as well as central obesity, and lactation time was positively associated to abdominal fat cell diameter. Premenopausal women showed higher mean body weight and hip circumference than postmenopausal women of the same age. Change from pre- to postmenopausal status was associated with increase of waist circumference as well as reduction of hip circumference, resulting in an increased waist-hip ratio (WHR). Oestrogen replacement suggested some postponement of this increase. CONCLUSION: Parity and menopause are the reproductive factors most associated with gradual changes in body fat distribution. Oestrogen medication seems to play an additional role in diminishing waist circumference increase and could thus contribute to decreased cardiovascular morbidity in women. PMID: 8653141 [PubMed - indexed for MEDLINE]

Postmenopausal Estrogen Use, Cigarette Smoking, and Cardiovascular Morbidity in Women Over 50

The Framingham Heart Study, Framingham, Massachusetts; and the Epidemiology and Biometry Program, National Heart, Lung, and Blood Institute, Bethesda, Maryland

Postmenopausal estrogen use, cigarette smoking, and cardiovascular morbidity in women over 50. The Framingham Study.

We studied the effect of estrogen use on morbidity from cardiovascular disease in 1234 postmenopausal women, aged 50 to 83 years, participating in the Framingham Heart Study's 12th biennial examination (index examination). The medication history recorded at biennial examinations 8 through 12 was used to classify the degree of estrogen exposure before eight years of observation for cardiovascular morbidity and mortality. Despite a favorable cardiovascular risk profile and control for the major known risk factors for heart disease, women reporting postmenopausal estrogen use at one or more examinations had over a 50 per cent elevated risk of cardiovascular morbidity (P less than 0.01) and more than a twofold risk for cerebrovascular disease (P less than 0.01) after the index examination. Increased rates for myocardial infarction (P less than 0.05) were observed particularly among the estrogen users who smoked cigarettes. Conversely, among nonsmokers estrogen use was associated only with an increased incidence of stroke (P less than 0.05). No benefits from estrogen use were observed in the study group; in particular, mortality from all causes and from cardiovascular disease did not differ for estrogen users and nonusers.