创作:尹小甜 审核:Epi汪 2020年10月16日
  • 检索并筛选文献,最终纳入32篇综述;
  • 使女性未来心血管疾病风险增加2倍的生殖事件包括子痫前期、死胎和早产;
  • 使其增加1.5-2.0倍的事件包括妊娠期高血压、胎盘早剥、妊娠期糖尿病、卵巢早衰;
  • 使其增加1.0-1.5倍的事件包括初潮早、多囊卵巢综合症、胎次及绝经早等;
  • 不同的生殖健康相关事件与缺血性心脏病、脑卒中、心衰等风险存在不同程度关联;
  • 暂未发现服用孕酮避孕药、辅助生殖等技术与心血管疾病的关联。

Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review



2020-08-24, Article

Abstract & Authors:展开

Objective : To consolidate evidence from systematic reviews and meta-analyses investigating the association between reproductive factors in women of reproductive age and their subsequent risk of cardiovascular disease.
Design : Umbrella review.
Data sources: Medline, Embase, and Cochrane databases for systematic reviews and meta-analyses from inception until 31 August 2019.
Review methods : Two independent reviewers undertook screening, data extraction, and quality appraisal. The population was women of reproductive age. Exposures were fertility related factors and adverse pregnancy outcomes. Outcome was cardiovascular diseases in women, including ischaemic heart disease, heart failure, peripheral arterial disease, and stroke.
Results : 32 reviews were included, evaluating multiple risk factors over an average follow-up period of 7-10 years. All except three reviews were of moderate quality. A narrative evidence synthesis with forest plots and tabular presentations was performed. Associations for composite cardiovascular disease were: twofold for pre-eclampsia, stillbirth, and preterm birth; 1.5-1.9-fold for gestational hypertension, placental abruption, gestational diabetes, and premature ovarian insufficiency; and less than 1.5-fold for early menarche, polycystic ovary syndrome, ever parity, and early menopause. A longer length of breastfeeding was associated with a reduced risk of cardiovascular disease. The associations for ischaemic heart disease were twofold or greater for pre-eclampsia, recurrent pre-eclampsia, gestational diabetes, and preterm birth; 1.5-1.9-fold for current use of combined oral contraceptives (oestrogen and progesterone), recurrent miscarriage, premature ovarian insufficiency, and early menopause; and less than 1.5-fold for miscarriage, polycystic ovary syndrome, and menopausal symptoms. For stroke outcomes, the associations were twofold or more for current use of any oral contraceptive (combined oral contraceptives or progesterone only pill), pre-eclampsia, and recurrent pre-eclampsia; 1.5-1.9-fold for current use of combined oral contraceptives, gestational diabetes, and preterm birth; and less than 1.5-fold for polycystic ovary syndrome. The association for heart failure was fourfold for pre-eclampsia. No association was found between cardiovascular disease outcomes and current use of progesterone only contraceptives, use of non-oral hormonal contraceptive agents, or fertility treatment.
Conclusions : From menarche to menopause, reproductive factors were associated with cardiovascular disease in women. In this review, presenting absolute numbers on the scale of the problem was not feasible; however, if these associations are causal, they could account for a large proportion of unexplained risk of cardiovascular disease in women, and the risk might be modifiable. Identifying reproductive risk factors at an early stage in the life of women might facilitate the initiation of strategies to modify potential risks. Policy makers should consider incorporating reproductive risk factors as part of the assessment of cardiovascular risk in clinical guidelines.

First Authors:
Kelvin Okoth

Correspondence Authors:
Krishnarajah Nirantharakumar

All Authors:
Kelvin Okoth,Joht Singh Chandan,Tom Marshall,Shakila Thangaratinam,G Neil Thomas,Krishnarajah Nirantharakumar,Nicola J Adderley