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Risk factors for cardiovascular disease in women during their reproductive life

21.03.23 10:11 PM Comment(s) By America

By América Torres

Cardiovascular disease in women
Photo: Looksutdio/Freepik

Besides the already known cardiovascular disease (CVD) factors, women face additional risks during their reproductive stage and pregnancy. The paper "Pregnancy and Reproductive Risk Factors for Cardiovascular Disease in Women" by Anna C. O'Kelly et al.summarizes the available evidence that some stages and aspects of female reproductive life, may increase their risk of CVD. The following is a summary of that document.


Cardiovascular disease: gender differences

Cardiovascular disease (CVD) is the leading cause of death among men and women worldwide. While both share risks, gender differences weigh. And in this case, women face some specific factors during their reproductive life and pregnancy that can increase their risks, for example:


  • Being late or early menarches
  • Polycystic ovary syndrome
  • Infertility
  • Adverse Pregnancy Outcomes (APOs) such as gestational diabetes, premature birth or hypertension
  • Do not breastfeed

Therefore, the authors of the paper suggest that it might be useful to incorporate patients' reproductive history into clinical practice and research.

Heart risks in menarche

Early menarche is considered when it occurs before 12 years of age. There is a clear relationship between early menarche and high body mass index (BMI) during childhood. And when contrasting the onset of normal vs. early/late menstruation, the latter two are associated with high levels of insulin, glucose, body fat, and blood pressure in teenager girls.


Being overweight can be due to genetic causes, or to a sedentary lifestyle and bad eating habits, but whatever the cause, that generates high levels of leptin. This hormone has to do with high levels of adiposity, which favor early menarche. The lack of regulation of adipokines during puberty can have a negative effect on the metabolism of teenage girls because it increases their risk of cardiovascular disease in their adult life.

Repercussions of infertility/infertility treatments

It is common for infertile women to have diabetes, obesity, or chronic hypertension, so it is not surprising that their risk of cardiovascular disease is increased by these factors. Additionally, it must be considered that assisted reproductive technology (ART) is associated with high CVD risks, although the causes are not yet well understood.


ART has significantly high rates of problems associated with pregnancy, such as hypertension and/or gestational diabetes, which, in turn, increase the risk of cardiovascular disease. In fact, a systematic review of 47 studies showed that in vitro fertilization was associated with hypertensive disorders during pregnancy.


On the other hand, a cohort study involving >6,000 women did not show an increased risk after a successful treatment. This suggests that ART itself is not necessarily a risk factor. However, more studies are needed to know if it is the cause of CVD or not.

Risks during pregnancy

Hypertensive disorders during pregnancy are factors in the long-term development of chronic hypertension and other cardiovascular conditions, such as coronary heart disease, stroke, and heart failure, among others. And women with a history of hypertensive disorders during gestation often develop CVD early.


In those cases, hypertension, diabetes, and hyperlipidemia are diagnosed up to 10 years earlier than normal. This suggests that these disorders are associated with accelerated cardiovascular aging. In fact, subclinical markers of vascular damage are significantly more prevalent among women with a history of hypertensive disorders in pregnancy vs. those without.

Menopause and cardiovascular disease

The impact of this transition that marks the end of the reproductive life in women has a great influence on the risk of cardiovascular disease; there are many causes. To begin with, during the transition of menopause they experience changes in lipid and lipoprotein levels, so it is common that between 1 year before – 1 year after the onset, they present an increase in total cholesterol, LDL-C, and apolipoprotein B (APO B), regardless of their chronological age.


In addition, women who reach this stage have weight gain, which although apparently is not related to the menopause transition, it does affect the place where women store fat, including cardiovascular fat.


Arterial stiffness must also be considered because perimenopause is associated with adverse vascular remodeling. Artery stiffness (measured with pulse wave velocity) accelerates 1 year after the onset of this phase, regardless of other risk factors. However, it is unclear whether these changes can predict CVD.


On the other hand, the relationship between premature menopause and CVD risk is not definitive. Data from the Framingham Heart Study show that the worst cardiovascular risk factor before menopause is when it occurs early, regardless of the factors that favor the onset of this stage.


Despite advances in understanding cardiovascular disease risk factors by sex, much research is still needed to understand its pathophysiology and the mechanisms that can trigger CVD in the lives of adult women.


The authors of the paper that we summarized in this article indicate that it is necessary to investigate whether prevention strategies attached to the specific conditions of patients can reduce cardiometabolic risks. To obtain results that clarify the questions on the subject, it is necessary to include in clinical trials women who are pregnant or breastfeeding, and also perimenopausal people.

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SOURCE: "Pregnancy and Reproductive Risk Factors for Cardiovascular Disease in Women".



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