Cardiovascular disease (CVD) is the leading cause of death among women. Recent findings show that reproductive risk factors significantly increase the risk of CVD in women. This understanding has led to the inclusion of premature menopause and adverse pregnancy outcomes (APOs) as risk-enhancing factors for atherosclerotic CVD (ASCVD) in recent guidelines. 

Age of Menarche and Cardiovascular Disease Risk

Starting your period early, before age 10, is linked to a higher risk of developing issues like metabolic syndrome, obesity, dyslipidemia, and hypertension. The relationship between the age you start your period and future CVD risk is U-shaped, with risks increasing both for early and late starts (after age 17).

Polycystic Ovary Syndrome and Cardiovascular Disease Risk

Polycystic ovary syndrome (PCOS) affects 5-13% of women and includes symptoms like polycystic ovaries, irregular periods, excess male hormones, and acne. Women with PCOS are more likely to have metabolic syndrome, obesity, dyslipidemia, hypertension, diabetes, insulin resistance, and a 30% increased risk of CVD, including coronary heart disease and stroke.

Contraception and Cardiovascular Disease Risk

Oral contraceptive pills, especially those with higher estrogen doses (≥50 µg), are associated with increased blood pressure and a higher risk of blood clots, which can lead to heart attacks and strokes. Newer oral contraceptives with lower estrogen doses (≤30 µg) present a lower risk. Long-acting reversible contraception (LARC) methods like IUDs and implants do not increase CVD risk.

Parity, Lactation, and Cardiovascular Disease Risk

There’s a J-shaped relationship between the number of pregnancies and CVD risk. Women who never give birth or have five or more pregnancies have the highest risk, while women with two pregnancies have a lower risk. Breastfeeding has long-term benefits for heart health, reducing the rates of diabetes, hypertension, and obesity. It also helps women who had complicated pregnancies.

Adverse Pregnancy Outcomes and Cardiovascular Disease Risk

APOs, affecting up to 30% of pregnancies, include hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), preterm delivery, and low birth weight. The American College of Cardiology and the American Heart Association guidelines now include these APOs as risk-enhancing factors in CVD risk estimation.

  • Hypertensive Disorders of Pregnancy (HDP): HDP, including chronic hypertension, gestational hypertension, and preeclampsia/eclampsia, affect 5-10% of pregnancies and are independent risk factors for future CVD. Women with HDP have higher odds of developing diabetes, metabolic syndrome, and central obesity.
  • Gestational Diabetes Mellitus (GDM): GDM occurs in 2-10% of pregnancies and increases the risk of future diabetes by seven times and CVD by two times. This risk persists even if diabetes does not develop post-pregnancy.
  • Preterm Delivery: Preterm delivery, between 20 and 37 weeks, is linked to higher maternal CVD risk. Extremely preterm deliveries significantly increase the risk of strokes, heart disease, and cardiovascular mortality.
  • Infant Birth Weight: Low birth weight is strongly correlated with coronary artery disease, diabetes, and hypertension, and is independently associated with ASCVD.

Menopause Transition and Cardiovascular Disease Risk

The menopause transition (MT) involves significant hormonal changes and is associated with increased CVD risk. Changes in lipid profiles and increased visceral abdominal fat during MT contribute to greater arterial stiffness and CVD risk.

Premature/Early Menopause

Premature menopause (<40 years) and early menopause (40-45 years) affect about 3% and 7% of women, respectively, and are associated with higher risks of coronary heart disease, heart failure, CVD mortality, and all-cause mortality. Hormone therapy (HT) is recommended for women with premature menopause to mitigate these risks.

Vasomotor Symptoms

Frequent and persistent vasomotor symptoms (VMS) are linked to a higher risk of CVD events. Severe VMS is associated with a 28% increased risk of CVD after adjusting for traditional risk factors.

Conclusion

Raising awareness and including reproductive risk factors in CVD risk assessments are crucial for improving cardiovascular health in women. Talk to your doctor to learn more about the links between reproductive factors and CVD to develop effective prevention strategies.

 

Dr. Alana Shaw ND