Study: Heart failure risks linked to history of infertility

A new study shows that a history of infertility is linked to an increased risk of heart failure. Researchers from Massachusetts General Hospital (MGH) published in the Journal of the American College of Cardiology (MGH) that women who have experienced infertility have a 16 percent increased risk of heart failure compared to women who did not have a history of infertility.

“We are beginning to realize that a woman’s reproductive history tells us a lot about her future heart risk,” says first author Emily Lau, MD, MPH, cardiologist and director of the Menopause, Hormone, and Cardiovascular Clinic. “Whether a woman has difficulty conceiving, what happens during pregnancy, when she transitions into menopause, all of this affects her risk of heart disease later in life.” Infertility affects about 1 in 5 women in the United States and includes a range of pregnancy difficulties, but its association with heart failure has not been well studied until recently. In partnership with the Women’s Health Initiative (WHI), which was designed in the early 1990s and inquired about a woman’s reproductive history, Lau and colleagues studied postmenopausal women from WHI and examined whether infertility was associated with the development of heart failure.

There are two types of heart failure: heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). The ejection fraction is a measurement of the volume of blood that is pumped out of the heart’s left ventricle during each beat. An ejection fraction less than 50 percent is usually seen as abnormal or low. The team found an association between infertility and heart failure in general, and specifically with HFpEF, a form of heart failure more common in women regardless of fertility history. Of the 38,528 postmenopausal women studied, 14 percent of the participants reported a history of infertility.

Over a 15-year follow-up period, the researchers noted that infertility was associated with a 16 percent future risk of developing total heart failure. When they examined heart failure subtypes, they found that infertility was associated with a 27 percent increased risk of developing HFpEF in the future. Over the past decade, HFpEF (in which the heart muscle does not relax well) in contrast to HFrEF (in which the left ventricle does not pump well) has become the predominant form of heart failure in both men and women. But it is still more common in women. “It’s a tricky case because we still don’t fully understand how HFpEF develops and we don’t have very good treatments for HFpEF,” says Lau.

“I think our findings are particularly noteworthy because heart failure with preserved ejection fraction is more prevalent in women,” says Lau. “We don’t understand why we see HFpEF more in women. Looking back at a woman’s early reproductive life may give us some clues as to why.” Notably, the team noted that the association persisted regardless of whether the individual eventually became pregnant or gave birth to a live birth. The increased risk was independent of traditional cardiovascular risk factors and other conditions associated with infertility. “There has been some suggestion in previous studies that infertile women have more cardiac risk factors,” Lau says, but the team did not find that cardiac risk factors explained the link between infertility and heart failure in this study.

They also looked to see if other conditions associated with infertility such as thyroid disease, irregular menstruation, and early menopause explained the link between infertility and heart failure, but they did not provide evidence to support this hypothesis either. “So it really begs the question: What are the mechanisms driving the association between infertility and heart failure,” says Lau. Are they common risk factors or is infertility on the causal pathway? Remember that vascular and endothelial dysfunction may be involved and plan to elucidate the mechanism behind the link between infertility and heart failure. In the future, Lau hopes to conduct a future study of women with a history of infertility that includes exercise criteria, vascular measures, and more, to solve the mystery.

“We as scientists and clinicians are beginning to realize how important a woman’s reproductive history is to her future risk of heart disease. Infertility is one of many cardiovascular risk factors, such as hypertension and hypertension, but reproductive history is not routinely considered as part of a risk assessment. Cardiovascular,” says Lau. Since people do not tend to develop heart failure until their 60s and beyond, and infertility is often in their 20s, 30s, and 40s, many doctors do not consider this link. “We can’t change a woman’s history of infertility, but if we know a woman has a history of infertility, we can be more aggressive about advising her about other modifiable risk factors including high blood pressure, high cholesterol, smoking, and beyond that.” (Ani)

(This story has not been edited by the Devdiscourse staff and is automatically generated from a shared feed.)

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