| Autor: |
O'Kelly AC; Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (A.C.O., M.C.H.)., Michos ED; Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (E.D.M.).; Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (E.D.M.)., Shufelt CL; Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.L.S., M.B.M.)., Vermunt JV; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN (J.V.V., V.D.G.)., Minissian MB; Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.L.S., M.B.M.).; Geri and Richard Brawerman Nursing Institute, Cedars-Sinai Medical Center, Los Angeles CA (M.B.M.)., Quesada O; Women's Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, OH (O.Q.).; The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH (O.Q.)., Smith GN; Department of Obstetrics and Gynecology, Queen's University, Kingston, Ontario, Canada (G.N.S.)., Rich-Edwards JW; Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.W.R.-E.).; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (J.W.R.-E.)., Garovic VD; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN (J.V.V., V.D.G.)., El Khoudary SR; Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (S.R.E.K.)., Honigberg MC; Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (A.C.O., M.C.H.).; Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA (M.C.H.).; Corrigan Women's Heart Health Program, Massachusetts General Hospital, Boston, MA (M.C.H.). |
| Abstrakt: |
Beyond conventional risk factors for cardiovascular disease, women face an additional burden of sex-specific risk factors. Key stages of a woman's reproductive history may influence or reveal short- and long-term cardiometabolic and cardiovascular trajectories. Early and late menarche, polycystic ovary syndrome, infertility, adverse pregnancy outcomes (eg, hypertensive disorders of pregnancy, gestational diabetes, preterm delivery, and intrauterine growth restriction), and absence of breastfeeding are all associated with increased future cardiovascular disease risk. The menopause transition additionally represents a period of accelerated cardiovascular disease risk, with timing (eg, premature menopause), mechanism, and symptoms of menopause, as well as treatment of menopause symptoms, each contributing to this risk. Differences in conventional cardiovascular disease risk factors appear to explain some, but not all, of the observed associations between reproductive history and later-life cardiovascular disease; further research is needed to elucidate hormonal effects and unique sex-specific disease mechanisms. A history of reproductive risk factors represents an opportunity for comprehensive risk factor screening, refinement of cardiovascular disease risk assessment, and implementation of primordial and primary prevention to optimize long-term cardiometabolic health in women. |
