Infertility and Risk of Cardiovascular Disease: A Prospective Cohort Study

• Type of Material: Article
• Authors: Leslie V Farland, University of Arizona; Yi-Xin Wang, Harvard T.H. Chan School of Public Health; Audrey Gaskins, Emory University; Janet W Rich-Edwards, Harvard T.H. Chan School of Public Health; Siwen Wang, Harvard T.H. Chan School of Public Health; Maria Christine Magnus, Norwegian Inst Publ Hlth; Jorge E Chavarro, Harvard T.H. Chan School of Public Health; Kathryn M Rexrode, Harvard T.H. Chan School of Public Health; Stacey A Missmer, Harvard T.H. Chan School of Public Health
• Language: English
• Date: 2023-03-07
• Publisher: WILEY
• Publication Version: Final Published Version
• Copyright Statement: © 2023 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1161/JAHA.122.027755
• Title of Journal or Parent Work: JOURNAL OF THE AMERICAN HEART ASSOCIATION
• Volume: 12
• Issue: 5
• Start Page: e027755
• End Page: e027755
• Grant/Funding Information: This work was supported by grants HD096033 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development; and U01 CA176726 and U01 HL145386 from the National Cancer Institute.
• Keywords: STAGE; MORTALITY; infertility; Science & Technology; ENDOMETRIOSIS; HEALTH; OUTCOMES; polycystic ovary syndrome; cardiovascular disease; myocardial infarction; coronary heart disease; POLYCYSTIC-OVARY-SYNDROME; Life Sciences & Biomedicine; stroke; WOMEN; CRITERIA; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; endometriosis; SUBFERTILITY

Abstract

BACKGROUND: Certain symptoms associated with infertility are associated with cardiovascular disease, including menstrual cycle irregularity, early menopause, and obesity; however, few studies have investigated the association between infertility and cardiovascular disease risk. METHODS AND RESULTS: Participants in the NHSII (Nurses’ Health Study II) who reported infertility (12 months of trying to con-ceive without success, including women who subsequently conceived) or who were gravid, with no infertility were followed from 1989 until 2017 for development of incident, physician-diagnosed coronary heart disease (CHD) (myocardial infarction, coronary artery bypass grafting, angioplasty, stent) and stroke. Time-varying Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% CIs and were adjusted a priori for potential confounding variables. Among 103 729 participants, 27.6% reported having ever experienced infertility. Compared with gravid women who had not reported infertility, women with a history of infertility had greater risk of CHD (HR, 1.13 [95% CI, 1.01–1.26]) but not stroke (HR, 0.91 [95% CI, 0.77– 1.07]). The association between history of infertility and CHD was strongest among women who reported infertility at an earlier age (HR for infertility first reported at ≤25 years, 1.26 [95% CI, 1.09–1.46]; HR at 26–30 years, 1.08 [95% CI, 0.93–1.25]; HR at >30 years, 0.91 [95% CI, 0.70–1.19]). When we investigated specific infertility diagnoses, elevated risk of CHD was observed among women whose infertility was attributed to an ovulatory disorder (HR, 1.28 [95% CI, 1.05–1.55]) or endometriosis (HR, 1.42 [95% CI, 1.09–1.85]). CONCLUSIONS: Women with infertility may be at an increased risk of CHD. Risk differed by age at first infertility diagnosis and was restricted to ovulatory-and endometriosis-related infertility.