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Arnold School of Public Health

Research links adverse pregnancy outcomes, menopausal symptoms to increased risk of cardiovascular disease

July 16, 2020 | Erin Bluvas,

Exercise science assistant professor Abbi Lane-Cordova has published findings in the Journal of the American Heart Association from a study that revealed a connection between certain adverse pregnancy outcomes (i.e., preterm birth, small-for-gestational-age infant), menopause symptoms, and estimated risk for heart disease or stroke in the next 10 years. The investigation found that women who experienced these adverse pregnancy outcomes were more likely to have severe vasomotor symptoms of menopause (e.g., night sweats, hot flashes). White women with both a past adverse pregnancy outcome and hot flashes/night sweats had higher estimated 10-year risk of cardiovascular disease or stroke.

These findings build on Lane-Cordova’s previous research around pregnancy complications and long-term heart disease risk that she began during her postdoctoral training and continued when she joined the Arnold School in 2017. Much of this work, including the present study, has been conducted in collaboration with the National Institutes of Health-funded CARDIA (Coronary Artery Risk Development in Young Adults) Study. This multicenter, longitudinal project works to identify risk factors from young adulthood through late middle age that often translate into cardiovascular disease later in life.

“The goal of the CARDIA study is to more fully understand how cardiovascular disease develops in Black and white men and women,” says Lane-Cordova. “We’re looking for predictors and modifiable factors associated with cardiovascular disease – two to three decades before its typical onset – to help mitigate those effects as individuals age. We are also using the information collected in CARDIA over time to create a fuller picture of novel cardiovascular disease risk factors.”

The clinical implications for this study suggest that a complete medical history should include details about pregnancy and menopause to better understand cardiovascular disease risk later in life. Looking at health across the adult lifespan, this project examined data collected from 1,866 women (mean age = 55+/-), adjusting for study center location, body mass index, education, current hormone replacement therapy use, number of births, and hysterectomy.

Previous research has already shown that pregnancy and menopause elicit profound cardiovascular changes in women, with adverse pregnancy outcomes and vasomotor menopausal symptoms being clearly linked to poorer cardiovascular health. This study showed that women with both adverse pregnancy outcomes and vasomotor symptoms were particularly at risk for cardiovascular disease.  These women were more likely to be Black and hypertensive, have completed fewer years of education, and have higher blood pressure than women who did not have either of these types of reproductive exposures. In the paper, the authors explore possible explanations for racial differences and disparities in these results.

“Our findings suggest that the presence of both pregnancy and menopause exposures are important and that obtaining a life‐course reproductive history could help clinicians assess risk in women,” Lane-Cordova says. “Future research should investigate race‐specific joint associations of pregnancy and menopause exposures with cardiovascular disease outcomes, including incident heart failure and mortality.”

The CARDIA (Coronary Artery Risk Development in Young Adults) study is supported by contracts HHSN268201800003I, HHSN268201800004I, HHSN268201800005I, HHSN268201800006I, and HHSN268201800007I from the National Heart, Lung, and Blood Institute. The analyses were supported by grants from R01DK106201 (E.P. Gunderson, principal investigator), R01DK090047 (E.P. Gunderson, principal investigator), and K01DK059944 (E.P. Gunderson, principal investigator) from the National Institute of Diabetes, Digestive and Kidney Diseases. A.D. Lane‐Cordova receives funding from the American Heart Association (18CDA34110038).


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