Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jan 10;110(3):170-177.
doi: 10.1136/heartjnl-2023-322442.

Lifetime cumulative effect of reproductive factors on ischaemic heart disease in a prospective cohort

Leying Hou #  1 , Wen Liu #  1 , Weidi Sun  1 , Jin Cao  1 , Shiyi Shan  1 , Yan Feng  2 , Yimin Zhou  2 , Changzheng Yuan  3 , Xue Li  3 , Peige Song  4
Affiliations

Lifetime cumulative effect of reproductive factors on ischaemic heart disease in a prospective cohort

Leying Hou et al. Heart. .

Abstract

Objective: This study aimed to examine the association between lifetime oestrogen exposure and ischaemic heart disease (IHD), based on the hypothesis that higher lifetime oestrogen exposure is linked to lower cardiovascular risk.

Methods: In 2004-2008, lifetime cumulative exposure to reproductive factors was assessed among postmenopausal females from the China Kadoorie Biobank using reproductive lifespan (RLS), endogenous oestrogen exposure (EEE) and total oestrogen exposure (TEE). EEE was calculated by subtracting pregnancy-related and contraceptive use duration from RLS, while TEE by adding up the same components except for lactation. Incident IHD during follow-up (2004-2015) was identified. Stratified Cox proportional hazards models estimated the HRs and 95% CIs of IHD for RLS, EEE and TEE.

Results: Among 118 855 postmenopausal females, 13 162 (11.1%) developed IHD during a median follow-up of 8.9 years. The IHD incidence rates were 13.0, 12.1, 12.5, 13.8 per 1000 person-years for RLS Q1-Q4, 15.8, 12.6, 11.3, 12.1 per 1000 person-years for EEE Q1-Q4 and 13.7, 12.3, 12.2, 13.4 per 1000 person-years for TEE Q1-Q4. The highest quartile (Q4) of RLS and TEE were associated with lower risks of IHD (adjusted HR (aHR) 0.95, 95% CI 0.91 to 1.00 and 0.92, 95% CI 0.88 to 0.97, respectively) compared with the lowest quartile (Q1). Longer EEE showed progressively lower risks of incident IHD (aHR 0.93, 95% CI 0.88 to 0.97; 0.88, 95% CI 0.84 to 0.93; 0.87, 95% CI 0.83 to 0.92 for Q2-Q4 vs Q1).

Conclusions: Longer RLS, TEE and EEE were associated with lower risks of IHD among Chinese postmenopausal females.

Keywords: coronary artery disease; epidemiology.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Visual overview of key study findings.
Figure 2
Figure 2
Flow chart of selected participants. CHD, coronary heart disease; EEE, endogenous oestrogen exposure; IHD, ischaemic heart disease.
Figure 3
Figure 3
RLS, EEE, TEE and the risk of IHD among postmenopausal females: multivariable Cox regression. *P<0.05 with a negative association. Incidence rate was expressed in 1000 person-years. Model was adjusted for sociodemographic characteristics (age at baseline, marital status, residence, education, occupation and household income), lifestyle factors (body mass index, waist circumference, smoking status, secondhand smoking, alcohol intake and physical activity in metabolic equivalent hours/day) and medical covariates (history of anticoagulation therapy, hypolipidemic therapy, stroke, diabetes and hypertension). EEE, endogenous oestrogen exposure; IHD, ischaemic heart disease; RLS, reproductive lifespan; TEE, total oestrogen exposure.
See this image and copyright information in PMC

References

    1. Khan MA, Hashim MJ, Mustafa H, et al. Global epidemiology of ischemic heart disease: results from the global burden of disease study. Cureus 2020;12:e9349. 10.7759/cureus.9349 - DOI - PMC - PubMed
    1. Roth GA, Mensah GA, Johnson CO, et al. Global burden of cardiovascular diseases and risk factors, 1990–2019: update from the GBD 2019 study. J Am Coll Cardiol 2020;76:2982–3021. 10.1016/j.jacc.2020.11.010 - DOI - PMC - PubMed
    1. Vogel B, Acevedo M, Appelman Y, et al. The lancet women and cardiovascular disease Commission: reducing the global burden by 2030. Lancet 2021;397:2385–438. 10.1016/S0140-6736(21)00684-X - DOI - PubMed
    1. Shufelt C, Waldman T, Wang E, et al. Female-specific factors for IHD: across the reproductive LifeSpan. Curr Atheroscler Rep 2015;17:1–9.:481. 10.1007/s11883-014-0481-6 - DOI - PubMed
    1. Vancheri F, Tate AR, Henein M, et al. Time trends in ischaemic heart disease incidence and mortality over three decades (1990–2019) in 20 Western European countries: systematic analysis of the global burden of disease study 2019. Eur J Prev Cardiol 2022;29:396–403. 10.1093/eurjpc/zwab134 - DOI - PubMed