Abstract P316: Reproductive Factors Associated With Subclinical Vascular Measures at Late Midlife: SWAN
Background: Sex-specific features, including adverse pregnancy outcomes (i.e., gestational hypertension, preeclampsia, gestational diabetes), have been associated with increased risk for CVD. However, there is limited research characterizing these associations with menopause features or with subclinical vascular measures at late midlife, when CVD risk increases.
Objective: To evaluate associations between reproductive factors (i.e. gestational hypertension, preeclampsia, and gestational diabetes) with validated and reliable markers of subclinical vascular damage and remodeling; carotid intima-media thickness (cIMT), adventitial diameter (cAD), carotid plaque presence, and brachial-ankle pulse wave velocity (baPWV).
Methods: A cross-sectional analysis was conducted with 1454 women (50% white, 31% black, 6% Hispanic, 13% Chinese) from the Study of Women’s Health Across the Nation (SWAN). Women were included if they completed a detailed reproductive history questionnaire and had a carotid ultrasound at visit 12 or 13. baPWV was performed at the same follow-up visit. Associations between reproductive history and subclinical CVD were tested using linear and logistic regression models adjusting for demographics and traditional CVD risk factors (age, site, race/ethnicity, financial strain, BMI, SBP, LDL-c, HDL-c, HOMA-IR). Additional models were adjusted for sex hormone levels and number of births.
Results: Women were on average 60 years old and mostly postmenopausal (94%). Two hundred fifty-six women (18%) were nulliparous. Approximately 10% of parous women had a self-reported history of gestational hypertension or preeclampsia, and 4% reported gestational diabetes. Among parous women, gestational hypertension was associated with higher mean cIMT (β±SE=0.053±0.015mm; P=0.0003) and preeclampsia was associated with higher odds of plaque (OR=1.7; 95% CI: 1.1, 2.6; P=0.01) in fully adjusted models. History of gestational diabetes was related to higher baPWV (β±SE=64.6±28.4cm/s; P=0.009). Associations between adverse pregnancy outcomes and subclinical vascular measures remained significant after adjusting for baseline estradiol and number of births. Compared to nulliparous women, parity≥3 was associated with higher cAD (β±SE=0.10±0.05mm; P=0.02) when controlling for demographics, but not after adjustment for CVD risk factors. Age at menarche, age at menopause, hormone ever use, and bilateral oophorectomy were not associated with subclinical vascular measures at late midlife.
Conclusions: Adverse pregnancy outcomes (i.e., gestational hypertension, preeclampsia, and gestational diabetes) converge to put women at excess risk for CVD, but may affect the vasculature through distinct pathways. Further studies are necessary to assess the joint effects of early and late midlife reproductive factors on future CVD.
Author Disclosures: Y.I. Cortes: None. J. Catov:None. M. Brooks: None. C. Isasi: None. E.A. Jackson: None. S. Harlow: None. K. Matthews: None. R. Thurston: None. E. Barinas-Mitchell: None.
- © 2017 by American Heart Association, Inc.