Pregnancy Loss and Later Risk of Atherosclerotic Disease
Pregnancy Loss and Later Risk of Atherosclerotic Disease
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DOI：
10.1161/circulationaha.112.000285
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发表时间：
2013-04-30
期刊：
影响因子：
37.8
通讯作者：
Boyd, Heather A.
中科院分区：
文献类型：
--
作者：
Ranthe, Mattis Flyvholm;Andersen, Elisabeth A. Wreford;Boyd, Heather A.
背景：妊娠失败和动脉粥样硬化性疾病可能通过潜在病理在病因学上联系在一起。我们研究了流产和死产是否会增加心肌梗死、脑梗死和肾血管性高血压的风险。方法和结果：在1977年至2008年间至少怀孕一次的妇女中，我们确定了流产、死产或单胎活产的妇女队列。这些妇女从妊娠结束时开始随访，观察心肌梗死、脑梗死和肾血管性高血压的发生率。使用泊松回归，我们根据流产和死产的历史估计了每种结局的发生率比。在1031 279名女性中，我们发现2798例心肌梗死，4053例脑梗死，1269例肾血管性高血压。死产妇女的心肌梗死、脑梗死和肾血管性高血压的发生率分别是无死产妇女的2.69（95%可信区间，2.06-3.50）、1.74（1.32-2.28）和2.42（1.59-3.69）倍。与没有流产的女性相比，流产的女性分别是相同结果的1.13倍（1.03-1.24），1.16倍（1.07-1.25）和1.20倍（1.05-1.38）；这些关联是剂量依赖性的，每增加一次流产，心肌和脑梗死和肾血管性高血压的发生率分别增加9%（3%至16%）、13%（7%至19%）和19%（9%至30%）。这种关联在年轻女性中最强(
Background-Pregnancy losses and atherosclerotic disease may be etiologically linked through underlying pathology. We examined whether miscarriage and stillbirth increase later risk of myocardial infarction, cerebral infarction, and renovascular hypertension.Methods and Results-Among women pregnant at least once between 1977 and 2008, we identified a cohort of women with miscarriages, stillbirths, or live singleton births. These women were followed from the end of pregnancy for incident myocardial infarction, cerebral infarction, and renovascular hypertension. Using Poisson regression, we estimated incidence rate ratios for each of the outcomes by history of miscarriage and stillbirth. Among 1 031 279 women followed for >15 928 900 person-years, we identified 27 98 myocardial infarctions, 40 53 cerebral infarctions, and 1269 instances of renovascular hypertension. Women with stillbirths had 2.69 (95% confidence interval, 2.06-3.50), 1.74 (1.32-2.28), and 2.42 (1.59-3.69) times the rates of myocardial infarction, cerebral infarction, and renovascular hypertension, respectively, as women with no stillbirths. Compared with women with no miscarriages, women with miscarriages had 1.13 (1.03-1.24), 1.16 (1.07-1.25), and 1.20 (1.05-1.38) times the rates of these same outcomes, respectively; these associations were dose dependent, with each additional miscarriage increasing the rates of myocardial and cerebral infarction and renovascular hypertension by 9% (3% to 16%), 13% (7% to 19%), and 19% (9% to 30%), respectively. Associations were strongest in younger women (