Pregnancy and Reproductive Risk Factors for Cardiovascular Disease in Women.
Pregnancy and Reproductive Risk Factors for Cardiovascular Disease in Women.
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女性心血管疾病的怀孕和生殖危险因素。
DOI：
10.1161/circresaha.121.319895
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发表时间：
2022-02-18
影响因子：
20.1
通讯作者：
Honigberg MC
中科院分区：
文献类型：
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作者：
O'Kelly AC;Michos ED;Shufelt CL;Vermunt JV;Minissian MB;Quesada O;Smith GN;Rich-Edwards JW;Garovic VD;El Khoudary SR;Honigberg MC
除了心血管疾病的传统风险因素外，女性还面临着性别特异性风险因素的额外负担。女性生殖史的关键阶段可能会影响或揭示短期和长期的心脏代谢和心血管轨迹。月经初潮早期和晚期、多囊卵巢综合征、不孕症、不良妊娠结局（例如，妊娠期高血压疾病、妊娠期糖尿病、早产和子宫内生长受限）以及缺乏母乳喂养都与未来心血管疾病风险增加有关。绝经过渡期还代表了一个加速心血管疾病风险的时期，随着时间的推移（例如，过早绝经）、机制和更年期症状以及更年期症状的治疗，每一种都会导致这种风险。传统心血管疾病风险因素的差异似乎可以解释一些，但不是全部，生殖史和晚年心血管疾病之间观察到的关联;需要进一步研究来阐明激素的影响和独特的性别特异性疾病机制。生殖风险因素的历史是一个机会，全面的风险因素筛查，完善心血管疾病风险评估，并实施原始和一级预防，以优化妇女的长期心脏代谢健康。
Beyond conventional risk factors for cardiovascular disease, women face an additional burden of sex-specific risk factors. Key stages of a woman’s reproductive history may influence or reveal short- and long-term cardiometabolic and cardiovascular trajectories. Early and late menarche, polycystic ovary syndrome, infertility, adverse pregnancy outcomes (e.g., hypertensive disorders of pregnancy, gestational diabetes, preterm delivery, and intrauterine growth restriction), and absence of breastfeeding are all associated with increased future cardiovascular disease risk. The menopause transition additionally represents a period of accelerated cardiovascular disease risk, with timing (e.g., premature menopause), mechanism, and symptoms of menopause, as well as treatment of menopause symptoms, each contributing to this risk. Differences in conventional cardiovascular disease risk factors appear to explain some, but not all, of the observed associations between reproductive history and later-life cardiovascular disease; further research is needed to elucidate hormonal effects and unique sex-specific disease mechanisms. A history of reproductive risk factors represents an opportunity for comprehensive risk factor screening, refinement of cardiovascular disease risk assessment, and implementation of primordial and primary prevention to optimize long-term cardiometabolic health in women.