Adverse Pregnancy Outcomes and Incident Heart Failure in the Women's Health Initiative.
Adverse Pregnancy Outcomes and Incident Heart Failure in the Women's Health Initiative.
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DOI：
10.1001/jamanetworkopen.2021.38071
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发表时间：
2021-12-01
影响因子：
13.8
通讯作者：
Parikh NI
中科院分区：
文献类型：
--
作者：
Hansen AL;Søndergaard MM;Hlatky MA;Vittinghof E;Nah G;Stefanick ML;Manson JE;Farland LV;Wells GL;Mongraw-Chaffin M;Gunderson EP;Van Horn L;Wild RA;Liu B;Shadyab AH;Allison MA;Liu S;Eaton CB;Honigberg MC;Parikh NI
不良妊娠结局与绝经后妇女心力衰竭的发生独立相关吗？在这项包括10292名妇女健康倡议参与者的队列研究中，妊娠期高血压疾病与绝经后妇女的心力衰竭事件独立相关，特别是射血分数保留的心力衰竭。这些结果表明，妊娠期高血压疾病是与心力衰竭风险相关的性别特异性因素，特别是射血分数保留的心力衰竭。这项队列研究调查了妇女健康倡议中绝经后妇女中不良妊娠结局与心力衰竭事件的总体相关性，并按心力衰竭亚型分层。一些先前的证据表明，不良妊娠结局（APO）可能与心力衰竭（HF）有关。识别与HF风险相关的独特因素并研究HF亚型是重要的下一步。在妇女健康倡议（WHI）的绝经后妇女中，研究APO与总体HF事件以及按HF亚型（射血分数保留与射血分数降低）分层的HF事件的相关性。2017年，在WHI研究中进行了一项APO病史调查，这是一项大型多种族绝经后妇女队列研究。分析了5种APO（妊娠期糖尿病、妊娠期高血压疾病[HDP]、低出生体重、高出生体重和早产）与判定的HF事件的相关性。在这项队列研究中，使用logistic回归模型评估每种APO与HF的相关性，并使用多项式回归评估每种APO与HF亚型的相关性，调整年龄、社会人口统计学特征、吸烟、随机化状态、生殖史和其他APO。数据分析于二零二零年一月至二零二一年九月进行。APO（妊娠期糖尿病、HDP、低出生体重、高出生体重和早产）。所有确诊的HF和HF亚型住院女性病例均由经过培训的医生使用标准化方法进行判定。在10292名女性（中位[IQR]年龄为60 [55-64]岁）中，3185名（31.0%）报告了1例或多例APO，336名（3.3%）诊断为HF。有任何载脂蛋白O病史的女性有更高的高血压、糖尿病、冠心病或吸烟的患病率。在研究的APO中，只有HDP与HF显著相关，完全校正的比值比（OR）为1.75（95% CI，1.22-2.50），在完全校正的模型中，HDP与射血分数保留的HF显著相关（OR，2.06; 95% CI，1.29-3.27）。在中介分析中，高血压解释了24%（95% CI，12%-73%），冠心病23%（95% CI，11%-68%），体重指数20%（95% CI，10%-64%）的HDP和HF之间的关联。在这个绝经后妇女的大队列中，HDP与HF事件独立相关，特别是射血分数保留的HF，并且这种相关性由随后的高血压、冠心病和肥胖介导。这些发现表明，在HDP女性患者中早期监测和改变这些因素可能与降低HF的长期风险相关。
Are adverse pregnancy outcomes independently associated with the development of heart failure among postmenopausal women? In this cohort study including 10 292 Women’s Health Initiative participants, hypertensive disorders of pregnancy were independently associated with incident heart failure, particularly heart failure with preserved ejection fraction, in postmenopausal women. These findings suggest that hypertensive disorders of pregnancy are sex-specific factors associated with risk of heart failure, particularly heart failure with preserved ejection fraction. This cohort study investigates the association of adverse pregnancy outcomes with incident heart failure overall and stratified by heart failure subtype among postmenopausal women in the Women’s Health Initiative. Some prior evidence suggests that adverse pregnancy outcomes (APOs) may be associated with heart failure (HF). Identifying unique factors associated with the risk of HF and studying HF subtypes are important next steps. To investigate the association of APOs with incident HF overall and stratified by HF subtype (preserved vs reduced ejection fraction) among postmenopausal women in the Women’s Health Initiative (WHI). In 2017, an APO history survey was administered in the WHI study, a large multiethnic cohort of postmenopausal women. The associations of 5 APOs (gestational diabetes, hypertensive disorders of pregnancy [HDP], low birth weight, high birth weight, and preterm delivery) with incident adjudicated HF were analyzed. In this cohort study, the association of each APO with HF was assessed using logistic regression models and with HF subtypes using multinomial regression, adjusting for age, sociodemographic characteristics, smoking, randomization status, reproductive history, and other APOs. Data analysis was performed from January 2020 to September 2021. APOs (gestational diabetes, HDP, low birth weight, high birth weight, and preterm delivery). All confirmed cases of women hospitalized with HF and HF subtype were adjudicated by trained physicians using standardized methods. Of 10 292 women (median [IQR] age, 60 [55-64] years), 3185 (31.0%) reported 1 or more APO and 336 (3.3%) had a diagnosis of HF. Women with a history of any APO had a higher prevalence of hypertension, diabetes, coronary heart disease, or smoking. Of the APOs studied, only HDP was significantly associated with HF with a fully adjusted odds ratio (OR) of 1.75 (95% CI, 1.22-2.50), and with HF with preserved ejection fraction in fully adjusted models (OR, 2.06; 95% CI, 1.29-3.27). In mediation analyses, hypertension explained 24% (95% CI, 12%-73%), coronary heart disease 23% (95% CI, 11%-68%), and body mass index 20% (95% CI, 10%-64%) of the association between HDP and HF. In this large cohort of postmenopausal women, HDP was independently associated with incident HF, particularly HF with preserved ejection fraction, and this association was mediated by subsequent hypertension, coronary heart disease, and obesity. These findings suggest that monitoring and modifying these factors early in women presenting with HDP may be associated with reduced long-term risk of HF.
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影响因子：
6
作者：
Liu, Longjian;Klein, Liviu;Manson, JoAnn E.
通讯作者：
Manson, JoAnn E.
影响因子：
3.5
作者：
Carter, Ebony Boyce;Stuart, Jennifer J.;Seely, Ellen W.
通讯作者：
Seely, Ellen W.
影响因子：
3.8
作者：
Alma LJ;Bokslag A;Maas AHEM;Franx A;Paulus WJ;de Groot CJM
通讯作者：
de Groot CJM
影响因子：
3.5
作者：
Parikh, Nisha, I;Laria, Barbara;Epel, Elissa
通讯作者：
Epel, Elissa
DOI：
10.1111/1471-0528.14522
发表时间：
2018-03
期刊：
BJOG : an international journal of obstetrics and gynaecology
影响因子：
--
作者：
Morken NH;Halland F;DeRoo LA;Wilcox AJ;Skjaerven R
通讯作者：
Skjaerven R