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Pregnancy-related factors may signal additional protection or risk of future cardiovascular diseases
Shivani M Reddy1, Tamy H M Tsujimoto2, Bajhat F Qaqish2
1Division of Translational Health Sciences, RTI International, 307 Waverly Oaks Road, #1023, Waltham, MA, 02452, USA. sreddy@rti.org.
Insights
Breastfeeding may reduce cardiovascular disease (CVD) risk in women, offering insights beyond traditional risk factors. History of low birthweight infants showed inconclusive results for CVD risk assessment.
Area of Science:
- Cardiology
- Reproductive Health
- Public Health
Background:
- Current cardiovascular disease (CVD) guidelines use the Pooled Cohort Equation (PCE) for risk assessment based on traditional factors.
- Pregnancy-related factors are increasingly recognized as potential indicators of future CVD risk.
- This study investigates the impact of low birthweight (LBW) infant history and breastfeeding on CVD risk.
Purpose of the Study:
- To evaluate the contribution of LBW infant history and breastfeeding to 10-year CVD risk.
- To determine if these pregnancy-related factors provide additional risk information beyond traditional PCE factors.
- To assess CVD outcomes including CVD death and CVD death plus surrogate CVD events.
Main Methods:
- Utilized a nationally representative sample of women aged 40-79 from NHANES 1999-2006 with no prior CVD.
- Employed Cox proportional hazards models to analyze CVD outcomes, adjusting for the PCE risk score.
- Examined outcomes of CVD mortality and a composite of CVD mortality plus surrogate CVD events.
Main Results:
- Breastfeeding was associated with a trend towards reduced CVD outcomes, including a 24% reduction in CVD deaths (HR 0.76) and a 33% reduction in CVD death + surrogate CVD (HR 0.77), though not statistically significant.
- History of a low birthweight infant showed inconclusive results for CVD risk, with wide confidence intervals for both outcome measures.
- The study included 3,758 women, with 479 reporting LBW infant history and 1,926 reporting breastfeeding, followed for a mean of 12.1 years.
Conclusions:
- Pregnancy-related factors, particularly breastfeeding, may offer valuable CVD risk information beyond traditional risk factors.
- Clinicians may consider discussing the potential cardiovascular health benefits of breastfeeding with patients.
- Further research with larger datasets is warranted to confirm these findings and refine CVD risk prediction models.
Background:
Cardiovascular disease (CVD) guidelines recommend using the Pooled Cohort Equation (PCE) to assess 10-year CVD risk based on traditional risk factors. Pregnancy-related factors have been associated with future CVD. We examined the contribution of two pregnancy-related factors, (1) history of a low birthweight (LBW) infant and (2) breastfeeding to CVD risk accounting for traditional risk factors as assessed by the PCE.
Methods:
A nationally representative sample of women, ages 40-79, with a history of pregnancy, but no prior CVD, was identified using NHANES 1999-2006. Outcomes included (1) CVD death and (2) CVD death plus CVD surrogates. We used Cox proportional hazards models to adjust for PCE risk score.
Results:
Among 3,758 women, 479 had a LBW infant and 1,926 reported breastfeeding. Mean follow-up time was 12.1 years. Survival models showed a consistent reduction in CVD outcomes among women with a history of breastfeeding. In cause-specific survival models, breastfeeding was associated with a 24% reduction in risk of CVD deaths (HR 0.76; 95% CI 0.45─1.27, p = 0.30) and a 33% reduction in risk of CVD deaths + surrogate CVD, though not statistically significant. (HR 0.77; 95% CI 0.52─1.14, p = 0.19). Survival models yielded inconclusive results for LBW with wide confidence intervals (CVD death: HR 0.98; 95% CI 0.47─2.05; p = 0.96 and CVD death + surrogate CVD: HR 1.29; 95% CI 0.74─2.25; p = 0.38).
Conclusion:
Pregnancy-related factors may provide important, relevant information about CVD risk beyond traditional risk factors. While further research with more robust datasets is needed, it may be helpful for clinicians to counsel women about the potential impact of pregnancy-related factors, particularly the positive impact of breastfeeding, on cardiovascular health.
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