Multiple Prior Live Births Are Associated With Cardiac Remodeling and Heart Failure Risk in Women

Area of Science:

• Cardiology
• Reproductive Health
• Public Health

Background:

• Parity, defined as the number of live births, has been anecdotally linked to cardiovascular disease.
• The specific impact of parity on cardiac remodeling and heart failure development requires further elucidation.

Purpose of the Study:

• To investigate the association between the number of live births and cardiac structure and function.
• To determine the relationship between parity and the risk of developing heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF).

Main Methods:

• Utilized data from the Framingham Heart Study (FHS) to assess cardiac measures via echocardiography and multivariable regression.
• Conducted a pooled analysis of 12,635 participants from multiple cohorts (FHS, CHS, MESA, VITAL) to examine incident heart failure subtypes using Fine-Gray subdistribution hazards models.
• Secondary analyses included major adverse cardiovascular events, myocardial infarction, and stroke.

Main Results:

• In FHS participants, increased live births correlated with diminished left ventricular fractional shortening and impaired cardiac mechanics.
• Women with five or more live births showed a significantly higher risk of developing HFrEF (HR 1.93) compared to nulliparous women.
• Conversely, a reduced risk of HFpEF was observed in women with a higher number of live births (HR 0.58).

Conclusions:

• Greater parity is associated with adverse changes in cardiac structure and function.
• While overall heart failure risk was not significantly altered, higher parity was linked to an increased risk of incident HFrEF.