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Race Differences in Vascular Health Persist After Adjustment for Reproductive History in Midlife Women: A SWAN
McKenna A Tharpe-Carter1, Raymond Jones1,2,3, Silvienne Sint Jago1
1Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Insights
Reproductive history does not explain accelerated vascular aging in non-Hispanic Black women. Race disparities in vascular health persist, indicating other factors are at play.
Area of Science:
- Cardiovascular health research
- Women's health
- Health disparities
Background:
- Cardiovascular disease (CVD) is a leading cause of death in women.
- Non-Hispanic Black (NHB) women experience accelerated vascular aging compared to non-Hispanic White (NHW) women.
- Traditional CVD risk factors do not fully account for these racial disparities, suggesting other contributors like reproductive history.
Purpose of the Study:
- To investigate race differences in reproductive history among midlife women.
- To determine if reproductive history explains the observed disparities in vascular health between NHB and NHW women.
Main Methods:
- Utilized cross-sectional data from 2,935 postmenopausal participants in the Study of Women's Health Across the Nation (SWAN).
- Assessed vascular health via pulse pressure (PP), estimated pulse wave velocity (ePWV), and estimated vascular overload index (eVOI).
- Analyzed reproductive history factors (age at menarche, pregnancy history, parity, breastfeeding duration) and menopause symptoms, adjusting for age, BMI, and smoking status.
Main Results:
- NHB women showed significantly poorer vascular health indices (PP, ePWV, eVOI) compared to NHW women, despite similar chronological ages.
- NHB women reported earlier first/last pregnancies, higher parity, and shorter breastfeeding durations.
- Reproductive history factors did not correlate with vascular health indices and did not attenuate the racial disparities in vascular health. NHB race remained a significant predictor.
Conclusions:
- Racial differences in vascular health between NHB and NHW women are not explained by reproductive history.
- These disparities persist even after accounting for traditional risk factors, highlighting the need to explore other determinants.
- Further research should investigate structural and psychosocial factors contributing to accelerated vascular aging in NHB women.
Introduction:
Cardiovascular disease is the leading cause of death among women, and non-Hispanic Black (NHB) women exhibit accelerated vascular aging compared with non-Hispanic White (NHW) women. Traditional risk factors do not fully explain these racial disparities, prompting increased interest in reproductive history as a potential contributor. We examined race differences in reproductive history and their contribution to vascular health among midlife women using data from the Study of Women's Health Across the Nation (SWAN).
Methods:
Using cross-sectional SWAN data, 2,935 postmenopausal participants (N = 1,108 NHB, 1,827 NHW) were analyzed. Vascular health was assessed using pulse pressure (PP), estimated pulse wave velocity (ePWV), and estimated vascular overload index (eVOI). Reproductive history outcomes included age at menarche, age at first and last pregnancy, parity, breastfeeding duration, and menopause symptom count. Multivariate linear regression models evaluated whether reproductive history attenuated race differences in vascular health, adjusting for age, body mass index (BMI), and smoking status.
Results:
Despite similar chronological age, NHB women exhibited greater PP, ePWV, and eVOI compared with NHW women (p < 0.001 for all). NHB women also reported a younger age at first and last pregnancy, higher parity, and shorter breastfeeding duration compared with NHW women (p < 0.002 for all). Older age, higher BMI, and current smoking status were independently associated with accelerated vascular health across all models. Reproductive history outcomes were not associated with any vascular health indices, and inclusion of these variables did not attenuate race differences. NHB race remained a significant predictor of vascular health across all models.
Conclusions:
Race differences in vascular health are not explained by differences in reproductive history and persist even after adjustment for traditional risk factors. These findings merit future research on other structural and psychosocial determinants of accelerated vascular health in NHB women.
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