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Reproductive factors, metabolic factors, and coronary artery calcification in older women

Atsma, Femke PhD1; Bartelink, Marie-Louise E.L. MD, PhD1; Grobbee, Diederick E. MD, PhD1; Rutten, Annemarieke MD, PhD2; Bots, Michiel L. MD, PhD1; Prokop, Matthias MD, PhD2; van der Schouw, Yvonne T. PhD1

Menopause:
doi: 10.1097/gme.0b013e3181653d7d
Articles
Abstract

Objective: Metabolic disturbances may explain the increased cardiovascular risk associated with reproductive factors. This cohort study investigated the relationship between reproductive factors and coronary artery calcification in elderly women and whether this relationship could be explained by metabolic disturbances.

Design: In total, 568 postmenopausal women were included in this cross-sectional study. Information about the women's reproductive life was obtained by a questionnaire. Metabolic factors were measured during a single visit. Coronary artery calcification was assessed with a multislice computed tomography scanner and dichotomized as absent or present. Logistic regression analysis was used to assess the relationship between reproductive factors and coronary artery calcification. Crude and multivariate adjusted odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were calculated. In addition, ORs were adjusted for several metabolic and cardiovascular risk factors.

Results: The mean age was 66.9 (± 5.5) years. Women with a history of irregular menstrual cycle lengths, as opposed to women with a history of regular menstrual cycles (26-30 d), had an increased risk of coronary artery calcification; multivariate-adjusted OR = 2.73 (95%CI: 1.24-5.98). Four or more pregnancies, compared with never pregnant, yielded an multivariate-adjusted OR of 1.89 (95% CI: 1.00-3.58). Having four children or more, compared with having no children, yielded a multivariate-adjusted OR of 1.97 (95% CI: 1.00-3.89). Adjustment for metabolic factors and other cardiovascular risk factors did not fully explain theses relationships.

Conclusion: Multigravidity (more than four pregnancies), multiparity (more than four births), and irregular menstrual cycle lengths were related to an increased risk of coronary artery disease. These associations could not be explained by metabolic abnormalities.

In Brief

In this cross-sectional study, multigravidity (more than four pregnancies), multiparity (more than four births), and irregular menstrual cycle lengths were related to an increased risk of coronary artery disease. These associations could not be explained by metabolic abnormalities

Author Information

From the 1Department of Julius Center for Health Sciences and Primary Care; and 2Radiology Department, University Medical Center Utrecht, Utrecht, the Netherlands.

Received September 24, 2007; revised and accepted December 13, 2007.

Funding/support: This study was supported by grant 2100.0078 from the Netherlands Organization for Health Research and Development.

Financial disclosure: None reported.

Address correspondence to: Yvonne T. van der Schouw, PhD, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands, PO Box 85500, Str. 6.131, 3508 GA Utrecht, the Netherlands; E-mail: Y.T.vanderSchouw@umcutrecht.nl

©2008The North American Menopause Society