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      Reproductive factors, intima media thickness and carotid plaques in a cross-sectional study of postmenopausal women enrolled in the population-based KORA F4 study

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          Abstract

          Background

          Reproductive events may affect the onset of chronic diseases. We examined the possible association between reproductive parameters and intima media thickness (IMT) or carotid plaques in the common carotid artery in a population-based sample.

          Methods

          This cross-sectional study analysed data of 800 postmenopausal women aged 50 to 81 years of the population-based KORA F4 study, conducted between 2006 and 2008 in Southern Germany. Reproductive parameters were obtained by standardised interviews.

          Results

          Age at menarche below 12 years compared to 12-15 years was significantly associated with carotid plaques (age-adjusted OR 2.23, 95% CI 1.13-4.43, p-value 0.018, multivariable adjusted 2.11, 1.05-4.26, 0.037), but not with IMT. Ever use of hormone replacement therapy was inversely associated with carotid plaques (age-adjusted 0.60, 0.44-0.81, p = 0.001, multivariable-adjusted 0.62, 0.45-0.86, 0.003) and IMT in the age-adjusted model (mean 0.89, 95% CI 0.88-0.90, p = 0.033) but not in the multivariable-adjusted model (mean 0.89, 95% CI 0.88-0.90, p = 0.075). Parity, age at menopause, time since menopause, duration of fertile period, current use of hormone replacement therapy, ever use of oral contraceptives, hysterectomy, bilateral oophorectomy, hot flashes and depressive mood in relation to the menopausal transition were not associated with carotid plaques or IMT.

          Conclusion

          Our study showed, that there may be an independent association between the reproductive parameters age at menarche and ever use of hormone replacement therapy with carotid plaques in the common carotid artery, but not with IMT. Further research, especially in studies with prospective population-based study design, is necessary to assess in detail what events in women’s life lead to increased IMT or CP.

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          Most cited references22

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          Early age at menarche associated with cardiovascular disease and mortality.

          The relationship between age at menarche and cardiovascular disease remains unclear. Two recent studies found an inverse association between age at menarche and all-cause mortality. The aim of this study was to examine the relationship between age at menarche and cardiovascular disease risk factors, events, and mortality. A population-based prospective study involving 15,807 women, aged 40-79 yr in 1993-1997 and followed up to March 2007 for cardiovascular disease events (median follow-up 10.6 yr) and February 2008 for mortality (median follow-up 12.0 yr) was used. Odds ratios for cardiovascular disease risk factors and hazard ratios for incident cardiovascular disease and mortality were calculated. There were 3888 incident cardiovascular disease events (1323 coronary heart disease, 602 stroke, and 1963 other) and 1903 deaths (640 cardiovascular disease, 782 cancer, and 481 other) during follow-up. Compared with other women, those who had early menarche (<12 yr) had higher risks of hypertension [1.13 (1.02-1.24)], incident cardiovascular disease [1.17 (1.07-1.27)], incident coronary heart disease [1.23 (1.06-1.43)], all-cause mortality [1.22 (1.07-1.39)], cardiovascular disease mortality [1.28 (1.02-1.62)], and cancer mortality [1.25 (1.03-1.51)], adjusted for age, physical activity, smoking, alcohol, educational level, occupational social class, oral contraceptive use, hormone replacement therapy, parity, body mass index, and waist circumference. Early age at menarche (before age 12 yr) was associated with increased risk of cardiovascular disease events, cardiovascular disease mortality, and overall mortality in women, and this association appeared to be only partly mediated by increased adiposity.
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            Cardiovascular function before, during, and after the first and subsequent pregnancies.

            This study was designed to test the hypothesis that the vascular remodeling of pregnancy begins early, persists for at least 1 year after delivery, and is accentuated by a second pregnancy. Serial estimates of heart rate, arterial pressure, left ventricular volumes, cardiac output, and calculated peripheral resistance were obtained before pregnancy, every 8 weeks during pregnancy, and 12, 24, and 52 weeks postpartum in 15 nulliparous and 15 parous women using electrocardiography, automated manometry, and M-mode ultrasound. During pregnancy, body weight increased 14.5 +/- 1.8 kg and returned to prepregnancy values 1 year postpartum. Heart rate peaked at term 15 +/- 1 beat/min above prepregnancy levels (57 +/- 1 beat/min). Mean arterial pressure reached its nadir (-6 +/- 1 mm Hg) at 16 weeks, returning to baseline at term. The increases in left ventricular volumes and cardiac output (2.2 +/- 0.2 L/min) peaked at 24 weeks as did the 500 +/- 29 dynes x cm x s(-5) decrease in peripheral resistance, and their magnitude was significantly greater in the parous women. Postpartum they gradually returned toward baseline but remained significantly different from prepregnancy values in both groups at 1 year. We conclude that cardiovascular adaptations to the initial pregnancy begin early, persist postpartum, and appear to be enhanced by a subsequent pregnancy. We speculate that persistence of these changes may lower cardiovascular risk in later life.
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              The Value of Carotid Artery Plaque and Intima‐Media Thickness for Incident Cardiovascular Disease: The Multi‐Ethnic Study of Atherosclerosis

              Background Carotid artery plaques are associated with coronary artery atherosclerotic lesions. We evaluated various ultrasound definitions of carotid artery plaque as predictors of future cardiovascular disease (CVD) and coronary heart disease (CHD) events. Methods and Results We studied the risk factors and ultrasound measurements of the carotid arteries at baseline of 6562 members (mean age 61.1 years; 52.6% women) of the Multi‐Ethnic Study of Atherosclerosis (MESA). ICA lesions were defined subjectively as >0% or ≥25% diameter narrowing, as continuous intima‐media thickness (IMT) measurements (maximum IMT or the mean of the maximum IMT of 6 images) and using a 1.5‐mm IMT cut point. Multivariable Cox proportional hazards models were used to estimate hazard ratios for incident CVD, CHD, and stroke. Harrell's C‐statistics, Net Reclassification Improvement, and Integrated Discrimination Improvement were used to evaluate the incremental predictive value of plaque metrics. At 7.8‐year mean follow‐up, all plaque metrics significantly predicted CVD events (n=515) when added to Framingham risk factors. All except 1 metric improved the prediction of CHD (by C‐statistic, Net Reclassification Improvement, and Integrated Discrimination Improvement. Mean of the maximum IMT had the highest NRI (7.0%; P=0.0003) with risk ratio of 1.43/mm; 95% CI 1.26–1.63) followed by maximum IMT with an NRI of 6.8% and risk ratio of 1.27 (95% CI 1.18–1.38). Conclusion Ultrasound‐derived plaque metrics independently predict cardiovascular events in our cohort and improve risk prediction for CHD events when added to Framingham risk factors.
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                Author and article information

                Journal
                BMC Womens Health
                BMC Womens Health
                BMC Women's Health
                BioMed Central
                1472-6874
                2014
                24 January 2014
                : 14
                : 17
                Affiliations
                [1 ]Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
                [2 ]Department of Obstetrics and Gynaecology, Campus Grosshadern, Ludwig-Maximilians-University, Munich, Germany
                [3 ]Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Augsburg, Germany
                [4 ]Department of Internal Medicine II – Cardiology, University of Ulm Medical Center, Ulm, Germany
                [5 ]Medizinische Klinik und Poliklinik IV, Diabetes Zentrum - Campus Innenstadt, Klinikum der Ludwig-Maximilians-Universität, München and Clinical Cooperation Group Diabetes, Ludwig-Maximilians-Universität München and Helmholtz Zentrum München, Munich, Germany
                [6 ]Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
                [7 ]Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
                Article
                1472-6874-14-17
                10.1186/1472-6874-14-17
                3904933
                24456930
                9a1cc065-53bb-454b-8aca-2f5ec5c9c359
                Copyright © 2014 Stöckl et al.; licensee BioMed Central Ltd.

                This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 12 August 2013
                : 18 January 2014
                Categories
                Research Article

                Obstetrics & Gynecology
                atherosclerosis,women,reproductive factors,cardiovascular disease,intima media thickness,gender studies

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