英国伯明翰大学Krishnarajah Nirantharakumar团队分析了年轻女性生殖健康与晚年心血管疾病的相关性。2020年10月7日，该研究发表在《英国医学杂志》上。

为了探讨育龄女性的生殖因素与随后患心血管疾病的风险之间的相关性，研究组在Medline、Embase和Cochrane数据库中检索从成立到2019年8月31日的相关文献，结局为女性心血管疾病，包括缺血性心脏病、心力衰竭、外周动脉疾病和中风。

研究组共纳入32篇综述文章，评估了平均随访7-10年的多种危险因素。除3篇外，其他所有综述的质量都为中等。采用森林图和表格展示进行了叙述性证据的综合。

先兆子痫、死产和早产发生综合性心血管疾病的风险比为两倍；妊娠期高血压、胎盘早剥、妊娠期糖尿病和卵巢早衰为1.5-1.9倍；月经初潮早、多囊卵巢综合症、经产和过早绝经不到1.5倍。

母乳喂养时间越长，患心血管疾病的风险就越低。子痫前期、复发性子痫前期、妊娠糖尿病和早产发生缺血性心脏病的风险为两倍及以上；当前口服避孕药（雌激素和孕激素）、反复流产、卵巢早衰和更年期提前为1.5-1.9倍；早期流产、多囊卵巢综合征和更年期症状则低于1.5倍。

目前使用任何口服避孕药、子痫前期和复发性子痫前期发生中风的风险为两倍及以上；当前口服复合避孕药、妊娠糖尿病和早产为1.5-1.9倍；而流产、多囊卵巢综合征和更年期症状则不到1.5倍。子痫前期发生心力衰竭的风险为四倍。心血管疾病的预后与目前仅使用孕酮避孕、使用非口服激素避孕药或生育治疗之间没有关联。

研究结果表明，从月经初潮到更年期，生殖因素与女性心血管疾病显著相关。

附：英文原文

Title: Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review

Author: Kelvin Okoth, Joht Singh Chandan, Tom Marshall, Shakila Thangaratinam, G Neil Thomas, Krishnarajah Nirantharakumar, Nicola J Adderley

Issue&Volume: 2020/10/07

Abstract:

Objective To consolidate evidence from systematic reviews and meta-analyses investigating the association between reproductive factors in women of reproductive age and their subsequent risk of cardiovascular disease.

Design Umbrella review.

Data sources Medline, Embase, and Cochrane databases for systematic reviews and meta-analyses from inception until 31 August 2019.

Review methods Two independent reviewers undertook screening, data extraction, and quality appraisal. The population was women of reproductive age. Exposures were fertility related factors and adverse pregnancy outcomes. Outcome was cardiovascular diseases in women, including ischaemic heart disease, heart failure, peripheral arterial disease, and stroke.

Results 32 reviews were included, evaluating multiple risk factors over an average follow-up period of 7-10 years. All except three reviews were of moderate quality. A narrative evidence synthesis with forest plots and tabular presentations was performed. Associations for composite cardiovascular disease were: twofold for pre-eclampsia, stillbirth, and preterm birth; 1.5-1.9-fold for gestational hypertension, placental abruption, gestational diabetes, and premature ovarian insufficiency; and less than 1.5-fold for early menarche, polycystic ovary syndrome, ever parity, and early menopause. A longer length of breastfeeding was associated with a reduced risk of cardiovascular disease. The associations for ischaemic heart disease were twofold or greater for pre-eclampsia, recurrent pre-eclampsia, gestational diabetes, and preterm birth; 1.5-1.9-fold for current use of combined oral contraceptives (oestrogen and progesterone), recurrent miscarriage, premature ovarian insufficiency, and early menopause; and less than 1.5-fold for miscarriage, polycystic ovary syndrome, and menopausal symptoms. For stroke outcomes, the associations were twofold or more for current use of any oral contraceptive (combined oral contraceptives or progesterone only pill), pre-eclampsia, and recurrent pre-eclampsia; 1.5-1.9-fold for current use of combined oral contraceptives, gestational diabetes, and preterm birth; and less than 1.5-fold for polycystic ovary syndrome. The association for heart failure was fourfold for pre-eclampsia. No association was found between cardiovascular disease outcomes and current use of progesterone only contraceptives, use of non-oral hormonal contraceptive agents, or fertility treatment.

Conclusions From menarche to menopause, reproductive factors were associated with cardiovascular disease in women. In this review, presenting absolute numbers on the scale of the problem was not feasible; however, if these associations are causal, they could account for a large proportion of unexplained risk of cardiovascular disease in women, and the risk might be modifiable. Identifying reproductive risk factors at an early stage in the life of women might facilitate the initiation of strategies to modify potential risks. Policy makers should consider incorporating reproductive risk factors as part of the assessment of cardiovascular risk in clinical guidelines.

DOI: 10.1136/bmj.m3502

Source: https://www.bmj.com/content/371/bmj.m3502