A study of reproductive factors in Indian women predisposing to coronary artery disease in later life

Abstract

Background: Reproductive factors in women may predispose to coronary artery disease (CAD) in later life. However, the evidence is meager and varying in response. If the appropriate factors are identified, it would enable much earlier and more aggressive risk factor modification as reproductive factors can be ascertained much earlier than traditional risk factors for CAD. The study aims to evaluate the reproductive factors in women which contribute to CAD in later life. Materials and Method: This is a retrospective study of 500 women. Reproductive factors including pregnancy details and lactation were assessed. The study population was divided into two groups depending on the presence and absence of CAD and reproductive factors compared using MINITAB version 17. Results: The CAD group was a decade older with a significant history of hypertension (P = 0.003) and diabetes (P = 0.02). Age of menarche was earlier in the CAD group (12.74 ± 1.29 years vs. 13.18 ± 1.43 years; P = 0.00) with statistically significant occurrence of early menarche, i.e., ≤12 years (46.8% vs. 33.6%; P = 0.002; risk ratio [RR] = 1.31; odds ratio [OR] = 1.74; 95% confidence interval = 1.1–1.56). Age at first pregnancy was significantly earlier in the CAD group (18.74 ± 2.94 years vs. 19.41 ± 3.36 years; P = 0.018), but early pregnancy (≤18 years) was not statistically significant (34.8% vs. 30.8%; P = 0.34). The CAD group had a higher order of parity (3.12 ± 1.49 vs. 2.67 ± 1.21; P = 0.000), but multiparity (>3 paras) was not significant. History of pregnancy complication (54% vs. 20.8%; P = 0.00; RR = 5.38, OR = 7.67) and pregnancy loss (44.4% vs. 16.4%; P = 0.00; RR = 2.71; OR = 4.07) were significantly higher in the CAD group. The average age of menopause was significantly earlier in CAD (44.25 ± 7.35 years vs. 46.16 ± 6.32 years; P = 0.006), and early menopause (≤45 years) was of borderline significance (P = 0.06; RR = 1.93; OR = 5.08). Breastfeeding did not have any impact. Conclusion: Early menarche, pregnancy complication, and pregnancy loss are associated with CAD in later life. Early menopause irrespective of whether natural or surgical also predisposed to CAD. Age of first pregnancy was earlier and order of parity was higher in the CAD group, but no definite relation between early pregnancy and multiparity with CAD could be established. Intake of hormonal therapy for menstrual irregularity, late menarche and breast feeding did not predispose to CAD.