Korean J Fam Pract 2020; 10(3): 182-191  https://doi.org/10.21215/kjfp.2020.10.3.182
Association between Reproductive Factors and Cardiovascular Disease Risk in Post-Menopausal Women: Cross-Sectional Study from the 2016–2017 Korea National Health and Nutrition Examination Survey
Jiyoun Kang, Jieun Kim, Nanie Yu, Heecheol Kang*
Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
Heecheol Kang
Tel: +82-2-2228-2332, Fax: +82-2-362-2473
E-mail: kanghc@yuhs.ac
ORCID: http://orcid.org/0000-0002-0309-7448
Received: August 22, 2019; Revised: February 26, 2020; Accepted: March 12, 2020; Published online: June 20, 2020.
© The Korean Academy of Family Medicine. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Reproductive factors such as childbirth, gravidity, age of menarche, breastfeeding, and use of oral contraceptives could affect the risk of cardiovascular disease in women. This study aimed to investigate the relationship between reproductive factors and cardiovascular disease in postmenopausal women in Korea.
Methods: This study included 2,310 women aged ≥45 years who experienced natural menopause and participated in the 7th Korea National Health and Nutrition Examination Survey (2016–2017). Cardiovascular disease was defined as myocardial infarction, angina, and stroke. Coronary heart disease was defined as myocardial infarction and angina. Logistic regression was performed to calculate the odds ratio of cardiovascular disease with respect to each reproductive factor.
Results: Women who breastfed for longer duration (≥24 months) group had a 3-fold higher risk of cardiovascular disease and 4–5-fold higher risk of coronary heart disease than those in the non-breastfeeding group. One-time pregnancy was associated with a higher risk of coronary heart disease than gravidity of 6. Early menarche (≤11 years of age) was associated with a high risk of stroke. Women who had a history of using oral contraceptives were at low risk of stroke.
Conclusion: Breastfeeding, low gravidity, and early menarche were associated with an increased risk of cardiovascular disease, whereas use of oral contraceptives was associated with reduced risk of stroke. However, some of these results were different from previous reports. Therefore, further studies are needed to identify the relationship between reproductive factors and cardiovascular disease in women.
Keywords: Cardiovascular Diseases; Reproduction; Postmenopause; Cross-Sectional Studies
References
  1. World Health Organization. Cardiovascular diseases (CVDs) [Internet]. Geneva: World Health Organization; 2017 [cited 2019 July 14].
    Available from: https://www.who.int/news-room/fact-sheets/detail/cardiovasculardiseases-(cvds)
  2. Statistics Korea. Causes of death statistics 2017 [Internet]. Daejeon: Statistics Korea; 2018 [cited 2019 July 14].
    Available from: https://meta.narastat.kr/metasvc/index.do?confmNo=101054&inputYear=2017
  3. Gallagher LG, Davis LB, Ray RM, Psaty BM, Gao DL, Checkoway H, et al. Reproductive history and mortality from cardiovascular disease among women textile workers in Shanghai, China. Int J Epidemiol 2011; 40: 1510-8.
    Pubmed KoreaMed CrossRef
  4. Merritt MA, Riboli E, Murphy N, Kadi M, Tjønneland A, Olsen A, et al. Reproductive factors and risk of mortality in the European Prospective Investigation into Cancer and Nutrition; a cohort study. BMC Med 2015; 13: 252.
    Pubmed KoreaMed CrossRef
  5. Parikh NI, Jeppson RP, Berger JS, Eaton CB, Kroenke CH, LeBlanc ES, et al. Reproductive risk factors and coronary heart disease in the Women’s Health Initiative Observational Study. Circulation 2016; 133: 2149-58.
    Pubmed KoreaMed CrossRef
  6. Canoy D, Beral V, Balkwill A, Wright FL, Kroll ME, Reeves GK, et al. Age at menarche and risks of coronary heart and other vascular diseases in a large UK cohort. Circulation 2015; 131: 237-44.
    Pubmed CrossRef
  7. Dekker JM, Schouten EG. Number of pregnancies and risk of cardiovascular disease. N Engl J Med 1993; 329: 1893-4; author reply 1894-5. Lawlor DA, Emberson JR, Ebrahim S, Whincup PH, Wannamethee SG, Walker M, et al. Is the association between parity and coronary heart disease due to biological effects of pregnancy or adverse lifestyle risk factors associated with child-rearing? Findings from the British Women’s Heart and Health Study and the British Regional Heart Study. Circulation 2003; 107:1260-4.
    Pubmed CrossRef
  8. Wang N, Qin MZ, Cui J. [Lipid profile comparison between pre- and postmenopausal women]. Zhonghua Xin Xue Guan Bing Za Zhi 2016; 44: 799-804. Chinese.
    Pubmed CrossRef
  9. Mesalić L, Tupković E, Kendić S, Balić D. Correlation between hormonal and lipid status in women in menopause. Bosn J Basic Med Sci 2008; 8: 188-92.
    Pubmed KoreaMed CrossRef
  10. Au Yeung SL, Jiang C, Cheng KK, Xu L, Zhang W, Lam TH, et al. Age at menarche and cardiovascular risk factors using Mendelian randomization in the Guangzhou Biobank Cohort Study. Prev Med 2017; 101: 142-8.
    Pubmed CrossRef
  11. Lakshman R, Forouhi NG, Sharp SJ, Luben R, Bingham SA, Khaw KT, et al. Early age at menarche associated with cardiovascular disease and mortality. J Clin Endocrinol Metab 2009; 94: 4953-60.
    Pubmed CrossRef
  12. Murakami K, Metoki H, Satoh M, Asayama K, Hosaka M, Matsuda A, et al. Menstrual factors and stroke incidence in Japanese postmenopausal women:the Ohasama Study. Neuroepidemiology 2016; 47: 109-16.
    Pubmed CrossRef
  13. Hsieh YC, Hwang LC, Hsieh FI, Lien LM, Lin HJ, Hu CJ, et al. Early menarche and ischemic stroke risk among postmenopausal women. Int J Gerontol 2010; 4: 16-22.
    CrossRef
  14. Bralić I, Tahirović H, Matanić D, Vrdoljak O, Stojanović-Spehar S, Kovacić V, et al. Association of early menarche age and overweight/obesity. J Pediatr Endocrinol Metab 2012; 25: 57-62.
    Pubmed CrossRef
  15. Koellhoffer EC, McCullough LD. The effects of estrogen in ischemic stroke. Transl Stroke Res 2013; 4: 390-401.
    Pubmed KoreaMed CrossRef
  16. Chang HS, Odongua N, Ohrr H, Sull JW, Nam CM. Reproductive risk factors for cardiovascular disease mortality among postmenopausal women in Korea: the Kangwha Cohort Study, 1985-2005. Menopause 2011; 18: 1205-12.
    Pubmed CrossRef
  17. Sim JH, Chung D, Lim JS, Lee MY, Chung CH, Shin JY, et al. Maternal age at first delivery is associated with the risk of metabolic syndrome in postmenopausal women: from 2008-2010 Korean National Health and Nutrition Examination Survey. PLoS One 2015; 10: e0127860.
    Pubmed KoreaMed CrossRef
  18. Nguyen B, Jin K, Ding D. Breastfeeding and maternal cardiovascular risk factors and outcomes: a systematic review. PLoS One 2017; 12: e0187923.
    Pubmed KoreaMed CrossRef
  19. Kirkegaard H, Bliddal M, Støvring H, Rasmussen KM, Gunderson EP, Køber L, et al. Breastfeeding and later maternal risk of hypertension and cardiovascular disease - the role of overall and abdominal obesity. Prev Med 2018; 114: 140-8.
    Pubmed CrossRef
  20. Zhang X, Shu XO, Gao YT, Yang G, Li H, Zheng W. Pregnancy, childrearing, and risk of stroke in Chinese women. Stroke 2009; 40: 2680-4.
    Pubmed KoreaMed CrossRef
  21. Zhang Y, Shen L, Wu J, Xu G, Song L, Yang S, et al. Parity and risk of stroke among Chinese women: cross-sectional evidence from the DongfengTongji Cohort Study. Sci Rep 2015; 5: 16992.
    Pubmed KoreaMed CrossRef
  22. Jacobsen BK, Knutsen SF, Oda K, Fraser GE. Parity and total, ischemic heart disease and stroke mortality. The Adventist Health Study, 1976-1988. Eur J Epidemiol 2011; 26: 711-8.
    Pubmed KoreaMed CrossRef
  23. Hannaford PC, Croft PR, Kay CR. Oral contraception and stroke. Evidence from the Royal College of General Practitioners’ Oral Contraception Study. Stroke 1994; 25: 935-42.
    Pubmed CrossRef
  24. Gerstman BB, Piper JM, Tomita DK, Ferguson WJ, Stadel BV, Lundin FE. Oral contraceptive estrogen dose and the risk of deep venous thromboembolic disease. Am J Epidemiol 1991; 133: 32-7.
    Pubmed CrossRef
  25. Zeitoun K, Carr BR. Is there an increased risk of stroke associated with oral contraceptives? Drug Saf 1999; 20: 467-73.
    Pubmed CrossRef
  26. Ciccone A, Melis M. Ischemic stroke risk in oral contraceptive users. Stroke 2003; 34: e231; author reply e231.
    Pubmed CrossRef
  27. Weill A, Dalichampt M, Raguideau F, Ricordeau P, Blotière PO, Rudant J, et al. Low dose oestrogen combined oral contraception and risk of pulmonary embolism, stroke, and myocardial infarction in five million French women:cohort study. BMJ 2016; 353: i2002.
    Pubmed KoreaMed CrossRef

This Article


Author ORCID Information

Services
Social Network Service

e-submission

Archives