Advertisement
Canadian Journal of Cardiology

Paring It Down: Parity, Sex Hormones, and Cardiovascular Risk

  • Nabilah Gulamhusein
    Affiliations
    Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

    Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
    Search for articles by this author
  • Sandra M. Dumanski
    Affiliations
    Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

    Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada

    O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
    Search for articles by this author
  • Sofia B. Ahmed
    Correspondence
    Corresponding author: Dr Sofia B. Ahmed, 3230 Hospital Drive NW, Rm 2AC70, Calgary, Alberta T2N 4Z6, Canada. Tel.: +1-403-220-2550; fax: +1-403-210-6660.
    Affiliations
    Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

    Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada

    O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
    Search for articles by this author
Published:October 08, 2022DOI:https://doi.org/10.1016/j.cjca.2022.10.003
      Cardiovascular disease (CVD) is the leading cause of death in women,
      • Vogel B.
      • Acevedo M.
      • Appelman Y.
      • et al.
      The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030.
      prompting examination of female sex–specific factors as potential contributors to cardiovascular risk. Complications of pregnancy, including hypertensive disorders of pregnancy, gestational diabetes, preterm birth, small for gestational age, and pregnancy loss, have been shown to be important markers of future CVD. Studies have suggested that the physiologic stress of pregnancy can unveil existing subclinical CVD,
      • Sanghavi M.
      • Rutherford J.D.
      Cardiovascular physiology of pregnancy.
      while other reports suggest that complications of pregnancy are contributors to increased risk of future CVD.
      • Sanghavi M.
      • Parikh N.I.
      Harnessing the power of pregnancy and pregnancy-related events to predict cardiovascular disease in women.
      However, whether pregnancy itself or the number of times an individual has been pregnant is associated with cardiovascular risk is less clear, although previous reports have suggested that multiparity is associated with greater CVD and mortality.
      • Lv H.
      • Wu H.
      • Yin J.
      • Qian J.
      • Ge J.
      Parity and cardiovascular disease mortality: a dose-response meta-analysis of cohort studies.
      Previous work has suggested that a more androgenic sex hormone profile is associated with increased CVD.
      • Zhao D.
      • Guallar E.
      • Ouyang P.
      • et al.
      Endogenous sex hormones and incident cardiovascular disease in post-menopausal women.
      Given the sex hormone–related changes of pregnancy, examining the association between multiparity and sex hormone profile in later life may shed light on a potential mechanism of increased cardiovascular risk in the female population.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Canadian Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Vogel B.
        • Acevedo M.
        • Appelman Y.
        • et al.
        The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030.
        Lancet. 2021; 397: 2385-2438
        • Sanghavi M.
        • Rutherford J.D.
        Cardiovascular physiology of pregnancy.
        Circulation. 2014; 130: 1003-1008
        • Sanghavi M.
        • Parikh N.I.
        Harnessing the power of pregnancy and pregnancy-related events to predict cardiovascular disease in women.
        Circulation. 2017; 135: 590-592
        • Lv H.
        • Wu H.
        • Yin J.
        • Qian J.
        • Ge J.
        Parity and cardiovascular disease mortality: a dose-response meta-analysis of cohort studies.
        Sci Rep. 2015; 513411
        • Zhao D.
        • Guallar E.
        • Ouyang P.
        • et al.
        Endogenous sex hormones and incident cardiovascular disease in post-menopausal women.
        J Am Coll Cardiol. 2018; 71: 2555-2566
        • Kazzi B.
        • Ogunmoroti O.
        • Rodriguez C.P.
        • et al.
        Parity history and later life sex hormone levels in the Multi-Ethnic Study of Atherosclerosis (MESA).
        Can J Cardiol. 2022; (XX:XXX-X)
        • Kalenga C.Z.
        • Dumanski S.M.
        • Metcalfe A.
        • et al.
        The effect of non-oral hormonal contraceptives on hypertension and blood pressure: a systematic review and meta-analysis.
        Physiol Rep. 2022; 10e15267
        • Roach R.E.
        • Helmerhorst F.M.
        • Lijfering W.M.
        • et al.
        Combined oral contraceptives: the risk of myocardial infarction and ischemic stroke.
        Cochrane Database Syst Rev. 2015; : CD011054
        • Dumanski S.M.
        • Anderson T.J.
        • Nerenberg K.A.
        • et al.
        Anti-müllerian hormone and vascular dysfunction in women with chronic kidney disease.
        Physiol Rep. 2022; 10e15154
        • Mishra S.R.
        • Chung H.F.
        • Waller M.
        • et al.
        Association between reproductive life span and incident nonfatal cardiovascular disease: a pooled analysis of individual patient data from 12 studies.
        JAMA Cardiol. 2020; 5: 1410-1418
        • Rexrode K.M.
        • Manson J.E.
        • Lee I.M.
        • et al.
        Sex hormone levels and risk of cardiovascular events in postmenopausal women.
        Circulation. 2003; 108: 1688-1693
        • Benn M.
        • Voss S.S.
        • Holmegard H.N.
        • et al.
        Extreme concentrations of endogenous sex hormones, ischemic heart disease, and death in women.
        Arterioscler Thromb Vasc Biol. 2015; 35: 471-477
        • Laughlin G.A.
        • Goodell V.
        • Barrett-Connor E.
        Extremes of endogenous testosterone are associated with increased risk of incident coronary events in older women.
        J Clin Endocrinol Metab. 2010; 95: 740-747
        • Sievers C.
        • Klotsche J.
        • Pieper L.
        • et al.
        Low testosterone levels predict all-cause mortality and cardiovascular events in women: a prospective cohort study in German primary care patients.
        Eur J Endocrinol. 2010; 163: 699-708
        • Barrett-Connor E.
        • Goodman-Gruen D.
        Prospective study of endogenous sex hormones and fatal cardiovascular disease in postmenopausal women.
        BMJ. 1995; 311: 1193-1196
        • Ramesh S.
        • James M.T.
        • Holroyd-Leduc J.M.
        • et al.
        Estradiol and mortality in women with end-stage kidney disease.
        Nephrol Dial Transplant. 2020; 35: 1965-1972
        • Iorga A.
        • Cunningham C.M.
        • Moazeni S.
        • et al.
        The protective role of estrogen and estrogen receptors in cardiovascular disease and the controversial use of estrogen therapy.
        Biol Sex Differ. 2017; 8: 33
        • Mishra S.R.
        • Chung H.F.
        • Waller M.
        • Mishra G.D.
        Duration of estrogen exposure during reproductive years, age at menarche and age at menopause, and risk of cardiovascular disease events, all-cause and cardiovascular mortality: a systematic review and meta-analysis.
        BJOG. 2021; 128: 809-821
        • Crandall C.J.
        • Barrett-Connor E.
        Endogenous sex steroid levels and cardiovascular disease in relation to the menopause: a systematic review.
        Endocrinol Metab Clin North Am. 2013; 42: 227-253
        • Rossouw J.E.
        • Anderson G.L.
        • Prentice R.L.
        • et al.
        Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women‘s Health Initiative randomized controlled trial.
        JAMA. 2002; 288: 321-333
        • Shufelt C.
        • Waldman T.
        • Wang E.
        • Merz C.N.
        Female-specific factors for IHD: across the reproductive lifespan.
        Curr Atheroscler Rep. 2015; 17: 481
        • Stone T.
        • Stachenfeld N.S.
        Pathophysiological effects of androgens on the female vascular system.
        Biol Sex Differ. 2020; 11: 45
        • Davis S.R.
        • Wahlin-Jacobsen S.
        Testosterone in women—the clinical significance.
        Lancet Diabetes Endocrinol. 2015; 3: 980-992
        • Oliver-Williams C.
        • Vladutiu C.J.
        • Loehr L.R.
        • Rosamond W.D.
        • Stuebe A.M.
        The association between parity and subsequent cardiovascular disease in women: the Atherosclerosis Risk in Communities Study.
        J Womens Health (Larchmt). 2019; 28: 721-727
        • O‘Leary P.
        • Boyne P.
        • Flett P.
        • Beilby J.
        • James I.
        Longitudinal assessment of changes in reproductive hormones during normal pregnancy.
        Clin Chem. 1991; 37: 667-672
        • Kallak T.K.
        • Hellgren C.
        • Skalkidou A.
        • et al.
        Maternal and female fetal testosterone levels are associated with maternal age and gestational weight gain.
        Eur J Endocrinol. 2017; 177: 379-388
        • Berggren E.K.
        • Groh-Wargo S.
        • Presley L.
        • Hauguel-de Mouzon S.
        • Catalano P.M.
        Maternal fat, but not lean, mass is increased among overweight/obese women with excess gestational weight gain.
        Am J Obstet Gynecol. 2016; 214 (e741-745): 745
        • Hutchins F.
        • El Khoudary S.R.
        • Catov J.
        • et al.
        Excessive gestational weight gain and long-term maternal cardiovascular risk profile: the Study of Women‘s Health Across the Nation.
        J Womens Health (Larchmt). 2022; 31: 808-818
        • Handelsman D.J.
        • Sikaris K.
        • Ly L.P.
        Estimating age-specific trends in circulating testosterone and sex hormone-binding globulin in males and females across the lifespan.
        Ann Clin Biochem. 2016; 53: 377-384
        • Loh N.Y.
        • Humphreys E.
        • Karpe F.
        • et al.
        Sex hormones, adiposity, and metabolic traits in men and women: a mendelian randomisation study.
        Eur J Endocrinol. 2022; 186: 407-416
        • Sathishkumar K.
        • Balakrishnan M.
        • Chinnathambi V.
        • et al.
        Fetal sex-related dysregulation in testosterone production and their receptor expression in the human placenta with preeclampsia.
        J Perinatol. 2012; 32: 328-335

      Linked Article