Observational studyCirculation2016
Reproductive Risk Factors and Coronary Heart Disease in the Women's Health Initiative Observational Study.
Open access · bronzeAbstract readObservational Study
In one paragraph
Observational study in Circulation, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 81 papers, 4 of them syntheses that pooled it.
0numbers the graph read from it
0cells of the map it votes in
81citing papers in PubMed, 4 pooled it
10.4field-weighted citation impact, top 1% of its field
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
81 citing papers in PubMed, 4 syntheses or guidelines pooled it, 130 citations in OpenAlex.
- Female infertility and long-term cardiovascular risk: a systematic review and meta-analysis.Endocrine · 2026Pooled it
- Breastfeeding Is Associated With a Reduced Maternal Cardiovascular Risk: Systematic Review and Meta-Analysis Involving Data From 8 Studies and 1 192 700 Parous Women.Journal of the American Heart Association · 2022Pooled it
- Cardiovascular risk prediction models for women in the general population: A systematic review.PloS one · 2019Pooled it
- Age at first birth and risk of later-life cardiovascular disease: a systematic review of the literature, its limitation, and recommendations for future research.BMC public health · 2017Pooled it
- Impact of a moderate-intensity aerobic exercise intervention on systemic and uterine natural killer cells in women with unexplained recurrent pregnancy loss.Frontiers in immunology · 2025Trial
- History of infertility, risk of type 2 diabetes and HbADiabetologia · 2026Article
- Cardiac Biomarkers and Pregnancy-Associated Cardiovascular Disease.Current cardiology reports · 2026Review
- Adverse Pregnancy Outcomes and Health-Related Social Needs Among Parous Women.JAMA network open · 2026Article
- Spontaneous miscarriage and later lifestyle in predicting hazard of premature mortality: a cohort study in UK Biobank.Archives of gynecology and obstetrics · 2026Article
- Population attributable risk of traditional, under-recognised and female-specific factors for heart failure in women.Heart (British Cardiac Society) · 2026Article
- A Review of Traditional and Non-Traditional Cardiovascular Risk Factors in Women.International journal of women's health · 2026Review
- Cardiovascular risk prediction in women: rethinking traditional approaches through precision medicine.Frontiers in global women's health · 2026Review
- Plasma metabolomic signature of breastfeeding and risk of cardiometabolic diseases.Nature communications · 2025Article
- The value of pregnancy-related factors in the prediction of cardiovascular disease: a systematic review.International journal of cardiology. Cardiovascular risk and prevention · 2025Review
- Decoding the potential association of liver steatosis with female infertility: an analysis from NHANES 2013-2018.BMC public health · 2025Article
- Duration and intensity of lactation and maternal risk of subsequent incident coronary artery disease and stroke-a prospective cohort study.The American journal of clinical nutrition · 2025Article
- Sustained Reduction of Subclinical Inflammation in the Years After Breastfeeding.The Journal of clinical endocrinology and metabolism · 2025Article
- The association between reproductive factors and frailty risk: a population-based analysis from the UK biobank.BMC public health · 2025Article
- Article
- Lifestyle Habits and Risk of Cardiovascular Mortality in Menopausal Women with Cardiovascular Risk Factors: A Retrospective Cohort Study.Journal of cardiovascular development and disease · 2024Article
21 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
17 authors at 1 institution in 1 country.
Nisha I ParikhFrom Division of Cardiology, University of California San Francisco (N.I.P.); Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.J., K.K.R.); Cardiology, Hematology, Vascular Surgery, NYU School of Medicine, New York (J.S.B.); Departments of Family Medicine and Epidemiology, Brown University, Providence, RI (C.B.E., D.R.P.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Kaiser Permanente Center for Health Research, Portland, OR (E.S.L.); University of Alabama at Birmingham (C.E.L.); Department of Epidemiology, Brown University School of Public Health, Providence, RI (E.B.L.); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (D.R.P.); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (E.R.-S.); Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.E.W.); Department of Obstetrics and Gynecology, The University of Texas Health Science Center, San Antonio (R.S.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Unit for Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden (A.-K.E.-B.); Department of Family Medicine, USCD, La Jolla, CA (M.A.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); and Georgetown University Center for Clinical and Translational Science, Washington, DC (B.V.H.). parikh.nisha@gmail.com.
Rebecca P JeppsonFrom Division of Cardiology, University of California San Francisco (N.I.P.); Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.J., K.K.R.); Cardiology, Hematology, Vascular Surgery, NYU School of Medicine, New York (J.S.B.); Departments of Family Medicine and Epidemiology, Brown University, Providence, RI (C.B.E., D.R.P.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Kaiser Permanente Center for Health Research, Portland, OR (E.S.L.); University of Alabama at Birmingham (C.E.L.); Department of Epidemiology, Brown University School of Public Health, Providence, RI (E.B.L.); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (D.R.P.); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (E.R.-S.); Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.E.W.); Department of Obstetrics and Gynecology, The University of Texas Health Science Center, San Antonio (R.S.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Unit for Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden (A.-K.E.-B.); Department of Family Medicine, USCD, La Jolla, CA (M.A.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); and Georgetown University Center for Clinical and Translational Science, Washington, DC (B.V.H.).
Jeffrey S BergerFrom Division of Cardiology, University of California San Francisco (N.I.P.); Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.J., K.K.R.); Cardiology, Hematology, Vascular Surgery, NYU School of Medicine, New York (J.S.B.); Departments of Family Medicine and Epidemiology, Brown University, Providence, RI (C.B.E., D.R.P.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Kaiser Permanente Center for Health Research, Portland, OR (E.S.L.); University of Alabama at Birmingham (C.E.L.); Department of Epidemiology, Brown University School of Public Health, Providence, RI (E.B.L.); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (D.R.P.); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (E.R.-S.); Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.E.W.); Department of Obstetrics and Gynecology, The University of Texas Health Science Center, San Antonio (R.S.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Unit for Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden (A.-K.E.-B.); Department of Family Medicine, USCD, La Jolla, CA (M.A.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); and Georgetown University Center for Clinical and Translational Science, Washington, DC (B.V.H.).
Charles B EatonFrom Division of Cardiology, University of California San Francisco (N.I.P.); Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.J., K.K.R.); Cardiology, Hematology, Vascular Surgery, NYU School of Medicine, New York (J.S.B.); Departments of Family Medicine and Epidemiology, Brown University, Providence, RI (C.B.E., D.R.P.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Kaiser Permanente Center for Health Research, Portland, OR (E.S.L.); University of Alabama at Birmingham (C.E.L.); Department of Epidemiology, Brown University School of Public Health, Providence, RI (E.B.L.); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (D.R.P.); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (E.R.-S.); Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.E.W.); Department of Obstetrics and Gynecology, The University of Texas Health Science Center, San Antonio (R.S.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Unit for Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden (A.-K.E.-B.); Department of Family Medicine, USCD, La Jolla, CA (M.A.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); and Georgetown University Center for Clinical and Translational Science, Washington, DC (B.V.H.).
Candyce H KroenkeFrom Division of Cardiology, University of California San Francisco (N.I.P.); Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.J., K.K.R.); Cardiology, Hematology, Vascular Surgery, NYU School of Medicine, New York (J.S.B.); Departments of Family Medicine and Epidemiology, Brown University, Providence, RI (C.B.E., D.R.P.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Kaiser Permanente Center for Health Research, Portland, OR (E.S.L.); University of Alabama at Birmingham (C.E.L.); Department of Epidemiology, Brown University School of Public Health, Providence, RI (E.B.L.); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (D.R.P.); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (E.R.-S.); Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.E.W.); Department of Obstetrics and Gynecology, The University of Texas Health Science Center, San Antonio (R.S.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Unit for Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden (A.-K.E.-B.); Department of Family Medicine, USCD, La Jolla, CA (M.A.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); and Georgetown University Center for Clinical and Translational Science, Washington, DC (B.V.H.).
Erin S LeBlancFrom Division of Cardiology, University of California San Francisco (N.I.P.); Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.J., K.K.R.); Cardiology, Hematology, Vascular Surgery, NYU School of Medicine, New York (J.S.B.); Departments of Family Medicine and Epidemiology, Brown University, Providence, RI (C.B.E., D.R.P.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Kaiser Permanente Center for Health Research, Portland, OR (E.S.L.); University of Alabama at Birmingham (C.E.L.); Department of Epidemiology, Brown University School of Public Health, Providence, RI (E.B.L.); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (D.R.P.); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (E.R.-S.); Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.E.W.); Department of Obstetrics and Gynecology, The University of Texas Health Science Center, San Antonio (R.S.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Unit for Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden (A.-K.E.-B.); Department of Family Medicine, USCD, La Jolla, CA (M.A.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); and Georgetown University Center for Clinical and Translational Science, Washington, DC (B.V.H.).
Cora E LewisFrom Division of Cardiology, University of California San Francisco (N.I.P.); Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.J., K.K.R.); Cardiology, Hematology, Vascular Surgery, NYU School of Medicine, New York (J.S.B.); Departments of Family Medicine and Epidemiology, Brown University, Providence, RI (C.B.E., D.R.P.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Kaiser Permanente Center for Health Research, Portland, OR (E.S.L.); University of Alabama at Birmingham (C.E.L.); Department of Epidemiology, Brown University School of Public Health, Providence, RI (E.B.L.); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (D.R.P.); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (E.R.-S.); Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.E.W.); Department of Obstetrics and Gynecology, The University of Texas Health Science Center, San Antonio (R.S.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Unit for Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden (A.-K.E.-B.); Department of Family Medicine, USCD, La Jolla, CA (M.A.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); and Georgetown University Center for Clinical and Translational Science, Washington, DC (B.V.H.).
Eric B LoucksFrom Division of Cardiology, University of California San Francisco (N.I.P.); Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.J., K.K.R.); Cardiology, Hematology, Vascular Surgery, NYU School of Medicine, New York (J.S.B.); Departments of Family Medicine and Epidemiology, Brown University, Providence, RI (C.B.E., D.R.P.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Kaiser Permanente Center for Health Research, Portland, OR (E.S.L.); University of Alabama at Birmingham (C.E.L.); Department of Epidemiology, Brown University School of Public Health, Providence, RI (E.B.L.); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (D.R.P.); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (E.R.-S.); Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.E.W.); Department of Obstetrics and Gynecology, The University of Texas Health Science Center, San Antonio (R.S.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Unit for Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden (A.-K.E.-B.); Department of Family Medicine, USCD, La Jolla, CA (M.A.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); and Georgetown University Center for Clinical and Translational Science, Washington, DC (B.V.H.).
Donna R ParkerFrom Division of Cardiology, University of California San Francisco (N.I.P.); Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.J., K.K.R.); Cardiology, Hematology, Vascular Surgery, NYU School of Medicine, New York (J.S.B.); Departments of Family Medicine and Epidemiology, Brown University, Providence, RI (C.B.E., D.R.P.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Kaiser Permanente Center for Health Research, Portland, OR (E.S.L.); University of Alabama at Birmingham (C.E.L.); Department of Epidemiology, Brown University School of Public Health, Providence, RI (E.B.L.); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (D.R.P.); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (E.R.-S.); Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.E.W.); Department of Obstetrics and Gynecology, The University of Texas Health Science Center, San Antonio (R.S.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Unit for Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden (A.-K.E.-B.); Department of Family Medicine, USCD, La Jolla, CA (M.A.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); and Georgetown University Center for Clinical and Translational Science, Washington, DC (B.V.H.).
Eileen Rillamas-SunFrom Division of Cardiology, University of California San Francisco (N.I.P.); Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.J., K.K.R.); Cardiology, Hematology, Vascular Surgery, NYU School of Medicine, New York (J.S.B.); Departments of Family Medicine and Epidemiology, Brown University, Providence, RI (C.B.E., D.R.P.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Kaiser Permanente Center for Health Research, Portland, OR (E.S.L.); University of Alabama at Birmingham (C.E.L.); Department of Epidemiology, Brown University School of Public Health, Providence, RI (E.B.L.); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (D.R.P.); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (E.R.-S.); Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.E.W.); Department of Obstetrics and Gynecology, The University of Texas Health Science Center, San Antonio (R.S.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Unit for Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden (A.-K.E.-B.); Department of Family Medicine, USCD, La Jolla, CA (M.A.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); and Georgetown University Center for Clinical and Translational Science, Washington, DC (B.V.H.).
Kelli K RyckmanFrom Division of Cardiology, University of California San Francisco (N.I.P.); Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.J., K.K.R.); Cardiology, Hematology, Vascular Surgery, NYU School of Medicine, New York (J.S.B.); Departments of Family Medicine and Epidemiology, Brown University, Providence, RI (C.B.E., D.R.P.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Kaiser Permanente Center for Health Research, Portland, OR (E.S.L.); University of Alabama at Birmingham (C.E.L.); Department of Epidemiology, Brown University School of Public Health, Providence, RI (E.B.L.); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (D.R.P.); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (E.R.-S.); Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.E.W.); Department of Obstetrics and Gynecology, The University of Texas Health Science Center, San Antonio (R.S.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Unit for Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden (A.-K.E.-B.); Department of Family Medicine, USCD, La Jolla, CA (M.A.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); and Georgetown University Center for Clinical and Translational Science, Washington, DC (B.V.H.).
Molly E WaringFrom Division of Cardiology, University of California San Francisco (N.I.P.); Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.J., K.K.R.); Cardiology, Hematology, Vascular Surgery, NYU School of Medicine, New York (J.S.B.); Departments of Family Medicine and Epidemiology, Brown University, Providence, RI (C.B.E., D.R.P.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Kaiser Permanente Center for Health Research, Portland, OR (E.S.L.); University of Alabama at Birmingham (C.E.L.); Department of Epidemiology, Brown University School of Public Health, Providence, RI (E.B.L.); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (D.R.P.); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (E.R.-S.); Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.E.W.); Department of Obstetrics and Gynecology, The University of Texas Health Science Center, San Antonio (R.S.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Unit for Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden (A.-K.E.-B.); Department of Family Medicine, USCD, La Jolla, CA (M.A.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); and Georgetown University Center for Clinical and Translational Science, Washington, DC (B.V.H.).
Robert S SchenkenFrom Division of Cardiology, University of California San Francisco (N.I.P.); Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.J., K.K.R.); Cardiology, Hematology, Vascular Surgery, NYU School of Medicine, New York (J.S.B.); Departments of Family Medicine and Epidemiology, Brown University, Providence, RI (C.B.E., D.R.P.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Kaiser Permanente Center for Health Research, Portland, OR (E.S.L.); University of Alabama at Birmingham (C.E.L.); Department of Epidemiology, Brown University School of Public Health, Providence, RI (E.B.L.); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (D.R.P.); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (E.R.-S.); Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.E.W.); Department of Obstetrics and Gynecology, The University of Texas Health Science Center, San Antonio (R.S.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Unit for Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden (A.-K.E.-B.); Department of Family Medicine, USCD, La Jolla, CA (M.A.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); and Georgetown University Center for Clinical and Translational Science, Washington, DC (B.V.H.).
Karen C JohnsonFrom Division of Cardiology, University of California San Francisco (N.I.P.); Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.J., K.K.R.); Cardiology, Hematology, Vascular Surgery, NYU School of Medicine, New York (J.S.B.); Departments of Family Medicine and Epidemiology, Brown University, Providence, RI (C.B.E., D.R.P.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Kaiser Permanente Center for Health Research, Portland, OR (E.S.L.); University of Alabama at Birmingham (C.E.L.); Department of Epidemiology, Brown University School of Public Health, Providence, RI (E.B.L.); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (D.R.P.); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (E.R.-S.); Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.E.W.); Department of Obstetrics and Gynecology, The University of Texas Health Science Center, San Antonio (R.S.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Unit for Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden (A.-K.E.-B.); Department of Family Medicine, USCD, La Jolla, CA (M.A.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); and Georgetown University Center for Clinical and Translational Science, Washington, DC (B.V.H.).
Anna-Karin Edstedt-BonamyFrom Division of Cardiology, University of California San Francisco (N.I.P.); Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.J., K.K.R.); Cardiology, Hematology, Vascular Surgery, NYU School of Medicine, New York (J.S.B.); Departments of Family Medicine and Epidemiology, Brown University, Providence, RI (C.B.E., D.R.P.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Kaiser Permanente Center for Health Research, Portland, OR (E.S.L.); University of Alabama at Birmingham (C.E.L.); Department of Epidemiology, Brown University School of Public Health, Providence, RI (E.B.L.); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (D.R.P.); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (E.R.-S.); Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.E.W.); Department of Obstetrics and Gynecology, The University of Texas Health Science Center, San Antonio (R.S.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Unit for Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden (A.-K.E.-B.); Department of Family Medicine, USCD, La Jolla, CA (M.A.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); and Georgetown University Center for Clinical and Translational Science, Washington, DC (B.V.H.).
Matthew A AllisonFrom Division of Cardiology, University of California San Francisco (N.I.P.); Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.J., K.K.R.); Cardiology, Hematology, Vascular Surgery, NYU School of Medicine, New York (J.S.B.); Departments of Family Medicine and Epidemiology, Brown University, Providence, RI (C.B.E., D.R.P.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Kaiser Permanente Center for Health Research, Portland, OR (E.S.L.); University of Alabama at Birmingham (C.E.L.); Department of Epidemiology, Brown University School of Public Health, Providence, RI (E.B.L.); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (D.R.P.); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (E.R.-S.); Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.E.W.); Department of Obstetrics and Gynecology, The University of Texas Health Science Center, San Antonio (R.S.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Unit for Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden (A.-K.E.-B.); Department of Family Medicine, USCD, La Jolla, CA (M.A.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); and Georgetown University Center for Clinical and Translational Science, Washington, DC (B.V.H.).
Barbara V HowardFrom Division of Cardiology, University of California San Francisco (N.I.P.); Fred Hutchinson Cancer Research Center, Seattle, WA (R.P.J., K.K.R.); Cardiology, Hematology, Vascular Surgery, NYU School of Medicine, New York (J.S.B.); Departments of Family Medicine and Epidemiology, Brown University, Providence, RI (C.B.E., D.R.P.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Kaiser Permanente Center for Health Research, Portland, OR (E.S.L.); University of Alabama at Birmingham (C.E.L.); Department of Epidemiology, Brown University School of Public Health, Providence, RI (E.B.L.); Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket (D.R.P.); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (E.R.-S.); Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.E.W.); Department of Obstetrics and Gynecology, The University of Texas Health Science Center, San Antonio (R.S.S.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Unit for Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden (A.-K.E.-B.); Department of Family Medicine, USCD, La Jolla, CA (M.A.A.); MedStar Health Research Institute, Hyattsville, MD (B.V.H.); and Georgetown University Center for Clinical and Translational Science, Washington, DC (B.V.H.).
Kaiser Permanente · US
Funding
University of Massachusetts Center for Clinical Science and Translational SupplementUL1TR001453 · NCATS · UNIV OF MASSACHUSETTS MED SCH WORCESTER · PI LUZURIAGA, KATHERINE F · 2015 to 2024
$39.0MMaternal Morbidity and Mortality: Risk Factors, Early Detection and Personalized InterventionUL1TR001409 · NCATS · GEORGETOWN UNIVERSITY · PI GONDRE-LEWIS, MARJORIE C, MELLMAN, THOMAS A · 2015 to 2024
$37.8MRESEARCH DESIGN AND BIOSTATISTICS COREU54MD007584 · NIMHD · UNIVERSITY OF HAWAII AT MANOA · PI HEDGES, JERRIS ROBERT, MOKUAU, NOREEN · 2012 to 2018
$21.1MUniversity of Alabama at Birmingham's Diabetes Research CenterP30DK079626 · NIDDK · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI W Timothy GARVEY · 2013 to 2026
$19.5MTRACE-COREU01HL105268 · NHLBI · UNIV OF MASSACHUSETTS MED SCH WORCESTER · PI KIEFE, CATARINA I. · 2010 to 2013
$5.8MUniversity of Massachusetts Center for Clinical and Translational ScienceKL2TR000160 · NCATS · UNIV OF MASSACHUSETTS MED SCH WORCESTER · PI LUZURIAGA, KATHERINE F · 2012 to 2014
$1.7MPregnancy complications, future cardiovascular disease risk factors and cardiovasR21HL115398 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI PARIKH, NISHA INDRAVADAN · 2013 to 2014
$446kAmerican Heart Association-American Stroke AssociationNCATS NIH HHS KL2 TR000160NCATS NIH HHS UL1 TR001409NCATS NIH HHS UL1 TR001453NHLBI NIH HHS HHSN268201100001INHLBI NIH HHS HHSN268201100002INHLBI NIH HHS HHSN268201100003INHLBI NIH HHS HHSN268201100004INHLBI NIH HHS HHSN268201100046CNHLBI NIH HHS L30 HL097670NHLBI NIH HHS R21 HL115398NHLBI NIH HHS U01 HL105268NIDDK NIH HHS P30 DK079626NIMHD NIH HHS U54 MD007584WHI NIH HHS HHSN268201100001CWHI NIH HHS HHSN268201100002CWHI NIH HHS HHSN268201100003CWHI NIH HHS HHSN268201100004C
Abstract
backgroundReproductive factors provide an early window into a woman's coronary heart disease (CHD) risk; however, their contribution to CHD risk stratification is uncertain. METHODS AND
resultsIn the Women's Health Initiative Observational Study, we constructed Cox proportional hazards models for CHD including age, pregnancy status, number of live births, age at menarche, menstrual irregularity, age at first birth, stillbirths, miscarriages, infertility ≥1 year, infertility cause, and breastfeeding. We next added each candidate reproductive factor to an established CHD risk factor model. A final model was then constructed with significant reproductive factors added to established CHD risk factors. Improvement in C statistic, net reclassification index (or net reclassification index with risk categories of <5%, 5 to <10%, and ≥10% 10-year risk of CHD), and integrated discriminatory index were assessed. Among 72 982 women (CHD events, n=4607; median follow-up,12.0 [interquartile range, 8.3-13.7] years; mean [standard deviation] age, 63.2 [7.2] years), an age-adjusted reproductive risk factor model had a C statistic of 0.675 for CHD. In a model adjusted for established CHD risk factors, younger age at first birth, number of still births, number of miscarriages, and lack of breastfeeding were positively associated with CHD. Reproductive factors modestly improved model discrimination (C statistic increased from 0.726 to 0.730; integrated discriminatory index, 0.0013; P<0.0001). Net reclassification for women with events was not improved (net reclassification index events, 0.007; P=0.18); and, for women without events, net reclassification was marginally improved (net reclassification index nonevents, 0.002; P=0.04)
conclusionsKey reproductive factors are associated with CHD independently of established CHD risk factors, very modestly improve model discrimination, and do not materially improve net reclassification.
Indexed as
Pregnancy RateReproductionWomen's HealthAdultAgedCoronary Artery DiseaseFemaleHumansLongitudinal StudiesMiddle AgedPregnancyRisk FactorsYoung Adultcoronary diseasereproductive historyrisk adjustmentspontaneous abortionwomen
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