Advertisement

Reproductive factors and its association with peripheral arterial disease in women aged 52–81 years: The KORA F4 study

  • Doris Stöckl
    Correspondence
    Corresponding author. Institute of Epidemiology II, Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany. Tel.: +49 89 3187 4153; fax: +49 89 3187 3667.
    Affiliations
    Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany

    Department of Obstetrics and Gynaecology, Campus Grosshadern, Ludwig-Maximilians-University, Munich, Germany
    Search for articles by this author
  • Angela Döring
    Affiliations
    Institute of Epidemiology I, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
    Search for articles by this author
  • Barbara Thorand
    Affiliations
    Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
    Search for articles by this author
  • Margit Heier
    Affiliations
    Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany

    Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Augsburg, Germany
    Search for articles by this author
  • Annette Peters
    Affiliations
    Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
    Search for articles by this author
  • Claudia Lamina
    Affiliations
    Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Innsbruck Medical University, Innsbruck, Austria
    Search for articles by this author
  • Florian Kronenberg
    Affiliations
    Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Innsbruck Medical University, Innsbruck, Austria
    Search for articles by this author
  • Christa Meisinger
    Affiliations
    Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany

    Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Augsburg, Germany
    Search for articles by this author

      Abstract

      Objective

      Sex differences in the onset of cardiovascular disease disappear in the postmenopause, suggesting that reproductive factors could be influential. The aim of the present study was to examine the possible association between reproductive parameters and peripheral arterial disease (PAD) in a female population-based sample.

      Methods

      In this cross-sectional study data of 887 women aged 52–81 years participating in the population-based KORA F4 study (conducted in 2006–2008) was analyzed. Reproductive parameters were obtained by standardized interviews. PAD was assessed by measuring noninvasively the ankle-brachial index and using a cut-off value of 0.9 and by assessing the presence of claudication by the Edinburgh questionnaire.

      Results

      In multivariable logistic regression analyses later age at menarche (>15 years) compared to age at menarche between 12 and 15 years was significantly associated with about half the probability for PAD (OR = 0.48; 95%CI 0.24–0.98). The presence of hot flashes was positively associated with PAD (OR = 2.09; 95%CI 1.11–3.92). Further reproductive parameters, such as parity, age at menopause, time since menopause, duration of fertility, ever use or current use of hormone replacement therapy, ever use of oral contraceptives, history of hysterectomy, bilateral oophorectomy and depressive mood in relation to menopausal transition showed no significant association with PAD.

      Conclusions

      Later age at menarche was inversely related to PAD and the presence of hot flashes was associated with an increased presence of PAD. Prospective population-based studies in women are needed to assess the impact of reproductive parameters on the development of PAD and subsequently cardiovascular disease.

      Highlights

      • Women from the population with symptomatic or asymptomatic peripheral arterial disease.
      • Later age at menarche was inversely related to peripheral arterial disease.
      • The presence of hot flashes was associated with an increased presence of peripheral arterial disease.

      Keywords

      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 Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Lamina C.
        • Meisinger C.
        • Heid I.M.
        • et al.
        Association of ankle-brachial index and plaques in the carotid and femoral arteries with cardiovascular events and total mortality in a population-based study with 13 years of follow-up.
        European Heart Journal. 2006; 27: 2580-2587
        • Gerhard M.
        • Baum P.
        • Raby K.E.
        Peripheral arterial-vascular disease in women: prevalence, prognosis, and treatment.
        Cardiology. 1995; 86: 349-355
        • Hirsch A.T.
        • Allison M.A.
        • Gomes A.S.
        • et al.
        A call to action: women and peripheral artery disease: a scientific statement from the American Heart Association.
        Circulation. 2012; 125: 1449-1472
        • Stöckl D.
        • Döring A.
        • Peters A.
        • et al.
        Age at menarche is associated with prediabetes and diabetes in women (aged 32-81 years) from the general population: the KORA F4 study.
        Diabetologia. 2012; 55: 681-688
        • Stöckl D.
        • Meisinger C.
        • Peters A.
        • et al.
        Age at menarche and its association with the metabolic syndrome and its components: results from the KORA F4 study.
        PloS One. 2011; 6: e26076
        • Lakshman R.
        • Forouhi N.G.
        • Sharp S.J.
        • et al.
        Early age at menarche associated with cardiovascular disease and mortality.
        The Journal of Clinical Endocrinology and Metabolism. 2009; 94: 4953-4960
        • Parikh N.I.
        • Cnattingius S.
        • Dickman P.W.
        • Mittleman M.A.
        • Ludvigsson J.F.
        • Ingelsson E.
        Parity and risk of later-life maternal cardiovascular disease.
        American Heart Journal. 2010; 159: e216
        • Cohen A.
        • Pieper C.F.
        • Brown A.J.
        • Bastian L.A.
        Number of children and risk of metabolic syndrome in women.
        Journal of Women's Health (Larchmt). 2006; 15: 763-773
        • Gunderson E.P.
        • Jacobs Jr., D.R.
        • Chiang V.
        • et al.
        Childbearing is associated with higher incidence of the metabolic syndrome among women of reproductive age controlling for measurements before pregnancy: the CARDIA study.
        American Journal of Obstetrics and Gynecology. 2009; 201: e171-179
        • Mesch V.R.
        • Boero L.E.
        • Siseles N.O.
        • et al.
        Metabolic syndrome throughout the menopausal transition: influence of age and menopausal status.
        Climacteric. 2006; 9: 40-48
        • Thurston R.C.
        • Sutton-Tyrrell K.
        • Everson-Rose S.A.
        • Hess R.
        • Matthews K.A.
        Hot flashes and subclinical cardiovascular disease: findings from the study of women's health across the Nation Heart Study.
        Circulation. 2008; 118: 1234-1240
        • Thurston R.C.
        • Sutton-Tyrrell K.
        • Everson-Rose S.A.
        • Hess R.
        • Powell L.H.
        • Matthews K.A.
        Hot flashes and carotid intima media thickness among midlife women.
        Menopause. 2011; 18: 352-358
        • Holzer G.
        • Koschat M.A.
        • Kickinger W.
        • Clementi W.
        • Holzer L.A.
        • Metka M.M.
        Reproductive factors and lower extremity arterial occlusive disease in women.
        European Journal of Epidemiology. 2007; 22: 505-511
        • Rathmann W.
        • Haastert B.
        • Icks A.
        • et al.
        High prevalence of undiagnosed diabetes mellitus in Southern Germany: target populations for efficient screening. The KORA survey 2000.
        Diabetologia. 2003; 46: 182-189
        • Meisinger C.
        • Thorand B.
        • Schneider A.
        • Stieber J.
        • Doring A.
        • Lowel H.
        Sex differences in risk factors for incident type 2 diabetes mellitus: the MONICA Augsburg cohort study.
        Archives of Internal Medicine. 2002; 162: 82-89
        • Stöckl D.
        • Döring A.
        • Thorand B.
        • Heier M.
        • Belcredi P.
        • Meisinger C.
        Reproductive factors and serum uric acid levels in females from the general population: the KORA F4 study.
        PloS One. 2012; 7: e32668
        • Murabito J.M.
        • White C.C.
        • Kavousi M.
        • et al.
        Association between chromosome 9p21 variants and the ankle-brachial index identified by a meta-analysis of 21 genome-wide association studies.
        Circulation. Cardiovascular Genetics. 2012; 5: 100-112
        • Leng G.C.
        • Fowkes F.G.
        The Edinburgh claudication questionnaire: an improved version of the WHO/Rose questionnaire for use in epidemiological surveys.
        Journal of Clinical Epidemiology. 1992; 45: 1101-1109
        • Bernstein E.F.
        • Fronek A.
        Current status of noninvasive tests in the diagnosis of peripheral arterial disease.
        The Surgical Clinics of North America. 1982; 62: 473-487
        • Kharazmi E.
        • Moilanen L.
        • Fallah M.
        • et al.
        Reproductive history and carotid intima-media thickness.
        Acta obstetricia et gynecologica Scandinavica. 2007; 86: 995-1002
        • Yeh S.T.
        • Morton D.J.
        • Barrett-Connor E.
        Lower extremity arterial disease in older women: the Rancho Bernardo study.
        Journal of Women's Health & Gender-based Medicine. 2000; 9: 373-380
        • Cui R.
        • Iso H.
        • Toyoshima H.
        • et al.
        Relationships of age at menarche and menopause, and reproductive year with mortality from cardiovascular disease in Japanese postmenopausal women: the JACC study.
        Journal of Epidemiology/Japan Epidemiological Association. 2006; 16: 177-184
        • Elks C.E.
        • Perry J.R.
        • Sulem P.
        • et al.
        Thirty new loci for age at menarche identified by a meta-analysis of genome-wide association studies.
        Nature Genetics. 2010; 42: 1077-1085
        • Kannel W.B.
        • Hjortland M.C.
        • McNamara P.M.
        • Gordon T.
        Menopause and risk of cardiovascular disease: the Framingham study.
        Annals of Internal Medicine. 1976; 85: 447-452
        • Vitale C.
        • Fini M.
        • Speziale G.
        • Chierchia S.
        Gender differences in the cardiovascular effects of sex hormones.
        Fundamental & Clinical Pharmacology. 2010; 24: 675-685
        • Webb C.M.
        • Rosano G.M.
        • Collins P.
        Oestrogen improves exercise-induced myocardial ischaemia in women.
        Lancet. 1998; 351: 1556-1557
        • Bar J.
        • Tepper R.
        • Fuchs J.
        • Pardo Y.
        • Goldberger S.
        • Ovadia J.
        The effect of estrogen replacement therapy on platelet aggregation and adenosine triphosphate release in postmenopausal women.
        Obstetrics and Gynecology. 1993; 81: 261-264
        • Atsma F.
        • van der Schouw Y.T.
        • Grobbee D.E.
        • Hoes A.W.
        • Bartelink M.L.
        No added value of age at menopause and the lifetime cumulative number of menstrual cycles for cardiovascular risk prediction in postmenopausal women.
        International Journal of Cardiology. 2008; 130: 190-195
        • Howard B.V.
        • Kuller L.
        • Langer R.
        • et al.
        Risk of cardiovascular disease by hysterectomy status, with and without oophorectomy: the Women's Health Initiative Observational Study.
        Circulation. 2005; 111: 1462-1470
        • Rivera C.M.
        • Grossardt B.R.
        • Rhodes D.J.
        • et al.
        Increased cardiovascular mortality after early bilateral oophorectomy.
        Menopause. 2009; 16: 15-23