Reproductive factors in relation to heart failure in women: A systematic review

Background The biological mechanisms underlying the sex-related differences in risk of heart failure are still not well understood. The aim of this review was to provide an overview of the current evidence on the association between reproductive factors and risk of heart failure in women. Methods A systematic review of the literature was conducted. PubMed and Embase databases were searched for publications on the following reproductive factors as potential risk factors for heart failure in women: age at menarche, duration and frequency of the menstrual cycle, reproductive lifespan, use of contraception, polycystic ovarian syndrome (PCOS), pregnancy characteristics (e.g. parity), pregnancy complications (e.g. preeclampsia), induced abortion, history of breastfeeding, fertility status, use of assisted reproductive methods, hysterectomy, age at menopause, and use of hormone replacement therapy (HRT). Results Twenty-one studies were eligible for inclusion. Hypertensive pregnancy disorders, preterm delivery or small-for-gestational-age (SGA) infants, shorter reproductive duration, and early menopause were risk factors for heart failure in women. It was suggested that PCOS, fertility therapy, gestational diabetes, and age at first pregnancy were not related to risk of heart failure, but a potential relation cannot be fully excluded as most studies were not of sufficient quality. Conflicting results were found for the associations between risk of heart failure and hysterectomy, gravidity and parity, and HRT. Conclusion Although some reproductive factors were considered risk factors for heart failure in women, the results were mostly conflicting or inconclusive. Further research is needed to confirm and expand the current evidence on the association between reproductive factors and risk of heart failure.