Author + information
- Ibrahim El-Battrawy, MD∗ (, )
- Martin Borggrefe, MD and
- Ibrahim Akin, MD
- ↵∗First Department of Medicine, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
The paper by Hall et al. (1) published in the Journal and describing the effect of reproductive factors such as duration of productive time and nulliparity among participants of the Women’s Health Initiative on incident heart failure elicited great interest among members of our research working group. Hall et al. (1) found that shorter total reproductive duration and nulliparity were associated with a risk of incident heart failure.
Because the precise cause of heart failure among participants of the Women’s Health Initiative was not defined, it is possible that a significant portion of cases could in fact be Takotsubo syndrome (TTS). TTS predominantly affects postmenopausal women. This observation suggests a role of estrogen in TTS, which is associated with 5.6% mortality rate per patient-year (2). However, the pathogenesis of TTS is still not fully understood. A popular hypothesis suggesting involvement of a catecholamine-mediated mechanism triggered by stress has been debated (3).
Therefore, more evidence of factors such as the cause of heart failure and coronary status would be of interest before the final conclusion can be made about the correlation between the duration of productive time and nulliparity and incident heart failure in postmenopausal women.
Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2017 American College of Cardiology Foundation
- Hall P.S.,
- Nah G.,
- Howard B.V.,
- et al.
- El-Battrawy I.,
- Borggrefe M.,
- Akin I.