Author + information
- Received January 13, 2020
- Revision received April 1, 2020
- Accepted April 29, 2020
- Published online June 29, 2020.
- Casey Crump, MD, PhDa,b,∗ (, )@MountSinaiNYC,
- Jan Sundquist, MD, PhDa,b,c,
- Elizabeth A. Howell, MD, MPPb,d,e,
- Mary Ann McLaughlin, MD, MPHb,f,
- Annemarie Stroustrup, MD, MPHd,g and
- Kristina Sundquist, MD, PhDa,b,c
- aDepartment of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York
- bDepartment of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
- cCenter for Primary Health Care Research, Lund University, Malmö, Sweden
- dThe Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- eDepartment of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
- fDepartment of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- gDepartments of Pediatrics and of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
- ↵∗Address for correspondence:
Dr. Casey Crump, Icahn School of Medicine at Mount Sinai, Departments of Family Medicine and Community Health and of Population Health Science and Policy, One Gustave L. Levy Place, Box 1077, New York, New York 10029.
Background Women who deliver pre-term have been reported to have increased future risks of cardiometabolic disorders. However, their long-term risks of ischemic heart disease (IHD) and whether such risks are due to shared familial factors are unclear. A better understanding of these risks may help improve long-term clinical follow-up and interventions to prevent IHD in women.
Objectives The purpose of this study was to determine the long-term risks of IHD in women by pregnancy duration.
Methods A national cohort study was conducted of all 2,189,190 women with a singleton delivery in Sweden from 1973 to 2015, who were followed up for IHD through the end of 2015. Cox regression was used to compute adjusted hazard ratios (aHRs) for IHD associated with pregnancy duration, and cosibling analyses assessed the influence of shared familial (genetic and/or environmental) factors.
Results In 47.5 million person-years of follow-up, 49,955 (2.3%) women were diagnosed with IHD. In the 10 years following delivery, the aHR for IHD associated with pre-term delivery (<37 weeks) was 2.47 (95% confidence interval [CI]: 2.16 to 2.82), and further stratified was 4.04 (95% CI: 2.69 to 6.08) for extremely pre-term (22 to 27 weeks), 2.62 (95% CI: 2.09 to 3.29) for very pre-term (28 to 33 weeks), 2.30 (95% CI: 1.97 to 2.70) for late pre-term (34 to 36 weeks), and 1.47 (95% CI: 1.30 to 1.65) for early-term (37 to 38 weeks), compared with full-term (39 to 41 weeks). These risks declined but remained significantly elevated after additional follow-up (pre-term vs. full-term, 10 to 19 years: aHR: 1.86; 95% CI: 1.73 to 1.99; 20 to 29 years: aHR: 1.52; 95% CI: 1.45 to 1.59; 30 to 43 years: aHR: 1.38; 95% CI: 1.32 to 1.45). These findings did not appear attributable to shared genetic or environmental factors within families. Additional pre-term deliveries were associated with further increases in risk.
Conclusions In this large national cohort, pre-term delivery was a strong independent risk factor for IHD. This association waned over time but remained substantially elevated up to 40 years later. Pre-term delivery should be recognized as a risk factor for IHD in women across the life course.
This work was supported by the National Heart, Lung, and Blood Institute at the National Institutes of Health (R01 HL139536 to Drs. Crump and K. Sundquist), the Swedish Research Council, the Swedish Heart-Lung Foundation, and ALF project grant, Region Skåne/Lund University, Sweden. The funding agencies had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Anne Marie Valente, MD, served as Guest Associate Editor for this paper. Deepak L. Bhatt, MD, MPH, served as Guest Editor-in-Chief for this paper.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.
- Received January 13, 2020.
- Revision received April 1, 2020.
- Accepted April 29, 2020.
- 2020 American College of Cardiology Foundation
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