Infertility history associated with increased risk of heart failure, new study finds

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New research has revealed that infertility is linked with a 16 percent increased risk of heart failure overall, and a 27 percent increase in a type more commonly found in women.

The study, published in the Journal of the American College of Cardiology, and conducted by researchers at Massachusetts General Hospital (MGH), found that a woman’s reproductive history can help predict her future risk of heart disease.

According to researchers, there are two types of heart failure: heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). Ejection fraction is a measurement related to the volume percentage of blood that is pumped from the left ventricle of the heart during each beat. An ejection fraction less than 50 percent is commonly viewed as abnormal or reduced.

In the study, researchers followed postmenopausal women from the Women’s Health Initiative for the development of heart failure. Infertility was self-reported at the study baseline. 

The team found an association between infertility and overall heart failure, specifically with HFpEF, a form of heart failure that is far more common in women regardless of fertility history. Among the 38,528 postmenopausal women studied, 14 percent of the participants reported a history of infertility. Over a 15-year follow up period, the researchers noted that infertility was associated with 16 percent increased future risk of overall heart failure. When they examined heart failure subtypes, they found that infertility was associated with a 27 percent increased future risk of HFpEF.

The authors recommend future research should investigate mechanisms that underlie the link between infertility and HFpEF.

“Scientists and doctors are beginning to recognize how important a woman's reproductive history is for their future risk of heart disease,” said study first author Emily Lau, MD, MPH, cardiologist and director of the Menopause, Hormones & Cardiovascular Clinic at MGH in a statement. “Infertility is one of many cardiovascular risk factors, such as hypertension and high blood pressure, but reproductive history is not routinely considered as part of the cardiovascular risk assessment. Since people do not tend to develop heart failure until well in their 60s and beyond, and infertility is mostly experienced in the 20s, 30s, and 40s, many physicians are not thinking about the connection. We cannot change a woman’s history of infertility, but if we know a woman has had a history of infertility, we can be more aggressive about counseling her about other modifiable risk factors including high blood pressure, high cholesterol, smoking, and beyond.”