Reproductive-associated risk factors and incident coronary heart disease in women: an umbrella review

Background: Reproductive risk factors influence women's risk of cardiovascular disease (CVD), particularly coronary heart disease (CHD). Despite growing evidence and recent guideline recommendations, their integration into cardiovascular risk screening and assessment remains limited. Evaluating...

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Main Authors: Khadeeja Alnefaie, Jennifer R. Dungan
Format: Article
Language:English
Published: Elsevier 2025-07-01
Series:American Heart Journal Plus
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Online Access:http://www.sciencedirect.com/science/article/pii/S2666602225000618
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author Khadeeja Alnefaie
Jennifer R. Dungan
author_facet Khadeeja Alnefaie
Jennifer R. Dungan
author_sort Khadeeja Alnefaie
collection DOAJ
description Background: Reproductive risk factors influence women's risk of cardiovascular disease (CVD), particularly coronary heart disease (CHD). Despite growing evidence and recent guideline recommendations, their integration into cardiovascular risk screening and assessment remains limited. Evaluating the effect sizes of reproductive-associated risk factors along with temporal trends, homogeneity, and additive effects could provide critical insights to guide future research and inform evidence-based policies for CHD prevention in women. Methods: This umbrella review synthesizes evidence from systematic reviews and meta-analyses examining reproductive-associated risk factors and their impact on incident coronary heart disease. A comprehensive search of PubMed and CINAHL databases was conducted for studies published between 2013 and 2024. Eligible articles were independently screened by two reviewers. Data were extracted using the Joanna Briggs Institute form and synthesized for effect sizes related to incident CHD. Prospective studies were used to assess temporality, and study quality was evaluated using the AMSTAR 2 tool. Forest plots were used for the effect size analysis based on comparative or time-to-event data. Results: Of 902 articles, 29 met the inclusion criteria. Female reproductive risk factors from menarche to menopause across three categories (adverse pregnancy outcomes, reproductive endocrine disorders, and emerging reproductive risk factors) were associated with elevated CHD risk. Recurrent preeclampsia was identified as a significant risk factor, markedly increasing the risk of CHD. Additionally, cardiovascular events, including ischemic heart disease, were most frequent within the first decade postpartum in women with a history of gestational diabetes. Notably, none of the included studies evaluated the combined effects of multiple reproductive risk factors on CHD outcome. Conclusion: Reproductive history is a critical factor in assessing CHD risk in women, with certain factors having temporal effects that correspond to heightened risk periods. Integrating these factors into screening tools, considering exposure and risk timing, may enable earlier intervention and improved outcomes.
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spelling doaj-art-6328dd7a899f45d08d4423330b3011de2025-08-20T03:26:39ZengElsevierAmerican Heart Journal Plus2666-60222025-07-015510055810.1016/j.ahjo.2025.100558Reproductive-associated risk factors and incident coronary heart disease in women: an umbrella reviewKhadeeja Alnefaie0Jennifer R. Dungan1Department of Nursing, Al-Baha University, Saudi Arabia; College of Nursing, University of Florida, USA; Corresponding author.College of Nursing, University of Florida, USABackground: Reproductive risk factors influence women's risk of cardiovascular disease (CVD), particularly coronary heart disease (CHD). Despite growing evidence and recent guideline recommendations, their integration into cardiovascular risk screening and assessment remains limited. Evaluating the effect sizes of reproductive-associated risk factors along with temporal trends, homogeneity, and additive effects could provide critical insights to guide future research and inform evidence-based policies for CHD prevention in women. Methods: This umbrella review synthesizes evidence from systematic reviews and meta-analyses examining reproductive-associated risk factors and their impact on incident coronary heart disease. A comprehensive search of PubMed and CINAHL databases was conducted for studies published between 2013 and 2024. Eligible articles were independently screened by two reviewers. Data were extracted using the Joanna Briggs Institute form and synthesized for effect sizes related to incident CHD. Prospective studies were used to assess temporality, and study quality was evaluated using the AMSTAR 2 tool. Forest plots were used for the effect size analysis based on comparative or time-to-event data. Results: Of 902 articles, 29 met the inclusion criteria. Female reproductive risk factors from menarche to menopause across three categories (adverse pregnancy outcomes, reproductive endocrine disorders, and emerging reproductive risk factors) were associated with elevated CHD risk. Recurrent preeclampsia was identified as a significant risk factor, markedly increasing the risk of CHD. Additionally, cardiovascular events, including ischemic heart disease, were most frequent within the first decade postpartum in women with a history of gestational diabetes. Notably, none of the included studies evaluated the combined effects of multiple reproductive risk factors on CHD outcome. Conclusion: Reproductive history is a critical factor in assessing CHD risk in women, with certain factors having temporal effects that correspond to heightened risk periods. Integrating these factors into screening tools, considering exposure and risk timing, may enable earlier intervention and improved outcomes.http://www.sciencedirect.com/science/article/pii/S2666602225000618Cardiovascular diseaseIschemic coronary heart diseaseWomenReproductive risk factorsLifespan
spellingShingle Khadeeja Alnefaie
Jennifer R. Dungan
Reproductive-associated risk factors and incident coronary heart disease in women: an umbrella review
American Heart Journal Plus
Cardiovascular disease
Ischemic coronary heart disease
Women
Reproductive risk factors
Lifespan
title Reproductive-associated risk factors and incident coronary heart disease in women: an umbrella review
title_full Reproductive-associated risk factors and incident coronary heart disease in women: an umbrella review
title_fullStr Reproductive-associated risk factors and incident coronary heart disease in women: an umbrella review
title_full_unstemmed Reproductive-associated risk factors and incident coronary heart disease in women: an umbrella review
title_short Reproductive-associated risk factors and incident coronary heart disease in women: an umbrella review
title_sort reproductive associated risk factors and incident coronary heart disease in women an umbrella review
topic Cardiovascular disease
Ischemic coronary heart disease
Women
Reproductive risk factors
Lifespan
url http://www.sciencedirect.com/science/article/pii/S2666602225000618
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