Introduction

Cardiovascular disease (CVD) is a leading cause of mortality, which was shown to be responsible for a third of all deaths among women in 2019. Ischemic heart disease (IHD) and stroke are predominant over other clinical manifestations [1]. The Global Burden of Disease report showed a decline in women’s age-standardised burden of cardiovascular mortality [2]. The rate of decline in developed countries is slowing, but there is a tendency for dominance to shift from males to females [2]. Underdiagnosis of CVD in women suggests that extra efforts are needed to focus on this specific population. The latest clinical guidelines also call for increased sensitivity in detection of CVD among young women[3].
Although traditional risk factors are shared between males and females, women have their own specific reproductive risk factors. More than 15% of women in the USA have one or more reproductive health abnormalities[4]. Existing studies have reported associations between individual reproductive risk factors and CVD. Female-specific risk factors are associated with vascular anomalies as well as extending the risks of cardiovascular morbidity and mortality when oestrogen protection is fading [5]. Early menarche, early menopause, recurrent abortion and abuse of hormonal contraceptives have been linked to increased risk of CVD [6, 7]. As dangerous cardiovascular consequences may not be directly related to single reproductive risk factors in a straightforward manner, further studies are needed to integrate the single factors and determine their combined effects. Moreover, it is also unclear whether the CVD associated with reproductive risk factors can be attenuated or reversed by effective measures and policies. Identification of individual women’s reproductive risk factors will enable policymakers to implement effective interventions to reduce the incidence of CVD.
In this study, we constructed a novel reproductive risk score (RRS) as a surrogate measure of reproductive health status, examined the predictive value of the RRS in estimating CVD risks and explored the modification effects of common healthy lifestyle factors on these associations. The results presented here will support efforts to address disparities in the physiology, social resources and prevention of CVD in women, finally leading to a reduction in the global CVD burden among women.