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.