Infertility History Associated with Increased Risk of Heart Failure

A new study published in the Journal of American College of Cardiology has found that a history of infertility is linked with an increased risk of heart failure. Researchers from the Massachusetts General Hospital (MGH) discovered that heart failure is 16% higher in women who experienced infertility than those who did not suffer from the medical problem.

The Study on Infertility

The first author of the study, Emily Lau, director of the Menopause, Hormones and Cardiovascular Clinic at the MGH, said, researchers are beginning to identify that a woman's reproductive history reveals a lot about the risks associated with heart diseases she may suffer at a later stage. "Everything related to a woman having difficulty with pregnancy, what happens during her pregnancy, and when she is passing through menopause has an impact on her heart's health in the later stage of her life."   

Studies have shown that one in five women in the United States experience infertility. They suffer from various difficulties in conceiving. However, until the findings of this study were published, it was not known that infertility is also associated with higher rates of heart disease in women. In collaboration with the Women's Health Initiative, Lau and her team examined postmenopausal women to find whether infertility was associated with risks of developing heart failure.   

Heart failure may be categorized as heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). In this case, ejection fraction is the volume of blood pumped from the left ventricle during each heartbeat. When the ejection fraction is below 50%, it is said to be reduced or abnormal. The HFpEF form of heart failure is more common in women, irrespective of whether they experienced infertility problems.   

Lau and her team found a link between infertility and heart failure, especially with HFpEF. Of the 38,528 postmenopausal women studied by the researchers, 14% of the subjects said they had a history of infertility. During a follow-up period of 15 years, the researchers noted that infertility increased the risk of heart failure by 16% in women. While examining the subtypes of heart failure, they discovered that women with infertility problems faced a 27% increase in the risk of developing HFpEF in the future.   

During the last decade, HFpEF (in this case, the heart muscle does not relax well), as opposed to HFrEF (in this case, the left ventricle does not pump well), has become the main form of heart failure in both men and women. Nevertheless, this type of heart failure is more common in women. According to Lau, it is a challenging condition because they cannot completely understand how HFpEF develops. Moreover, to date, there are no suitable therapies to treat HFpEF.   

Lau says, "I think our findings are noteworthy because heart failure with preserved ejection fraction is more prevalent in women." "We don't understand why we see HFpEF more in women. Looking back in a woman's early reproductive life may give us some clues as to why." It is worth mentioning here that the team observed that the association persisted irrespective of whether an individual eventually conceived or had a live birth.   

The augmented risk was free of traditional cardiovascular risk factors and other infertility-related conditions. Some previous studies have suggested that women with infertility have more cardiometabolic risk factors. Still, the team did not find that cardiometabolic risk factors elucidated the link between infertility with heart failure in this study. The team also examined if other infertility-related conditions such as irregular menses, early menopause, and thyroid disease explained the association between infertility and heart failure but did not find evidence to support that hypothesis.