Women’s reproductive risk score and healthy lifestyle modification in
cardiovascular disease, ischemic heart disease and stroke: a prospective
cohort study
Abstract
Background: Reproductive risk factors are associated with
increased risk of cardiovascular disease (CVD) in women. However, the
combined effects of the composite reproductive risk factors on CVD are
unknown. This study was performed to construct a reproductive risk score
(RRS) to measure reproductive status, examine the association between
RRS and CVD, and explore the modification effect of healthy lifestyle on
the association in women in the UK Biobank cohort. Methods: The
RRS was constructed in 74 141 female participants with data about the
items derived for the RRS in the UK Biobank. The RRS was derived from 17
baseline variables, all of which indicated women’s reproductive health
status. We defined four categories of RRS status: low-risk group (score
0–1); low-intermediate group (score 2–3); high-intermediate group
(score 4–5); and high-risk group (score 6–13). We also constructed a
healthy lifestyle score (HLS) with five related factors, and categorized
into unhealthy lifestyle group (score: 0–1), intermediate lifestyle
group (score: 2–3) and healthy lifestyle group (score: 4–5).
Findings: Each point increase in the RRS was associated with a
22% higher risk of CVD (adjusted hazard ratio (aHR): 1.22; 95%
confidence interval (CI): 1.16 to 1.28), 23% higher risk of IHD (1.23;
1.17 to 1.31) and 19% higher risk of stroke (1.19; 1.07 to 1.32). The
percentage population-attribution risks (PAR%) were 16% (95% CI: 8 to
24) for CVD, 15% (95% CI: 6 to 24) for IHD and 18% (95% CI: 1 to 33)
for stroke. A healthy lifestyle significantly attenuated RRS
associations with the incidence of CVD and IHD. The attributable
proportions due to additive interaction ( P < 0.001)
between RRS and HLS were 0.14 (95% CI: 0.07 to 0.22) for CVD and 0.15
(95% CI: 0.09 to 0.23) for IHD, respectively. Interpretation:
High RRS was associated with increased risks of CVD, IHD and stroke in
female participants in the UK Biobank. The early-stage identification of
women with reproductive risk using synthesised indicators and
appropriate healthy lifestyle interventions could be useful for the
prevention of early CVD and the extension of healthy active life
expectancy. Funding: This study was supported by grants from
the National Key R&D Program of China (2020YFC2003401) and the
High-performance Computing Platform of Peking University. The funders
had no role in the study design, data collection, data analysis and
interpretation, writing of the report or the decision to submit the
article for publication.