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  • Higher number of live births is associated with left ventricular diastolic dysfunction and adverse cardiac remodelling among US Hispanic/Latina women: results from the Echocardiographic Study of Latinos

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Heart failure and cardiomyopathies
Original research article
Higher number of live births is associated with left ventricular diastolic dysfunction and adverse cardiac remodelling among US Hispanic/Latina women: results from the Echocardiographic Study of Latinos
  1. Shivani R Aggarwal1,
  2. David M Herrington1,
  3. Catherine J Vladutiu2,
  4. Jill C Newman1,
  5. Katrina Swett1,
  6. Franklyn Gonzalez2,
  7. Jorge R Kizer3,
  8. Michelle A Kominiarek4,
  9. Karen M Tabb5,
  10. Linda C Gallo6,
  11. Gregory A Talavera6,
  12. Barry E Hurwitz7 and
  13. Carlos J Rodriguez1
  1. 1 Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
  2. 2 University of North Carolina, Chapel Hill, North Carolina, USA
  3. 3 Albert Einstein College of Medicine, Bronx, New York, USA
  4. 4 University of Illinois at Chicago, Chicago, Illinois, USA
  5. 5 University of Illinois Urbana-Champaign, Urbana, Illinois, USA
  6. 6 San Diego State University, San Diego, California, USA
  7. 7 University of Miami, Miami, Florida, USA
  1. Correspondence to Dr Shivani R Aggarwal; saggarwa{at}wakehealth.edu

Abstract

Introduction Female sex is a risk factor for heart failure with preserved ejection fraction (HFpEF). Previous literature suggests that some diastolic dysfunction (DD) develops during pregnancy and may persist postdelivery. Our objective was to examine the relationship between parity and cardiac structure and function in a population-based cohort.

Methods Participants included 1172 Hispanic/Latina women, aged ≥45 years, enrolled in the Echocardiographic Study of Latinos from four US communities (Bronx, Miami, San Diego and Chicago). Standard echocardiographic techniques were used to measure cardiac volumes, left ventricular mass, systolic and diastolic function. Using sampling weights and survey statistics, multivariable linear and logistic regression models were constructed adjusting for age, body mass index, diabetes or prediabetes, systolic blood pressure, use of antihypertensive medications, smoking, total cholesterol and high-density lipoprotein cholesterol.

Results In the target population, 5.0% were nulliparous (no live births) and 10.5% were grand multiparous (≥5 live births). Among the nulliparous women, 46% had DD as compared with 51%–58% of women with 1–4 live births and 81% of women with ≥5 live births (p<0.01). In full multivariate models, higher parity was significantly associated with greater left ventricular end-systolic volumes, end-diastolic volumes, left atrial volume indices and presence of DD (all p<0.01) but was not associated with ejection fraction. The log odds for having any grade of DD in grand-multiparous women was over three times that seen in nulliparous women (OR=3.4, 95% CI 1.5 to 7.9, p<0.01) in models further adjusted for income and education.

Conclusions Higher parity is associated with increased cardiac mass, volumes and the presence of DD. Further studies are needed to elucidate this apparent deleterious relation and whether parity can help explain the increased risk of HFpEF in women.

  • parity
  • diastolic Dysfunction by echo
  • heart failure with preserved ejection fraction
  • hispanic

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/openhrt-2016-000530

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    Footnotes

    • Funding The HCHS/SOL was carried out as a collaborative study supported by contracts from the National Heart, Lung, and Blood Institute (NHLBI) to the University of North Carolina (N01- HC65233), University of Miami (N01-HC65234), Albert Einstein College of Medicine (N01-HC65235), Northwestern University (N01-HC65236) and San Diego State University (N01-HC65237). The following Institutes/Centres/Offices contribute to the HCHS/SOL through a transfer of funds to the NHLBI: National Institute on Minority Health and Health Disparities, National Institute on Deafness and Other Communication Disorders, National Institute of Dental and Craniofacial Research, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Neurological Disorders and Stroke, NIH Institution-Office of Dietary Supplements.

      ECHO-SOL was supported by a grant from the NHLBI (R01 HL104199, Epidemiologic Determinants of Cardiac Structure and Function among Hispanics: CJR, Principal Investigator).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Data sharing statement All HCHS-SOL data will be included in a limited access database that will be available to the larger scientific public as part of the main HCHS-SOL study database for public use. It will be encouraged that all use of data and publications from ancillary studies invite the participation of the ancillary study PI and co-investigators. For more information on HCHS/SOL related limited access datasets see the URL: http://www.cscc.unc.edu/hchs/.