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Long Term Cardiovascular Risk in Women Prescribed Fertility Therapy
Study Questions:
Does fertility therapy increase long-term cardiovascular risk in women?
Methods:
Women, ages 15-55 years, who had given birth in Ontario, Canada between July 1, 1993 and March 31, 2010, were included in this cohort. Patients were identified through the Ontario Health Insurance Plan (OHIP) that covered prenatal care as well as hospital and postnatal care. Women were grouped by receipt of fertility therapy in the 2 years prior to delivery: yes versus no. Information on demographic and clinical factors, including cardiovascular risk factors, was also included. The primary outcome was a composite cardiovascular endpoint of death, nonfatal coronary ischemia, stroke, transient ischemic attack, thromboembolism, or heart failure.
Results:
A total of 1,186,753 women (mean age 29 years) were included in this analysis, of which 6,979 (0.6%) had received fertility therapy in the 2 years prior to delivery. In this population, use of fertility therapy increased significantly over time, from about 1-in-400 to about 1-in-80 during the 17-year study interval. Women with a delivery following fertility therapy were more likely to be older, living in the highest income quintile, and accumulated a greater number of prenatal visits, and higher prevalence of cardiovascular risk factors including hypertension, hyperlipidemia, and diabetes compared with women delivering without fertility therapy. After 9.7 years of median follow-up, women who delivered following fertility therapy had fewer cardiovascular events than controls (103 vs. 117 events per 100,000 person-years), equivalent to an unadjusted hazard ratio [HR] of 0.96 (95% confidence interval [CI], 0.72-1.29, p = 0.79) and an adjusted HR of 0.55 (95% CI, 0.41-0.74, p < 0.0001). Women who received fertility therapy also had lower risk-adjusted all-cause mortality, thromboembolic events, subsequent depression, alcoholism, and self-harm (p < 0.01 for each).
Conclusions:
The investigators concluded that successful fertility therapy was not associated with an increased risk of cardiovascular disease later in life.
Perspective:
These data suggest that although women who received fertility therapy were older and more likely to have additional risk factors for cardiovascular events, receipt of fertility therapy was not associated with increased cardiovascular risk.
Keywords: Depression, Fertility, Prevalence, Follow-Up Studies, Hyperlipidemias, Cardiovascular Diseases, Risk Factors, Confidence Intervals, Estrogen Replacement Therapy, Hypertension, Diabetes Mellitus
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