Cardiovascular Risk Following Fertility Therapy

Sep 06, 2017
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Authors:
Dayan N, Filion KB, Okano M, et al.
Citation:
Cardiovascular Risk Following Fertility Therapy: Systematic Review and Meta-Analysis. J Am Coll Cardiol 2017;70:1203-1213.
Summary By:
Melinda Davis, MD, FACC

Study Questions:

Does fertility therapy lead to long-term increased risk of cardiovascular disease (CVD)?

Methods:

This was a systematic review of studies that reported CV outcomes among women who received fertility therapy versus those who did not. Follow-up of more than 1 year was required for inclusion. DerSimonian and Laird random-effects models were used. The outcomes assessed were: acute cardiac event, stroke, venous thromboembolism, hypertension, and diabetes mellitus.

Results:

Inclusion criteria were met by six observational studies representing 41,910 women receiving fertility therapy and 1,400,202 who did not. Overall, women receiving fertility therapy had no increased risk of a cardiac event (pooled hazard ratio [HR], 0.91; 95% confidence interval [CI], 0.67-1.25; I2 = 36.6%) or diabetes (pooled HR, 0.93; 95% CI, 0.87-1.001; I2 = 0%). Due to study heterogeneity, results were inconclusive about risk of hypertension or venous thromboembolism. There was a trend toward higher risk of stroke among women receiving fertility therapy (pooled HR, 1.25; 95% CI, 0.96-1.63, I2 = 0%).

Conclusions:

More studies are needed to definitively address whether fertility therapy leads to increased CVD risk, particularly stroke.

Perspective:

As increasing numbers of women use fertility therapies, the long-term impact on CVD becomes increasingly important to understand. This systematic review demonstrated that the current data are heterogeneous and more studies are needed before drawing definitive conclusions. The results are hypothesis-generating with the findings of no increased risk of cardiac events, but a trend toward higher risk of stroke. Studies can be confounded because infertility/subfertility has been associated with increased risk of CVD independent of fertility therapy. Although further studies are needed, this meta-analysis did not prove that there was an association with CVD events.

Keywords: Cardiovascular Diseases, Diabetes Mellitus, Fertility, Hypertension, Infertility, Pregnancy, Primary Prevention, Risk Factors, Stroke, Venous Thromboembolism, Women, Vascular Diseases


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