Life‐Course Reproductive History and Cardiovascular Risk Profile in Late Mid‐Life: The CARDIA Study

Background Reproductive events, that is, a preterm birth (PTB ), small‐for‐gestational‐age infant (SGA ), and vasomotor symptoms of menopause, are associated with subclinical atherosclerotic cardiovascular disease (ASCVD ). We evaluated whether women with a pastPTB and/orSGA (henceforthPTB /SGA ) were more likely to have severe vasomotor symptoms of menopause and whether the estimated 10‐yearASCVD risk was higher in women withPTB /SGA and vasomotor exposures.Methods and Results We assigned 1866 women (mean age=55±1 years) in theCARDIA (Coronary Artery Risk Development in Young Adults) study to the following categories of reproductive exposures: none,PTB /SGA only, vasomotor symptoms only, or bothPTB /SGA and vasomotor symptoms. We used Kruskal‐Wallis tests to evaluate the differences in pooled cohort equationASCVD risk scores by category and linear regression to evaluate the associations of categories withASCVD risk scores adjusted for study center,body mass index , education, current hormone replacement therapy use, parity, and hysterectomy. Women withPTB /SGA were more likely to have severe vasomotor symptoms, 36% versus 30%,P <0.02.ASCVD risk score was higher in women with bothPTB /SGA and vasomotor symptoms (4.6%; 95% CI, 4.1%–5.1%) versus women with no exposures (3.3%; 95%CI , 2.9%–3.7%) or vasomotor symptoms only (3.8%; 95%CI , 3.5%–4.0%).ASCVD risk score was higher in womenPTB /SGA (4.8%; 95%CI , 3.6%–5.9%) versus no exposures.PTB /SGA and vasomotor symptoms was associated withASCVD risk score in white women versus no exposures (β=0.40; 95% CI, 0.02–0.78).Conclusions Women with priorPTB /SGA were more likely to have severe vasomotor symptoms of menopause. Reproductive exposures were associated with an estimated 10‐yearASCVD risk in white women.