Failed fertility therapy associated with increased risk of subsequent cardiac disease
Women who have fertility therapy but do not get pregnant have a higher risk of developing long-term cardiovascular disease than women who go on to become pregnant, according to a new study by researchers at the Institute for Clinical Evaluative Sciences (ICES), Peter Munk Cardiac Centre, University Health Network and Women's College Hospital.
“We found that two-thirds of women never became pregnant after being managed for fertility treatment and these women also had worse long-term cardiovascular risk, specifically higher risks of stroke and heart failure, compared with the remaining third of women who did become pregnant and delivered a baby,” says Dr. Jacob Udell, lead author of the study, scientist at ICES and cardiologist at the Peter Munk Cardiac Centre and Women's College Hospital.
Fertility therapy failure was associated with a 19 per cent increased risk of adverse cardiovascular events (in particular, heart failure) yet the researchers stress the absolute risk was modest at about 10 events per 1,000 women after 10 years for those where fertility therapy failed versus 6 events per 1,000 women for those who became pregnant and delivered a child after fertility therapy.
The study published today in CMAJ, examined 28, 442 women who received fertility therapy in Ontario between April 1, 1993, and March 31, 2011 and followed them until March 31, 2015. The study found 9,349 (33 per cent) of the women gave birth and 19,093 (67 per cent) did not give birth within one year after treatment. The average age of the women who received fertility therapy was 35 years old. 23,575 (83 per cent) had no prior deliveries, and the median number of fertility cycles was three.
“An association between failed fertility therapy and long-term cardiovascular risk could provide insight into a new risk factor potentially contributing to the cardiovascular mortality and morbidity later diagnosed in middle-aged women,” says Dr. Donald Redelmeier, co-author of the study and senior scientist at ICES.
“We don’t want to alarm women who undergo fertility therapy; we are instead suggesting that as women age, they should stay mindful of their health and remind their physician about any fertility therapy years earlier. It can be an opportunity for their doctor to review other risk factors for heart disease and discuss ways to protect against future cardiac problems,” adds Redelmeier.
The study was funded by a grant from the Heart and Stroke Foundation (HSF) and the Canada Research Chair in Medical Decision Science. The team and research is also generously supported by a HSF National New Investigator/Ontario Clinician Scientist (Phase I) Award; WCRI; WCH Dept. of Medicine; Peter Munk Cardiac Centre; and the Dept. of Medicine of the University of Toronto; and an Ontario Ministry of Research and Innovation Early Researcher Award.
“Failure of fertility therapy and subsequent adverse cardiovascular events,” was published today in CMAJ.
Author block: Jacob A. Udell, Hong Lu and Donald A. Redelmeier.
The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of health care issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario
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For more than 100 years Women’s College Hospital (WCH) has been developing revolutionary advances in healthcare. Today, WCH is a world leader in the health of women and Canada’s leading, academic ambulatory hospital. A champion of equitable access, WCH advocates for the health of all women from diverse cultures and backgrounds and ensures their needs are reflected in the care they receive. It focuses on delivering innovative solutions that address Canada’s most pressing issues related to population health, patient experience and system costs. The WCH Institute for Health System Solutions and Virtual Care (WIHV) is developing new, scalable models of care that deliver improved outcomes for patients and sustainable solutions for the health system as a whole.
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