title: Reproductive factors, metabolic factors, and coronary artery calcification in older women.
abstract: OBJECTIVE
  Metabolic disturbances may explain the increased cardiovascular risk associated with reproductive factors. This cohort study investigated the relationship between reproductive factors and coronary artery calcification in elderly women and whether this relationship could be explained by metabolic disturbances.
  
  
  METHODS
  In total, 568 postmenopausal women were included in this cross-sectional study. Information about the women's reproductive life was obtained by a questionnaire. Metabolic factors were measured during a single visit. Coronary artery calcification was assessed with a multislice computed tomography scanner and dichotomized as absent or present. Logistic regression analysis was used to assess the relationship between reproductive factors and coronary artery calcification. Crude and multivariate adjusted odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were calculated. In addition, ORs were adjusted for several metabolic and cardiovascular risk factors.
  
  
  RESULTS
  The mean age was 66.9 (+/- 5.5) years. Women with a history of irregular menstrual cycle lengths, as opposed to women with a history of regular menstrual cycles (26-30 d), had an increased risk of coronary artery calcification; multivariate-adjusted OR = 2.73 (95%CI: 1.24-5.98). Four or more pregnancies, compared with never pregnant, yielded an multivariate-adjusted OR of 1.89 (95% CI: 1.00-3.58). Having four children or more, compared with having no children, yielded a multivariate-adjusted OR of 1.97 (95% CI: 1.00-3.89). Adjustment for metabolic factors and other cardiovascular risk factors did not fully explain theses relationships.
  
  
  CONCLUSIONS
  Multigravidity (more than four pregnancies), multiparity (more than four births), and irregular menstrual cycle lengths were related to an increased risk of coronary artery disease. These associations could not be explained by metabolic abnormalities.
authors.affiliation: Department of Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Femke
authors.initials: F
authors.lastname: Atsma
authors.forename: Marie-Louise E L
authors.initials: ML
authors.lastname: Bartelink
authors.forename: Diederick E
authors.initials: DE
authors.lastname: Grobbee
authors.forename: Annemarieke
authors.initials: A
authors.lastname: Rutten
authors.forename: Michiel L
authors.initials: ML
authors.lastname: Bots
authors.forename: Matthias
authors.initials: M
authors.lastname: Prokop
authors.forename: Yvonne T
authors.initials: YT
authors.lastname: van der Schouw
mesh_terms: D000368:Aged; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000209:etiology*; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D015331:Cohort Studies; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008597:Menstrual Cycle; D008599:Menstruation Disturbances / Q000150:complications*; D024821:Metabolic Syndrome / Q000150:complications; D008875:Middle Aged; D016017:Odds Ratio; D010298:Parity; D017698:Postmenopause; D011247:Pregnancy; D014057:Tomography, X-Ray Computed; D016387:Women's Health