title: Association between number of live births and markers of subclinical atherosclerosis: The Dallas Heart Study.
abstract: OBJECTIVE
  Higher parity has been associated with increased maternal risk of cardiovascular disease, but the mechanism is not well delineated. Whether the number of live births is associated with coronary and aortic subclinical atherosclerosis has not been fully evaluated.
  
  
  RESULTS
  Women from the Dallas Heart Study, a multiethnic population-based cohort of subjects aged 30-65 years, were included if they had data on self-reported live births and coronary artery calcium (CAC) measured by computed tomography or aortic wall thickness (AWT) by MRI. Coronary artery calcium was positive if >10 Agatston units, and aortic wall thickness if greater than the 75(th) percentile reference point for age and gender. Among the 1644 women included in the study, the mean age was 45 years and 55% were Black. Sequential multivariable models were done adjusting for age, race, traditional cardiovascular risk factors, body mass index, income, education, hormone replacement therapy, oral contraceptives, and physical activity. Using women with 2-3 live births as the reference, those with four or more live births had an increased prevalence of elevated coronary artery calcium (odds ratio (OR) 2.2, 95% confidence interval (CI) 1.28-3.65) and aortic wall thickness (OR 1.6, 95% CI 1.04-2.41). Women with 0-1 live births also had increased coronary artery calcium (OR 1.9, 95% CI 1.16-3.03) and aortic wall thickness (OR 1.5, 95% CI 1.05-2.09) after multivariable adjustment.
  
  
  CONCLUSIONS
  The number of live births is associated with subclinical coronary and aortic atherosclerosis, with an apparent U-shaped relationship. Further studies are needed to confirm this association and explore the biological underpinnings of these findings.
authors.affiliation: Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, USA monsanghavi@gmail.com.
authors.forename: Monika
authors.initials: M
authors.lastname: Sanghavi
authors.affiliation: Cardiovascular Division, Medical College of Wisconsin, Milwaukee, USA.
authors.forename: Jacquelyn
authors.initials: J
authors.lastname: Kulinski
authors.affiliation: Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, USA.
authors.forename: Colby R
authors.initials: CR
authors.lastname: Ayers
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, USA.
authors.forename: David
authors.initials: D
authors.lastname: Nelson
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Stewart
authors.affiliation: Cardiovascular Division, University of California San Francisco, USA.
authors.forename: Nisha
authors.initials: N
authors.lastname: Parikh
authors.affiliation: Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, USA.
authors.forename: James A
authors.initials: JA
authors.lastname: de Lemos
authors.affiliation: Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Khera
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000473:pathology; D050197:Atherosclerosis / Q000175:diagnosis / Q000453:epidemiology*; D015331:Cohort Studies; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D050498:Live Birth / Q000453:epidemiology*; D008875:Middle Aged; D013781:Texas / Q000453:epidemiology; D061205:Vascular Calcification / Q000000981:diagnostic imaging
keywords: Women; aortic wall thickness; cardiovascular disease; coronary artery calcification; pregnancy; subclinical atherosclerosis