title: Reproductive History of Women With Takotsubo Cardiomyopathy.
abstract: Takotsubo cardiomyopathy (TC) occurs predominantly in postmenopausal women, suggesting a possible role of reproductive and hormonal factors in the pathophysiology of this condition. Yet reproductive characteristics of women with TC have received limited attention. This prospective case-control study sought to explore reproductive characteristics associated with TC. Incident TC cases and myocardial infarction (MI) controls were recruited among consecutive women presenting at the emergency departments of 2 large medical centers in Massachusetts and Connecticut. Female healthy controls were recruited from a registry of research volunteers. Information about reproductive history was collected 1 month after discharge using standardized questionnaires completed during phone interviews. Linear and logistic regression models were used to estimate associations with reproductive factors. From March 2013 to October 2015, 209 women were screened for eligibility and 107 (45 TC, 32 MI, and 30 healthy controls) were enrolled. Conditions uniquely associated with TC were a history of irregular menses (adjusted OR, TC vs MI 8.30; 95% CI 1.01 to 69.18), number of pregnancies (adjusted β coefficient 0.69; SE 0.35, p = 0.05), and use of post-menopausal hormone replacement therapy (OR 5.79; CI 1.20 to 28.02). We did not find associations with history of infertility, breastfeeding, hysterectomy or oophorectomy, oral contraceptive use, and age at menopause. In conclusion, our findings suggest that premenopausal reproductive factors may play an important role in the onset of TC at a later age. These results need to be confirmed in future studies with larger populations.
authors.affiliation: Department of Medicine, Medical School, Brown University, Providence, Rhode Island, USA; Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA. Electronic address: elena_salmoirago-blotcher@brown.edu.
authors.forename: Elena
authors.initials: E
authors.lastname: Salmoirago-Blotcher
authors.affiliation: Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA; Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA.
authors.forename: Shira
authors.initials: S
authors.lastname: Dunsiger
authors.affiliation: Department of Medicine, Hartford Hospital, Hartford, Connecticut, USA.
authors.forename: Heather H
authors.initials: HH
authors.lastname: Swales
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
authors.forename: Gerard P
authors.initials: GP
authors.lastname: Aurigemma
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
authors.forename: Ira
authors.initials: I
authors.lastname: Ockene
authors.affiliation: Department of Psychology, East Carolina University, Greenville, North Carolina, USA.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Rosman
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Ilan S
authors.initials: IS
authors.lastname: Wittstein
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001942:Breast Feeding / Q000706:statistics & numerical data; D016022:Case-Control Studies; D003237:Connecticut / Q000453:epidemiology; D003276:Contraceptives, Oral / Q000627:therapeutic use; D015914:Estrogen Replacement Therapy / Q000706:statistics & numerical data*; D005260:Female; D020073:Gravidity; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D015994:Incidence; D007247:Infertility, Female / Q000453:epidemiology; D016014:Linear Models; D016015:Logistic Models; D008404:Massachusetts / Q000453:epidemiology; D008599:Menstruation Disturbances / Q000453:epidemiology*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D010052:Ovariectomy / Q000706:statistics & numerical data; D017698:Postmenopause; D011446:Prospective Studies; D017584:Reproductive History; D012307:Risk Factors; D054549:Takotsubo Cardiomyopathy / Q000453:epidemiology*
chemical_list: D003276:Contraceptives, Oral