Association between female infertility and stroke mortality: evidence from the PLCO cancer screening trial.
Level 3 - non-randomized controlled study
Prospective cohort analysis (secondary analysis of PLCO cancer screening trial participants)
PubMed 39381444 · doi:10.3389/fendo.2024.1433930
What was done
This study examined the prospective association between self-reported female infertility and long-term stroke mortality using data from 75,778 women aged 55–74 years enrolled in the Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening trial. Participants were followed for a median of 16.84 years. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) adjusted for age, race, education, marital status, smoking, BMI, hypertension, heart attack history, diabetes, oral contraceptive use, hormone replacement therapy, endometriosis, age at menarche, and pregnancy history.
What was found
Infertility was reported by 14.53% of participants, and 1,159 stroke deaths occurred during follow-up. Women with a history of infertility had a significantly higher risk of stroke mortality compared to those without infertility in both unadjusted models (HR 1.21, 95% CI 1.04–1.41, p = 0.016) and multivariable-adjusted models (HR 1.20, 95% CI 1.02–1.42, p = 0.029).
Why it matters
The findings identify a history of female infertility as a potential long-term risk indicator for fatal stroke later in life, supporting reproductive history as a component of cardiovascular risk assessment.
Limits
The analysis is observational and cannot establish causality. Infertility was self-reported, and specific underlying causes of infertility (such as ovulatory disorders, tubal factor, or male factor contributions) were not characterized in the abstract. Non-fatal stroke incidence was not evaluated, and residual confounding from unmeasured lifestyle or metabolic variables remains possible.
Cited by
- supports Infertility is associated with increased rates of metabolic syndrome, cardiovascular disease, stroke, cancer, and early mortality.