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Failure of fertility therapy and subsequent adverse cardiovascular events.

Abstract Infertility may indicate an underlying predisposition toward premature cardiovascular disease, yet little is known about potential long-term cardiovascular events following fertility therapy. We investigated whether failure of fertility therapy is associated with subsequent adverse cardiovascular events.
PMID
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Long-term cardiovascular risk in women prescribed fertility therapy.

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Journal Title cmaj : canadian medical association journal = journal de l'association medicale canadienne
Publication Year Start




PMID- 28385819
OWN - NLM
STAT- In-Process
DA  - 20170407
LR  - 20170409
IS  - 1488-2329 (Electronic)
IS  - 0820-3946 (Linking)
VI  - 189
IP  - 10
DP  - 2017 Mar 13
TI  - Failure of fertility therapy and subsequent adverse cardiovascular events.
PG  - E391-E397
LID - 10.1503/cmaj.160744 [doi]
AB  - BACKGROUND: Infertility may indicate an underlying predisposition toward
      premature cardiovascular disease, yet little is known about potential long-term
      cardiovascular events following fertility therapy. We investigated whether
      failure of fertility therapy is associated with subsequent adverse cardiovascular
      events. METHODS: We performed a population-based cohort analysis of women who
      received gonadotropin-based fertility therapy between Apr. 1, 1993, and Mar. 31, 
      2011, distinguishing those who subsequently gave birth and those who did not.
      Using multivariable Poisson regression models, we estimated the relative rate
      ratio of adverse cardiovascular events associated with fertility therapy failure,
      accounting for age, year, baseline risk factors, health care history and number
      of fertility cycles. The primary outcome was subsequent treatment for nonfatal
      coronary ischemia, stroke, transient ischemic attack, heart failure or
      thromboembolism. RESULTS: Of 28 442 women who received fertility therapy, 9349
      (32.9%) subsequently gave birth and 19 093 (67.1%) did not. The median number of 
      fertility treatments was 3 (interquartile range 1-5). We identified 2686
      cardiovascular events over a median 8.4 years of follow-up. The annual rate of
      cardiovascular events was 19% higher among women who did not give birth after
      fertility therapy than among those who did (1.08 v. 0.91 per 100 patient-years, p
      < 0.001), equivalent to a 21% relative increase in the annual rate (95%
      confidence interval 13%-30%). We observed no association between event rates and 
      number of treatment cycles. INTERPRETATION: Fertility therapy failure was
      associated with an increased risk of long-term adverse cardiovascular events.
      These women merit surveillance for subsequent cardiovascular events.
CI  - (c) 2017 Canadian Medical Association or its licensors.
FAU - Udell, Jacob A
AU  - Udell JA
AD  - Women's College Hospital and Toronto General Hospital (Udell), University of
      Toronto; Institute for Clinical Evaluative Sciences (Udell, Lu); Department of
      Medicine (Redelmeier), Sunnybrook Health Sciences Centre, University of Toronto; 
      Evaluative Clinical Sciences (Redelmeier), Sunnybrook Research Institute,
      Toronto, Ont. [email protected]
FAU - Lu, Hong
AU  - Lu H
AD  - Women's College Hospital and Toronto General Hospital (Udell), University of
      Toronto; Institute for Clinical Evaluative Sciences (Udell, Lu); Department of
      Medicine (Redelmeier), Sunnybrook Health Sciences Centre, University of Toronto; 
      Evaluative Clinical Sciences (Redelmeier), Sunnybrook Research Institute,
      Toronto, Ont.
FAU - Redelmeier, Donald A
AU  - Redelmeier DA
AD  - Women's College Hospital and Toronto General Hospital (Udell), University of
      Toronto; Institute for Clinical Evaluative Sciences (Udell, Lu); Department of
      Medicine (Redelmeier), Sunnybrook Health Sciences Centre, University of Toronto; 
      Evaluative Clinical Sciences (Redelmeier), Sunnybrook Research Institute,
      Toronto, Ont.
LA  - eng
PT  - Journal Article
PL  - Canada
TA  - CMAJ
JT  - CMAJ : Canadian Medical Association journal = journal de l'Association medicale
      canadienne
JID - 9711805
PMC - PMC5359104
EDAT- 2017/04/08 06:00
MHDA- 2017/04/08 06:00
CRDT- 2017/04/08 06:00
PHST- 2016/11/29 [accepted]
AID - 189/10/E391 [pii]
AID - 10.1503/cmaj.160744 [doi]
PST - ppublish
SO  - CMAJ. 2017 Mar 13;189(10):E391-E397. doi: 10.1503/cmaj.160744.

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