Background: Cardiovascular disease (CVD), the most common cause of death in most developed countries, have gender-specific characteristics. Protective effect of endogenous estrogen for CVD is established. In older ages, women have similar rates of CVD, and even a higher prevalence of hypertension than that of men. Although CVD is considered as a man s disease , CVD kills more women. Most of our knowledge about management guidelines for CVD in women arise from studies conducted mostly in men. The increasing number of women with CVD shows the substantial need for identification of those specific variables relevant to cardiovascular health in women. Whether pregnancy-related factors and hysterectomy would reveal some of these variables and risk for CVD, is still uncertain.

Objective: To further elucidate the associations between reproduction, hysterectomy, and risk of CVD in women. Materials and methods: Data were obtained from Health 2000 study, a cross-sectional comprehensive survey carried out in 2000-1 in Finland, except for Study II. Study I comprised 746 Finnish women aged 45-74, in which associations of reproductive history (assessed by questionnaire) and measures of subclinical atherosclerosis (by ultrasonographic detection) were studied. In Study III, associations between pregnancy-related factors and isolated systolic hypertension (ISH) were assessed in 3,937 Finnish women aged 30-99. In Study IV, data of 2,514 Finnish women aged 30-99 were used to investigate associations between hysterectomy and CVD.

A total of 4,090 Finnish women who delivered in the period 1954-1963 were followed up for an average of 44 years in Study II. Mortality data were obtained from the Finnish cause-of-death registry. Logistic, linear regression and Cox-proportional hazard models were used for analysis.

Results: Women with a history of stillbirth tended to have higher IMT than other women. A history of stillbirth was associated with an increased age-adjusted risk of plaque [Odd ratio (OR): 3.43, 95% CI: 1.07-11.05] but in the fully-adjusted model it lost its statistical significance (OR:2.73, 95% CI: 0.55-13.55). Cardiovascular mortality was significantly higher among women with systolic hypertension in early or late pregnancy than in normotensive subjects. Younger age at first delivery predicted a higher risk of ISH (OR after adjustment for age, height, weight diastolic blood pressure (BP), fasting blood glucose, low-density lipoprotein and total cholesterol, education, smoking, and physical activity: 1.04, 95 % CI: 1.01-1.06). Age at first and last delivery was significantly associated with age, education and marital status; age at first delivery was also associated with toxemia in any pregnancy, weight and BMI. Hysterectomy was significantly associated with hypertension, angina pectoris, stroke, age, education, oral contraceptive use, postmenopausal hormone therapy, BMI, fasting blood glucose, and cholesterol. The fully-adjusted ORs for associations between CVD and hysterectomy were dramatically lower than the crude ORs and remained significant only for medication for hypertension.

Conclusion: Hypertension in pregnancy and earlier age at first delivery may predict higher risk of CVD in later life. The adverse effect of child bearing and hysterectomy, as the most common non-obstetric surgery, on cardiovascular systems seems to be mediated by more adverse common known risk factors, rather than these factors per se. Pregnancy acts as an important screening opportunity for CVD. Further studies are needed to show whether risk of later CVD morbidity or mortality decreases with early intervention and precise control of common known risk factors of CVD in women who delivered in younger age or who had experienced pregnancy complication such as systolic hypertension.