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Recurrent Miscarriage Factors May Increase Heart Attack Risk
Repeated miscarriages may cause more than the grief of losing a pregnancy. A new study published in the journal Heart has found a strong correlation between recurrent miscarriage and subsequent heart attacks, giving doctors another important indicator for monitoring cardiovascular risk factors for female patients.
According to Dr. Bruce Albrecht, a fertility doctor at Albrecht Women’s Care fertility clinic in Colorado, the results from this study can affect the way in which women are screened for heart disease.
“If we consider women who experience repeated pregnancy losses to be at high risk for cardiovascular disease, then the take-home message is that the known modifiable risk factors of cardiovascular disease should be controlled in these women, even when they are young and have no symptoms of heart disease,” he says.
The Study Linking Miscarriage to Heart Attack
The study analyzed data over 10 years of more than 11,500 women participating in the European Prospective Investigation into Cancer and Nutrition cohort in Heidelberg, Germany. Researchers found that 25 percent of the woman had at least one miscarriage. But when looking at repeated miscarriages, the researchers found that women who had more than three spontaneous miscarriages had a ninefold increased risk of heart attack.
The lead author of the study, Dr. Elham Kharazmi of the German Cancer Research Center, refers to earlier studies that found a link between stillbirth and mothers with hypertensive disorders, gestational diabetes and obesity.
“We infer that stillbirth is an outcome due to the underlying risk factors of cardiovascular disease (CVD), rather than a causative risk factor of (heart disease),” Kharazmi says. “Given the importance of the placental function for the risk of miscarriage, it may be speculated that women with a tendency for repeated miscarriage may also be at a higher risk of vascular disease later in life.”
According to the data analyzed during the study, each miscarriage increased a woman’s risk of heart attack by 40 percent. Women who had at least one stillbirth were about 3.5 times as likely to suffer a heart attack.
When the researchers adjusted the data for known factors of heart attack, such as smoking, weight, and alcohol consumption, there was still a higher risk for heart attack with repeated miscarriage. When factoring in this data, women with multiple miscarriages still had a risk of heart attack that was about five times greater than average.
Miscarriage and Heart Attack Factors
The study controlled for some of the factors related to both miscarriage and heart attack, and still found an increased risk. The study adjusted for miscarriage and heart attack causes, including high blood pressure, diabetes and blood vessel dysfunction.
However, Albrecht states that the study did not control for other disorders that can increase the likelihood of miscarriage and heart attack later in life, including polycystic ovarian syndrome (PCOS), chlamydia and coagulopathies/thrombophillias.
- Polycystic Ovarian Syndrome (PCOS): According to the U.S. Department of Health and Human Services Office on Women’s Health, studies have shown that women with PCOS have a risk of heart attack that is four to seven times higher than women of the same age who do not have PCOS. Women with PCOS may have a higher rate of miscarriage because of elevated levels of luteinizing hormones, insulin or glucose.
- Chlamydia: According to Albrecht, infections like chlamydia can contribute to plaque buildup in the arteries, which can lead to heart attack. Chlamydia, a sexually transmitted disease caused by bacteria that can damage a woman’s reproductive system, can also cause pelvic inflammatory disease and ectopic pregnancy.
- Thrombophilia: Thrombophilia, a genetic blood clotting disorder, is a significant risk factor for miscarriage, especially after the first trimester, since it may cause blood clots to the placenta. Albrecht says that thrombophilia can also cause heart attack by increasing the risk of blood clots on plaque in cardiac vessels.
According to Albrecht, all of the risks of miscarriage that can also cause heart attacks were not controlled for in the study.
“When the obvious cardiovascular risk factors were controlled for, the risk for (heart attacks) decreased; and perhaps if these other factors had also been evaluated and controlled for, the increased risk of (heart attacks) in patients with pregnancy losses might have disappeared,” he says.
Future Implications of the Miscarriage and Heart Attack Study
So what is the takeaway from this study? Albrecht says there are a number of lifestyle modifications that can reduce the risks of both miscarriage and heart attack.
“Many of these factors involve lifestyle modification such as weight loss or control, moderate exercise, healthy diet, increased antioxidant intake in the form of fresh fruits and vegetables,” he says. “Incidentally, some of these factors may also reduce the risk for pregnancy losses.”
According to Kharazmi, the results from this study show the need for further research on the gender-specific risk factors for heart disease, including those related to recurrent miscarriage.
“Although we are aware of gender-related differences in CVD, most of our knowledge about CVD and management guidelines in women arise from studies conducted mostly in men,” he says. “The increasing prevalence of cardiovascular pathology in women shows the substantial need for identification of those variables specifically relevant to cardiovascular health in women.”