Women diagnosed with premenstrual disorders had a statistically significant increase in the risk of cardiovascular diseases, according to a nationwide Swedish cohort study conducted from 2001 to 2022.
The study included 99,411 women diagnosed with premenstrual disorders (PMDs) and 947,263 matched women without PMDs in the population cohort. The sibling cohort included 36,061 women with PMDs and 45,451 of their sisters without PMDs.
During a median follow-up of 6.2 years, researchers identified 8,944 cardiovascular events among women with PMDs–an incidence rate of 12.15 per 1,000 person-years)–compared with 73,798 events among women without PMDs (10.67 per 1,000 person-years). The adjusted hazard ratio (HR) for any CVD was 1.11 (95% confidence interval [CI] = 1.08–1.13) in the population cohort and 1.10 (95% CI = 1.06–1.15) in the sibling cohort.
In the sibling cohort, which was designed to control for shared familial and genetic factors, patients diagnosed before age 25 had a hazard ratio of 1.41 (95 percent CI, 1.09 to 1.82). Those with both premenstrual disorders and perinatal depression had a hazard ratio of 1.68 (95 percent CI, 1.27 to 2.22). These findings suggest that the increased cardiovascular risk is unlikely to be explained solely by familial confounding.
Researchers reported increased risk across specific CVD subtypes. In the population analysis, PMDs were associated with arrhythmia (HR = 1.31; 95% CI = 1.25–1.37), ischemic stroke (HR = 1.18; 95% CI = 1.08–1.28), ischemic heart disease (HR = 1.13; 95% CI = 1.04–1.23), and cerebrovascular disease (HR = 1.11; 95% CI = 1.04–1.19). These associations were consistent in the sibling analysis, where the HR for ischemic stroke was 1.27 (95% CI = 1.08–1.50).
The study accounted for multiple confounders including birth year, county of residence, educational level, country of birth, income, civil status, psychiatric history, hormonal contraceptive use, hormone replacement therapy, body mass index, smoking, parity, diabetes, asthma, autoimmune diseases, menstrual disorders, polycystic ovary syndrome, dyslipidemia, and medication use.
The data were drawn from Swedish national registers, including the Total Population Register, National Patient Register, Causes of Death Register, Prescribed Drug Register, and regional primary care databases.
“Our study illustrated that women who received a PMD diagnosis in specialist or primary care are at a higher risk of CVDs,” said Yihui Yang from the Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Results remained consistent across sensitivity analyses, including those limited to women with two PMD diagnoses ≥28 days apart and those residing in counties with primary care data.
The findings suggest that PMDs may indicate elevated cardiovascular risk, particularly among women diagnosed before age 25 or those with concurrent perinatal depression. Further research is warranted to validate these findings and explore implications for cardiovascular risk stratification in women.
The authors reported no conflicts of interest.
Source: Nature Cardiovascular Research
