Association of heavy menstrual bleeding with cardiovascular diseases in US female hospitalizations

Abstract

BACKGROUNDHeavy menstrual bleeding (HMB) is a common type of menstrual disorder that causes social and mental distress leading to a variety of health problems. Although limited evidence highlights the links between HMB and metabolic abnormalities, the association between HMB and CVD outcomes is unknown in the presence or absence of comorbid irregular menstruation (IM).METHODSAll female hospitalizations between the ages of 12 to 40 years were identified using the National Inpatient Sample database in 2017 and grouped into HMB and no menstrual disorders. Outcomes including major adverse cardiovascular events (MACE), coronary heart disease (CHD), stroke/cerebrovascular accident (CVA), heart failure (HF), arterial fibrillation (AF) or arrhythmia, myocardial infarction (MI), and diabetes (DM) were extracted using ICD-10 codes. Adjusted logistic regression models were conducted to summarize associations with an odds ratio (OR) along with a 95% confidence interval (CI).RESULTSIn the entire cohort, 8,291 (0.69%) had an HMB diagnosis including 1623 (0.14%) with IM and 6668 (0.55%) without IM. In the fully adjusted analysis, HMB was significantly associated with most CVD outcomes, including MACE (OR=1.61; 95% CI: 1.38, 1.88, p<0.001), CHD (OR=1.88; 95% CI: 1.52, 2.31, p<0.001), Stroke/CVA (OR=1.51; 95% CI: 1.1, 2.07, p=0.011), HF (OR=1.60; 95% CI: 1.33, 1.92, p<0.001), AF/arrhythmia (OR=1.93; 95% CI: 1.16, 2.45, p=0.006), and DM (OR=1.45; 95% CI: 1.33, 1.58), p<0.001). HMB without IM was strongly associated with DM, HF, AF, and MACE outcomes while HMB with IM was strongly associated with CHD and AF outcomes.CONCLUSIONSHMB is independently and strongly associated with CVD events among US hospitalizations of young women. Our findings suggest promoting increased awareness, early detection, and optimum management of HMB to avoid adverse CVD outcomes.Clinical PerspectiveWhat Is New?Although menstruation dysfunction is associated with cardiovascular disease (CVD), the relationship between heavy menstrual bleeding (HMB) and CVD outcomes is not evaluated.In a US sample of 1,204,715 hospitalized women, HMB was independently and strongly associated with major adverse cardiovascular events and coronary heart disease.HMB without irregular menstruation was markedly associated with CVD outcomes than HMB with irregular menstruation.What Are the Clinical Implications?Our findings support that HMB as an early vital sign for CVD outcomes among young women. A routine investigation and screening of menstrual disorders, especially HMB, and its effective management is useful for the prevention of CVD risk in women.