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Abstract：
BACKGROUND: Heavy menstrual bleeding (HMB) is a common menstrual disorder associated with multiple risk factors of cardiovascular disease (CVD) in women. In addition, HMB is often present with irregular menstruation (IM) which is a risk factor for CVD outcomes. However, the relationship between HMB and CVD outcomes is unexplored in the presence or absence of IM. We determined the association of HMB with multiple CVD outcomes using a nationally representative sample of female hospitalizations in the US.
METHODS: All hospitalizations of females with HMB diagnosis and normal menstrual cycles from ages of 18 to 70 years were extracted from the National Inpatient Sample Database, 2017. The HMB was defined using the International Classification of Diseases (ICD)-10 for excessive and frequent menstruation bleeding and included any current or history of HMB diagnosis. Outcomes including major adverse cardiovascular events (MACE), coronary heart disease (CHD), stroke, heart failure (HF), atrial fibrillation (AF) or arrhythmia, myocardial infarction (MI), and diabetes (DM) were defined using ICD-10 codes. Adjusted logistic regression and prosperity scores-matched logistic regression analyses were conducted to summarize adjusted associations with an odds ratio (OR) and a 95% confidence interval (CI).
RESULTS: Among 2,430,851 hospitalizations, HMB was observed in 7762 (0.68%) females with age ≤ 40 years and 11,164 (0.86%) females with age > 40 years. Among hospitalizations with age ≤ 40 years, HMB was significantly associated with increased odds of CVD outcomes including MACE (OR = 1.61; 95% CI: 1.25, 2.08), CHD (OR = 1.72; 95% CI: 1.10, 2.71), stroke (OR = 1.95; 95% CI: 1.12, 3.40), HF (OR = 1.53; 95% CI: 1.15, 2.03), and AF/arrhythmia (OR = 1.84; 95% CI: 1.34, 2.54). These associations were confirmed in multiple sensitivity analyses. In contrast, HMB was not robustly associated with CVD events among hospitalizations of women with age > 40 years. 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 in hospitalizations of young women.
CONCLUSIONS: HMB is associated with CVD events among US hospitalizations of young women. A routine investigation and screening of menstrual disorders, especially HMB, is useful for CVD risk stratification and management in young women.
METHODS: All hospitalizations of females with HMB diagnosis and normal menstrual cycles from ages of 18 to 70 years were extracted from the National Inpatient Sample Database, 2017. The HMB was defined using the International Classification of Diseases (ICD)-10 for excessive and frequent menstruation bleeding and included any current or history of HMB diagnosis. Outcomes including major adverse cardiovascular events (MACE), coronary heart disease (CHD), stroke, heart failure (HF), atrial fibrillation (AF) or arrhythmia, myocardial infarction (MI), and diabetes (DM) were defined using ICD-10 codes. Adjusted logistic regression and prosperity scores-matched logistic regression analyses were conducted to summarize adjusted associations with an odds ratio (OR) and a 95% confidence interval (CI).
RESULTS: Among 2,430,851 hospitalizations, HMB was observed in 7762 (0.68%) females with age ≤ 40 years and 11,164 (0.86%) females with age > 40 years. Among hospitalizations with age ≤ 40 years, HMB was significantly associated with increased odds of CVD outcomes including MACE (OR = 1.61; 95% CI: 1.25, 2.08), CHD (OR = 1.72; 95% CI: 1.10, 2.71), stroke (OR = 1.95; 95% CI: 1.12, 3.40), HF (OR = 1.53; 95% CI: 1.15, 2.03), and AF/arrhythmia (OR = 1.84; 95% CI: 1.34, 2.54). These associations were confirmed in multiple sensitivity analyses. In contrast, HMB was not robustly associated with CVD events among hospitalizations of women with age > 40 years. 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 in hospitalizations of young women.
CONCLUSIONS: HMB is associated with CVD events among US hospitalizations of young women. A routine investigation and screening of menstrual disorders, especially HMB, is useful for CVD risk stratification and management in young women.
摘要：
背景：大量月经出血（HMB）是女性常见的月经紊乱，与心血管疾病（CVD）的多种危险因素相关。此外,HMB常伴有月经不调（IM），这是CVD结局的危险因素。然而,在存在或不存在IM的情况下，HMB与CVD结局之间的关系尚未被研究。我们使用美国女性住院的全国代表性样本确定了HMB与多种CVD结局的关联。
方法：从国家住院患者样本数据库中提取所有年龄为18至70岁的诊断为HMB且月经周期正常的女性住院患者，2017.使用国际疾病分类(ICD)-10定义HMB用于过量和频繁的月经出血,并且包括HMB诊断的任何当前或病史。结果包括主要不良心血管事件（MACE），冠心病,中风,心力衰竭(HF),心房颤动（AF）或心律失常，心肌梗死（MI），和糖尿病（DM）使用ICD-10代码定义。进行了调整后的逻辑回归和繁荣评分匹配的逻辑回归分析，以总结具有优势比（OR）和95％置信区间（CI）的调整后关联。
结果：在2,430,851例住院患者中，在年龄≤40岁的7762名(0.68%)女性和年龄>40岁的11,164名(0.86%)女性中观察到HMB。在年龄≤40岁的住院患者中，HMB与包括MACE在内的CVD结局的几率增加显著相关(OR=1.61;95%CI:1.25,2.08),冠心病（OR=1.72；95%CI：1.10，2.71），中风（OR=1.95；95%CI：1.12，3.40），HF（OR=1.53；95%CI：1.15，2.03），和AF/心律失常（OR=1.84；95%CI：1.34，2.54）。这些关联在多重敏感性分析中得到证实。相比之下,在年龄>40岁的女性住院患者中，HMB与CVD事件并不密切相关。没有IM的HMB与DM密切相关，HF,AF,和MACE结局,而合并IM的HMB与年轻女性住院的CHD和AF结局密切相关。
结论：在美国住院的年轻女性中，HMB与CVD事件相关。月经紊乱的常规调查和筛查，尤其是HMB,对于年轻女性的CVD风险分层和管理是有用的。
方法：从国家住院患者样本数据库中提取所有年龄为18至70岁的诊断为HMB且月经周期正常的女性住院患者，2017.使用国际疾病分类(ICD)-10定义HMB用于过量和频繁的月经出血,并且包括HMB诊断的任何当前或病史。结果包括主要不良心血管事件（MACE），冠心病,中风,心力衰竭(HF),心房颤动（AF）或心律失常，心肌梗死（MI），和糖尿病（DM）使用ICD-10代码定义。进行了调整后的逻辑回归和繁荣评分匹配的逻辑回归分析，以总结具有优势比（OR）和95％置信区间（CI）的调整后关联。
结果：在2,430,851例住院患者中，在年龄≤40岁的7762名(0.68%)女性和年龄>40岁的11,164名(0.86%)女性中观察到HMB。在年龄≤40岁的住院患者中，HMB与包括MACE在内的CVD结局的几率增加显著相关(OR=1.61;95%CI:1.25,2.08),冠心病（OR=1.72；95%CI：1.10，2.71），中风（OR=1.95；95%CI：1.12，3.40），HF（OR=1.53；95%CI：1.15，2.03），和AF/心律失常（OR=1.84；95%CI：1.34，2.54）。这些关联在多重敏感性分析中得到证实。相比之下,在年龄>40岁的女性住院患者中，HMB与CVD事件并不密切相关。没有IM的HMB与DM密切相关，HF,AF,和MACE结局,而合并IM的HMB与年轻女性住院的CHD和AF结局密切相关。
结论：在美国住院的年轻女性中，HMB与CVD事件相关。月经紊乱的常规调查和筛查，尤其是HMB,对于年轻女性的CVD风险分层和管理是有用的。
