Heart：流产与后续冠心病风险升高相关

　　英国学者的一项荟萃分析表明，流产病史或复发性流产与后续冠心病风险升高具有相关性。论文于2013年3月28日在线发表于《心脏》（Heart）。

　　研究者检索了PubMed、Web of Knowledge和Scopus数据库，并确认了在其他方面健康女性中评估流产和后续心血管疾病相关性的研究。利用随机效应meta分析计算冠心病和心血管疾病的综合相关指标。评估发表偏倚和研究间异质性。

　　结果显示，共有10项研究符合纳入标准；冠心病和心血管疾病荟萃分析分别纳入517,504和134,461例受试者。流产病史与冠心病形成机率升高具有相关性（OR= 1.45），但与脑血管疾病无关。复发性流产和冠心病具有显著相关性（OR=1.99）。在冠心病分析中，研究间异质性和发表偏倚均呈中度。

与冠心病相关的拓展阅读：

• Heart：流产与后续冠心病风险升高相关
• Eur Heart J：常见遗传变异可影响血脂水平和冠心病风险
• AIM：慢性肾病是冠心病的危险因素
• NEJM：Dalcetrapib对近期有急性冠脉综合征的稳定性冠心病患者的疗效
• Heart：贫富阶层冠心病负担差异大
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Miscarriage and future maternal cardiovascular disease: a systematic review and meta-analysis

Context 

The 2011 American Heart Association guidelines identified pregnancy complications as a risk factor for cardiovascular disease in women. However, miscarriage was not mentioned within the guidelines, and there is no consensus on the association between miscarriage and future risk of cardiovascular disease.

Objective 

To confirm or refute the association, a meta-analysis of published papers was conducted.

Data sources 

PubMed, Web of Knowledge and Scopus were systematically searched to identify appropriate articles. Reference lists were then hand searched for additional relevant titles.

Study Selection 

To be included, articles had to assess the association between miscarriage and subsequent cardiovascular disease in otherwise healthy women. Only women who had miscarriages were considered exposed. Pooled association measures, using random effects meta-analysis, were calculated for coronary heart disease and cerebrovascular disease. Publication bias and between-study heterogeneity were evaluated.

Data Extraction 

Two authors individually reviewed all studies and extracted data on patient and study characteristics along with cardiovascular outcomes.

Results 

10 studies were identified, with 517 504 individuals included in the coronary heart disease meta-analysis and 134 461 individuals in the cerebrovascular disease analysis. A history of miscarriage was associated with a greater odds of developing coronary heart disease, OR (95% CI) =1.45 (1.18 to 1.78), but not with cerebrovascular disease, OR=1.11 (0.72 to 1.69). There was a strong association between recurrent miscarriage and coronary heart disease OR=1.99 (1.13 to 3.50). Evidence was found for moderate between-study heterogeneity and publication bias in the coronary heart disease analysis.

Conclusions 

The meta-analysis indicates that a history of miscarriage or recurrent miscarriage is associated with a greater risk of subsequent coronary heart disease.