Reproductive factors and its association with peripheral arterial disease in women aged 52-81 years: the KORA F4 study

Atherosclerosis. 2013 May;228(1):224-9. doi: 10.1016/j.atherosclerosis.2013.01.035. Epub 2013 Feb 5.


Objective: Sex differences in the onset of cardiovascular disease disappear in the postmenopause, suggesting that reproductive factors could be influential. The aim of the present study was to examine the possible association between reproductive parameters and peripheral arterial disease (PAD) in a female population-based sample.

Methods: In this cross-sectional study data of 887 women aged 52-81 years participating in the population-based KORA F4 study (conducted in 2006-2008) was analyzed. Reproductive parameters were obtained by standardized interviews. PAD was assessed by measuring noninvasively the ankle-brachial index and using a cut-off value of 0.9 and by assessing the presence of claudication by the Edinburgh questionnaire.

Results: In multivariable logistic regression analyses later age at menarche (>15 years) compared to age at menarche between 12 and 15 years was significantly associated with about half the probability for PAD (OR = 0.48; 95%CI 0.24-0.98). The presence of hot flashes was positively associated with PAD (OR = 2.09; 95%CI 1.11-3.92). Further reproductive parameters, such as parity, age at menopause, time since menopause, duration of fertility, ever use or current use of hormone replacement therapy, ever use of oral contraceptives, history of hysterectomy, bilateral oophorectomy and depressive mood in relation to menopausal transition showed no significant association with PAD.

Conclusions: Later age at menarche was inversely related to PAD and the presence of hot flashes was associated with an increased presence of PAD. Prospective population-based studies in women are needed to assess the impact of reproductive parameters on the development of PAD and subsequently cardiovascular disease.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Ankle Brachial Index
  • Contraceptives, Oral / therapeutic use
  • Cross-Sectional Studies
  • Depressive Disorder / epidemiology
  • Female
  • Hot Flashes / epidemiology
  • Hot Flashes / physiopathology
  • Humans
  • Hysterectomy / statistics & numerical data
  • Logistic Models
  • Menarche / physiology
  • Menopause / physiology*
  • Middle Aged
  • Multivariate Analysis
  • Ovariectomy / statistics & numerical data
  • Peripheral Arterial Disease / epidemiology*
  • Peripheral Arterial Disease / physiopathology*
  • Reproduction / physiology*
  • Risk Factors
  • Sex Characteristics
  • Surveys and Questionnaires


  • Contraceptives, Oral