Race Differences in Vascular Health Persist After Adjustment for Reproductive History in Midlife Women: A SWAN Analysis.

INTRODUCTION

Cardiovascular disease is the leading cause of death among women, and non-Hispanic Black (NHB) women exhibit accelerated vascular aging compared with non-Hispanic White (NHW) women. Traditional risk factors do not fully explain these racial disparities, prompting increased interest in reproductive history as a potential contributor. We examined race differences in reproductive history and their contribution to vascular health among midlife women using data from the Study of Women's Health Across the Nation (SWAN).

METHODS

Using cross-sectional SWAN data, 2,935 postmenopausal participants (N = 1,108 NHB, 1,827 NHW) were analyzed. Vascular health was assessed using pulse pressure (PP), estimated pulse wave velocity (ePWV), and estimated vascular overload index (eVOI). Reproductive history outcomes included age at menarche, age at first and last pregnancy, parity, breastfeeding duration, and menopause symptom count. Multivariate linear regression models evaluated whether reproductive history attenuated race differences in vascular health, adjusting for age, body mass index (BMI), and smoking status.

RESULTS

Despite similar chronological age, NHB women exhibited greater PP, ePWV, and eVOI compared with NHW women (p < 0.001 for all). NHB women also reported a younger age at first and last pregnancy, higher parity, and shorter breastfeeding duration compared with NHW women (p < 0.002 for all). Older age, higher BMI, and current smoking status were independently associated with accelerated vascular health across all models. Reproductive history outcomes were not associated with any vascular health indices, and inclusion of these variables did not attenuate race differences. NHB race remained a significant predictor of vascular health across all models.

CONCLUSIONS

Race differences in vascular health are not explained by differences in reproductive history and persist even after adjustment for traditional risk factors. These findings merit future research on other structural and psychosocial determinants of accelerated vascular health in NHB women.