Lifetime cumulative effect of reproductive factors, "Life's essential 8" health status and risk of chronic kidney disease: a nationwide prospective cohort study.
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Xu Xiaoli, Xu Yuchen, Ding Yi, Zhu Yuanyue, Xu Yiping, Xu Min, Xu Yu, Wang Tiange, Chen Yuhong, Wang Shuangyuan, Lin Hong, Zhao Zhiyun, Lu Jieli, Zheng Jie, Qin Guijun, Yan Li, Shi Lixin, Gao Zhengnan, Chen Lulu, Zeng Tianshu, Hu Ruying, Ye Zhen, Yu Xuefeng, Chen Gang, Su Qing, Mu Yiming, Tang Xulei, Wan Qin, Wang Guixia, Liu Yan, Shen Feixia, Luo Zuojie, Qin Yingfen, Chen Li, Huo Yanan, Li Qiang, Zhang Yinfei, Liu Chao, Wang Youmin, Wu Shengli, Yang Tao, Li Qifu, Deng Huacong, Zhao Jiajun, Ning Uang, Wang Weiqing, Hu Weiguo, Bi Yufang, Li Mian
Аннотация
METHODS: The study included 33,700 postmenopausal participants from the China Cardiometabolic Disease and Cancer Cohort (4 C) Study, enrolled between 2011 and 2012 with follow-up assessments conducted between 2014 and 2016 (median follow-up: 3.1 years). Lifetime cumulative estrogen exposure due to reproductive factors was evaluated through reproductive lifespan (RLS), endogenous estrogen exposure (EEE), and total estrogen exposure (TEE). Health behaviors information in Life's Essential 8 (LE8) was collected by questionnaire and laboratory examination. The risk of CKD was analyzed with Cox proportional hazards models.
RESULTS: Shorter lifetime cumulative estrogen exposure was associated with an increased risk of CKD (RLS, HR: 1.42, 95% CI: 1.19-1.70; EEE, HR: 1.39, 95% CI: 1.12-1.72; TEE, HR: 1.28, 95% CI: 1.06-1.54). Moreover, the risk decreased gradually with increasing number of optimal cardiovascular health metrics (OCVHMs). Participants with shorter duration of lifetime cumulative estrogen exposure combined with 5 or more OCVHMs no longer conferred risk for incident CKD (RLS, HR: 1.01, 95% CI: 0.70-1.47; EEE, HR: 1.15, 95% CI: 0.80-1.65; TEE, HR: 0.95, 95% CI: 0.65-1.37).
CONCLUSIONS: Shorter lifetime cumulative estrogen exposure was correlated with an elevated risk of CKD. It should be encouraged for postmenopausal women to preserve good CVH status for prevention of CKD.