American Heart Association ideal cardiovascular health score and subclinical atherosclerosis in 22–35-year-old adults conceived with and without assisted reproductive technologies
Authors: Juonala Markus , Lewis Sharon , McLachlan Robert , Hammarberg Karin , Kennedy Joanne , Saffery Richard , McBain John , Welsh Liam , Cheung Michael , Doyle Lex W , Amor David J , Burgner David P , Halliday Jane 
Published: November 2019

Abstract

STUDY QUESTION
Is ART related with the association of American Heart Association (AHA) ideal cardiovascular health score and markers of subclinical atherosclerosis?

SUMMARY ANSWER
The associations between AHA score and markers of subclinical atherosclerosis in ART and non-ART groups were similar in magnitude.

WHAT IS KNOWN ALREADY
Long-term consequences of ART on cardiovascular health are unknown.

STUDY DESIGN, SIZE, DURATION
The study cohort for the cross-sectional analyses consisted of 172 ART-conceived and 78 non-ART conceived individuals of same age (range 22–35 years).

PARTICIPANTS/MATERIALS, SETTING, METHODS
Cardiovascular risk factor status was evaluated with American Heart Association (AHA) ideal cardiovascular health score consisting of seven factors (body mass index, blood pressure, total cholesterol, glucose, diet and physical activity, non-smoking). Carotid artery intima-media thickness (cIMT), arterial pulse-wave velocity (PWV) and retinal microvascular parameters were evaluated as markers of early atherosclerosis. Group comparisons in continuous variables were performed with t-tests. For categorical variables, comparisons were performed with chi-square tests. The relationships between AHA score and the markers of atherosclerosis were examined with linear regression analyses adjusted for age and sex.

MAIN RESULTS AND THE ROLE OF CHANCE
There was no difference in AHA ideal health score between the ART and non-ART groups; mean (SD) scores were 4.1(1.4) versus 4.0(1.5), respectively, P = 0.65. No differences were observed between groups for any individual ideal health metric (P always &gt;0.2). AHA score was not associated with cIMT or retinal measures in either group (P always &gt;0.05). An inverse association was observed between AHA score and PWV in the ART group (beta (95% CI) −0.18(−0.26 to −0.10)). A numerically similar relationship was observed in the smaller non-ART group (−0.19(−0.39 to 0.01)).

LIMITATIONS, REASONS FOR CAUTION
Even though this cohort is among the largest ART studies with extensive cardiovascular data, the sample is still relatively small and the statistical power is limited. As the study population was still in early adulthood, we were not able to evaluate the associations with clinical cardiovascular events, but utilized non-invasive methods to assess early markers of subclinical atherosclerosis.

WIDER IMPLICATIONS OF THE FINDINGS
These findings suggest that ART-conceived individuals do not have increased vulnerability for cardiovascular risk factors.

STUDY FUNDING/COMPETING INTEREST(S)
This study was funded by a National Health & Medical Research Council Project Grant (APP1099641), The Royal Children’s Hospital Research Foundation, Monash IVF Research and Education Foundation, and Reproductive Biology Unit Sperm Fund, Melbourne IVF. The authors have no conflicts of interest relevant to this article to disclose.