Background: Cardiovascular disease (CVD) deaths occur in women without traditional risk factors. While estrogen is known to protect against CVD, it is not used in risk assessment due to challenges in precisely capturing lifetime exposure. Reproductive history, a common surrogate measure, is associated with increased CVD though evidence is inconsistent due to differential inclusion of reproductive events, oral contraceptives, and hormone replacement therapy in studies.

Objective: Utilize timing of reproductive events (menarche, pregnancies, live births, breastfeeding, and oral contraceptive use) to calculate years of unopposed estrogen exposure to examine their combined effect on CVD risk in women.

Methods: Years of lifetime estrogen exposure was calculated using 1994-2007 data from the Study of Women's Health Across the Nation (SWAN), a longitudinal study of 3,302 women throughout the United States. Logistic regression was used to quantify the association between reproductive history and incident CVD (coronary heart disease, stroke, angina, and heart attacks), adjusting for age, smoking, race/ethnicity, and hormone replacement therapy, and ATP-III risk factors.

Results: Odds of CVD among women in the 25^th percentile or lower of lifetime estrogen exposure (≤25.1 years) were almost three times greater than for women with higher exposure (OR=2.68, 95% CI: 1.15-6.25). Additional adjustment for hyperglycemia, waist circumference, and BMI attenuated the effect slightly, but the association remained significant (OR=2.56, 95% CI: 1.10-5.96).

Conclusion: Reproductive history is a promising independent measure for CVD risk and its use may enhance CVD prevention strategies for women who would otherwise be missed by relying solely on conventional factors.

Background: The impact of multimorbidity on health-related quality of life (HRQoL) is unknown. Our aim is to evaluate the difference in HRQoL between multimorbid and non-multimorbid adults, as well as its variation throughout the life course.

Methods: Multimorbidity (individuals with two or more chronic conditions) was identified among adults ≥18 years of age in the 2013 - 2014 nationally-representative Medical Expenditure Panel Survey data. HRQoL was measured using the SF-12v2 Health Survey. The overall, mental component (MCS) and physical component (PCS) scores were calculated among young (18-35), middle-aged (35-65), and older (65+) adults. Impact of multimorbidity on HRQoL was assessed through mean score differences between multimorbid and non-multimorbid adults. Linear regression was used to examine the impact of multimorbidity and age on the overall, MCS, and PCS scores, adjusted for sociodemographic variables. All estimates were weighted to represent the national census-based population.

Results: Adults with multimorbidity had significantly overall lower HRQoL (-12.01;95%CI-12.68--11.33), PCS (-8.59%CI-9.04—8.15), and MCS (-3.42;95%CI:-3.86—2.97) compared to those without. Only middle-aged adults had lower overall HRQoL (b=-3.08;p<.01) when compared to young adults. Middle-aged (b=-3.23;p<.01) and older adults (b=-4.14;p<.01) had lower PCS scores when compared to young adults. However, older adults had higher MCS scores (b=4.05;p<0.01) than young adults.

Conclusion: Multimorbidity affects adults at increasingly younger ages, and has a significant impact on overall HRQoL. The variation on the perception of mental and physical wellbeing is differential by age group , with mental components having a higher impact among younger adults.

Background. Hypertension is known to be the major risk of cardiovascular diseases. The development of high blood pressure in young adulthood has been rarely studied.

This study aims to examine the development of blood pressure from age 30 to 50 years, and the underline metabolic profiles at baseline.

Method. Data came from the MJ Health Screening Center. There were 78,816 men and 74,936 between age 30 and 50, and had at least two measures of blood pressures. Group-based trajectory modeling was used to identify clusters of blood pressures based on the longitudinal measurements. After groups were identified, their baseline characteristics were compared using ANOVA.

Results. Four groups were identified in men and women. Two persistently high groups were identified in men, one was around 130 mmHg and increasing slowly, the other was higher than 140 mmHg all the time. In women, only one group started with 130 mmHg and increased to ~150 mmHg at 50 years old. Baseline BMI, waist hip ratio, fasting glucose, triglycerides, total cholesterol, uric acid, %body fat already significantly different in 4 groups of men. Similar results were found in women.

Discussion. Metabolic profile existed difference in 30 years old, even they might not reach disease status. Attention should be given in young adults with higher values in metabolic profiles.

Background. Significant socioeconomic differences in health begin to emerge as early as young adulthood. Socioeconomic position (SEP) is considered a key determinant of health as the relationship between SEP and health has been well-documented. However, the time-varying relationship between different indices of SEP and health outcomes during young adulthood are not well known.

Objective. This study aims to investigate the relationship between SEP and health using 18-year evidence from a national representative survey.

Method. Data were drawn from the National Longitudinal Survey of Youth 1997 (NLSY 97). Three data points were included, when respondents were aged 20, 25, and 30. The primary dependent variable was dichotomized self-rated health (SRH). SEP indicators included net worth, household income, education, income-to-poverty ratio, and employment status. Sociodemographic factors that were adjusted age, gender, race/ethnicity, census region, urbanicity, and health insurance. The final sample size was 6,945. Two-level logistic regression was performed.

Results. Each ten thousand dollars increase in net worth increased the likelihood of having excellent/very good/good health by a factor of .037 (95% CI: 1.022, 1.053). Each additional year of education was associated with higher likelihood of excellent/very good/ good SRH (OR: 1.355, 95% CI: 1.243, 1.478). Household income was not significantly associated with SRH.

Conclusion. This study examined how time-varying SEP indicators were correlated with SRH during young adulthood. Findings from this study indicate that there are notable SEP and racial/ethnic differences in health that emerge in early adulthood. These findings also demonstrate how the patterning of SRH differs by SEP indicators.