Reproductive factors associated with cardiovascular risk among rural women: A community-based cross-sectional study from South India

Background: Cardiovascular disease (CVD) is the leading cause of mortality among women in low- and middle-income countries. Reproductive factors such as age at menarche, parity, and age at menopause may influence long-term cardiometabolic risk through cumulative hormonal exposure and metabolic changes. However, their independent contribution to CVD risk among rural South Indian postmenopausal women remains underexplored. Methods: A 2024 community-based cross-sectional study was conducted among 512 postmenopausal women aged 45–65 years in rural Coimbatore, Tamil Nadu, selected through multistage random sampling. Reproductive history was collected using structured interviews. Ten-year CVD risk was estimated using the Framingham risk score (FRS), with standardized anthropometric and fasting biochemical measurements. Multivariable logistic regression adjusted for major confounders assessed associations with high CVD risk (FRS ≥20%). Results: Mean age was 54.2 ± 6.1 years. Early menarche (<12 years) was associated with increased CVD risk (adjusted odds ratio [OR] 1.78; 95% confidence interval [CI] 1.09–2.91). High parity (≥4) was associated with elevated odds (adjusted OR 1.58; 95% CI 1.02–2.45). Early menopause (<45 years) was associated with the strongest risk (adjusted OR 2.32; 95% CI 1.52–3.54). Short reproductive lifespan (<30 years) also predicted higher risk (adjusted OR 2.05; 95% CI 1.31–3.21). Overall, 28.3% had high CVD risk. Conclusion: Reproductive history independently predicts elevated CVD risk among rural South Indian postmenopausal women and should be incorporated into primary-care prevention strategies. Early identification of high-risk women using reproductive markers may improve targeted screening and reduce long-term cardiovascular burden.