Abstract

Dysmenorrhea has been suggested as a risk factor for ischemic heart disease (IHD) in prior research; however, the evidence was limited by a single study that relied solely on coded diagnoses and lacked adjustment for key confounders. This study further explores the relationship between dysmenorrhea and IHD comparing different dysmenorrhea definition methods across three cohorts: Mount Sinai, All of Us (AoU), and the Australian Longitudinal Survey on Women’s Health (ALSWH). Dysmenorrhea was alternatively identified via diagnostic codes, a large language model-EHR phenotyping algorithm (LLM-EHR), and self-report. Hazard ratios (HR) for IHD were estimated with Cox regression models and propensity score matching. Diagnostic codes had a 37.3% false negative rate. The LLM-EHR and self-reported dysmenorrhea showed higher HRs (2.5 and 3.3) compared to diagnostic code definitions (1.5). The risk was higher in women of color and those with persistent dysmenorrhea since adolescence. These findings highlight the need to recognize dysmenorrhea’s impact beyond reproduction and call for greater clinical and research awareness.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This project was supported in part by a grant from the National Institute for Child Health and Human Development (NICHD) (R01HD10826), a grant from the National Library of Medicine (NLM) (R01 LM013766), and the Hasso Plattner Foundation (HPF).

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This study was approved by the Icahn School of Medicine at Mount Sinai's Institutional Review Board (Institutional Review Board 19-00951). The IRB has determined that this research involves no greater than minimal risk and approved the waiver for informed consent.

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Abbreviations30FRS30-Year Framingham Risk ScoreALSWHAustralian Longitudinal Study on Women’s HealthAoUAll of UsASCVDAtherosclerotic Cardiovascular DiseaseAUROCArea Under the Receiver Operating CurveBIPOCBlack, Indigenous and Other People of ColorC-IndexConcordance IndexcNRIContinuous Net Reclassification IndexDMDiabetes MellitusEHRElectronic Health RecordGDMGestational Diabetes MellitusHDPHypertensive Disorders of PregnancyHMBHeavy Menstrual BleedingHRHazard RatioHTNHypertensionIHDIschemic Heart DiseaseIMIrregular MenstruationLRTLog-Likelihood Ratio TestMSMount Sinai