ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Reproduction
This article is part of the Research TopicOptimizing Women's Health through Exercise Prescription and Physiological Assessments across Life StagesView all 4 articles
Composite Cardiovascular Health Indices (LE8 & LC9) and Female Infertility: A NHANES‑Based Predictive Modeling Study
Provisionally accepted
- First People's Hospital of Datong, Datong, China
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Background: Female infertility affects 10–15% of couples worldwide and is influenced by multiple factors, including cardiovascular and metabolic health. This study examines the association between composite cardiovascular health indices—Life's Essential 8 (LE8) and Life's Crucial 9(LC9)—and the risk of infertility. Methods: We analyzed data from the NHANES 2013–2018, including 2,360 women aged 20– 45. We conducted a cross-sectional analysis of NHANES 2013–2018, including 2,360 women aged 20–45 years, and incorporated complex survey weights. We used survey‑weighted multivariable logistic regression, restricted cubic splines (RCS), and subgroup/interaction analyses. For prediction, we applied LASSO with 10‑fold cross‑validation, followed by multivariable logistic regression to construct a nomogram. Discrimination (AUC with 95% CI), bootstrap calibration (1,000 resamples), and decision curve analysis (DCA) were reported. Results: n fully adjusted models, LE8 Q4 vs Q1 OR 0.39 (95% CI 0.26–0.58) and LC9 Q4 vs Q1 OR 0.43 (0.29–0.65) (p‑trend < 0.001). Associations were stronger among women without hypertension and with a BMI < 30kg/m ² . The nomogram demonstrated moderate discrimination (AUC 0.691, 95% CI 0.668–0.714) with good internal calibration; however, external validation was not available. Conclusion: Better composite cardiovascular health—captured by LE8 and LC9—is associated with lower prevalence of self‑reported infertility. Given the cross‑sectional design and moderate AUC without external validation, causality cannot be inferred, and clinical utility is limited; prospective studies are warranted.
Keywords: Female infertility, Cardiovascular health, Life's Essential 8, Life's Crucial 9, Insulin Resistance, Inflammation, reproductive function
Received: 21 Feb 2025; Accepted: 06 Nov 2025.
Copyright: © 2025 Duan, Liu, Li and Gao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yanping Gao, yukunduan1984@qq.com
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