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Zhang S, Liu R, Ma Y, Ma Y, Feng H, Ding X, Zhang Q, Li Y, Shan J, Bian H, Zhu R, Meng Q. Lactiplantibacillus plantarum ATCC8014 Alleviates Postmenopausal Hypercholesterolemia in Mice by Remodeling Intestinal Microbiota to Increase Secondary Bile Acid Excretion. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2024; 72:6236-6249. [PMID: 38484389 DOI: 10.1021/acs.jafc.3c08232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Hypercholesterolemia poses a significant cardiovascular risk, particularly in postmenopausal women. The anti-hypercholesterolemic properties of Lactiplantibacillus plantarum ATCC8014 (LP) are well recognized; however, its improving symptoms on postmenopausal hypercholesterolemia and the possible mechanisms have yet to be elucidated. Here, we utilized female ApoE-deficient (ApoE-/-) mice undergoing bilateral ovariectomy, fed a high-fat diet, and administered 109 colony-forming units (CFU) of LP for 13 consecutive weeks. LP intervention reduces total cholesterol (TC) and triglyceride (TG) accumulation in the serum and liver and accelerates their fecal excretion, which is mainly accomplished by increasing the excretion of fecal secondary bile acids (BAs), thereby facilitating cholesterol conversion. Correlation analysis revealed that lithocholic acid (LCA) is an important regulator of postmenopausal lipid abnormalities. LP can reduce LCA accumulation in the liver and serum while enhancing its fecal excretion, accomplished by elevating the relative abundances of Allobaculum and Olsenella in the ileum. Our findings demonstrate that postmenopausal lipid dysfunction is accompanied by abnormalities in BA metabolism and dysbiosis of the intestinal microbiota. LP holds therapeutic potential for postmenopausal hypercholesterolemia. Its effectiveness in ameliorating lipid dysregulation is primarily achieved through reshaping the diversity and abundance of the intestinal microbiota to correct BA abnormalities.
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Affiliation(s)
- Shurui Zhang
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Ronghui Liu
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Yuxin Ma
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Yuting Ma
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Han Feng
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Xue Ding
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Qichun Zhang
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China
- Jiangsu Key Laboratory for Pharmacology and Safety Evaluation of Chinese Materia Medica, School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Yu Li
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Jinjun Shan
- First School of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Huimin Bian
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China
- Jiangsu Key Laboratory for Pharmacology and Safety Evaluation of Chinese Materia Medica, School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Ruigong Zhu
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China
- Jiangsu Key Laboratory for Pharmacology and Safety Evaluation of Chinese Materia Medica, School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Qinghai Meng
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, China
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Lee GB, Nam GE, Kim W, Han B, Cho KH, Kim SM, Choi YS, Kim DH, Park Y, Jung J, Han K, Kim Y. Association Between Premature Menopause and Cardiovascular Diseases and All-Cause Mortality in Korean Women. J Am Heart Assoc 2023; 12:e030117. [PMID: 37947103 PMCID: PMC10727283 DOI: 10.1161/jaha.123.030117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 09/26/2023] [Indexed: 11/12/2023]
Abstract
Background Mortality from cardiovascular diseases in Asian populations is considerable. Menopause is a risk-enhancing factor for cardiovascular disease, but it is unclear whether menopause is an independent risk factor for cardiovascular disease and mortality in Asian women. Methods and Results A total of 1 159 405 postmenopausal women, who had participated in the health examinations of the Korean National Health Insurance Service in 2009, were analyzed, and their reproductive histories were taken. A multivariable Cox proportional hazard model assessed the hazard ratios (HRs) of myocardial infarction (MI), ischemic stroke, and all-cause mortality, according to the history of premature menopause and age at menopause. After an average 10-year follow-up, there were 31 606, 45 052, and 77 680 new cases of MI, ischemic stroke, and all-cause mortality, respectively. The women with premature menopause exhibited increased risks of MI (HR, 1.40 [95% CI, 1.31-1.50]), ischemic stroke (HR, 1.24 [95% CI, 1.17-1.31]), and all-cause mortality (HR, 1.19 [95% CI, 1.14-1.24]) when compared with women with menopause aged ≥50 years. The highest risk was evident with menopause between the ages of 30 and 34 years (HR for MI, 1.52 [95% CI, 1.30-1.78]; HR for ischemic stroke, 1.29 [95% CI, 1.12-1.48]; HR for all-cause mortality, 1.33 [95% CI, 1.20-1.47]) when compared with women with menopause aged ≥50 years. Conclusions Earlier age at menopause was associated with increased risks for MI, ischemic stroke, and all-cause mortality. Future guidelines and risk assessment tools should consider menopause as an independent risk factor of cardiovascular disease in Korean women.
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Affiliation(s)
- Gyu Bae Lee
- Department of Family MedicineKorea University College of MedicineSeoulKorea
| | - Ga Eun Nam
- Department of Family MedicineKorea University College of MedicineSeoulKorea
| | - Wonsock Kim
- Department of Family MedicineUijeongbu Eulji Medical CenterUijeongbuKorea
| | - Byoungduck Han
- Department of Family MedicineKorea University College of MedicineSeoulKorea
| | - Kyung Hwan Cho
- Department of Family MedicineKorea University College of MedicineSeoulKorea
| | - Seon Mee Kim
- Department of Family MedicineKorea University College of MedicineSeoulKorea
| | - Youn Seon Choi
- Department of Family MedicineKorea University College of MedicineSeoulKorea
| | - Do Hoon Kim
- Department of Family MedicineKorea University College of MedicineSeoulKorea
| | - Yong‐Gyu Park
- Department of Medical StatisticsCatholic University College of MedicineSeoulKorea
| | - Jin‐Hyung Jung
- Samsung Biomedical Research Institute, Sungkyunkwan University School of MedicineSuwonKorea
| | - Kyungdo Han
- Department of Statistics and Actuarial ScienceSoongsil UniversitySeoulKorea
| | - Yang‐Hyun Kim
- Department of Family MedicineKorea University College of MedicineSeoulKorea
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Ma G, Li J, Xie J, Li Y, Xu K, He Y, Yang J, Du H, Liu X. Pulse pressure and its association with body composition among Chinese men and women without diagnosed hypertension: the China Kadoorie Biobank. J Hypertens 2023; 41:1802-1810. [PMID: 37682069 PMCID: PMC10552820 DOI: 10.1097/hjh.0000000000003549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Wide brachial pulse pressure (PP) has been associated with cardiovascular events, while its population distribution and association with body composition were poorly characterized in large populations. METHODS We evaluated the age and sex distributions of PP and its associations with body composition using baseline data from the China Kadoorie Biobank. A total of 434 200 participants without diagnosed hypertension were included in the analysis. Wide PP was defined as PP above 65 mmHg. Body composition variables, including BMI, waist circumference, waist-to-hip ratio (WHR), fat mass index (FMI), fat-free mass index (FFMI), and body fat percentage (BF%), were obtained from bioelectrical impedance analysis. RESULTS Overall, 14.3% of the participants had wide PP. Older age was consistently associated with wider PP in women but only after the andropause stage in men. The independent associations of BMI with wide PP were stronger than other body composition measures. The adjusted differences (men/women, mmHg) in PP per standard deviation (SD) increase in BMI (1.55/1.47) were higher than other body composition (BF%: 0.32/0.64, waist circumference: 0.33/0.39; WHR: 0.49/0.42). In addition, sex differences were observed. In men, the per SD difference in PP was higher for FFMI than for FMI (0.91 vs. 0.67, P < 0.05), whereas in women, it was higher for FMI than for FFMI (1.01 vs. 0.72, P < 0.05). CONCLUSION Our nationwide population-based study presented the sex-specific distribution of PP over age and identified differential associations of PP with fat and fat-free mass in men and women.
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Affiliation(s)
- Guoqing Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Global Health Institute, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Junqi Li
- Department of Epidemiology and Biostatistics, School of Public Health, Global Health Institute, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Jiawen Xie
- Department of Epidemiology and Biostatistics, School of Public Health, Global Health Institute, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Yunfeng Li
- Department of Epidemiology and Biostatistics, School of Public Health, Global Health Institute, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Kun Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Global Health Institute, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Yafang He
- Department of Epidemiology and Biostatistics, School of Public Health, Global Health Institute, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Jiaomei Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Global Health Institute, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Huaidong Du
- Medical Research Council Population Health Research Unit at the University of Oxford
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Xin Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Global Health Institute, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
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Tschiderer L, Peters SAE, van der Schouw YT, van Westing AC, Tong TYN, Willeit P, Seekircher L, Moreno‐Iribas C, Huerta JM, Crous‐Bou M, Söderholm M, Schulze MB, Johansson C, Själander S, Heath AK, Macciotta A, Dahm CC, Ibsen DB, Pala V, Mellemkjær L, Burgess S, Wood A, Kaaks R, Katzke V, Amiano P, Rodriguez‐Barranco M, Engström G, Weiderpass E, Tjønneland A, Halkjær J, Panico S, Danesh J, Butterworth A, Onland‐Moret NC. Age at Menopause and the Risk of Stroke: Observational and Mendelian Randomization Analysis in 204 244 Postmenopausal Women. J Am Heart Assoc 2023; 12:e030280. [PMID: 37681566 PMCID: PMC10547274 DOI: 10.1161/jaha.123.030280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/08/2023] [Indexed: 09/09/2023]
Abstract
Background Observational studies have shown that women with an early menopause are at higher risk of stroke compared with women with a later menopause. However, associations with stroke subtypes are inconsistent, and the causality is unclear. Methods and Results We analyzed data of the UK Biobank and EPIC-CVD (European Prospective Investigation Into Cancer and Nutrition-Cardiovascular Diseases) study. A total of 204 244 postmenopausal women without a history of stroke at baseline were included (7883 from EPIC-CVD [5292 from the subcohort], 196 361 from the UK Biobank). Pooled mean baseline age was 58.9 years (SD, 5.8), and pooled mean age at menopause was 47.8 years (SD, 6.2). Over a median follow-up of 12.6 years (interquartile range, 11.8-13.3), 6770 women experienced a stroke (5155 ischemic strokes, 1615 hemorrhagic strokes, 976 intracerebral hemorrhages, and 639 subarachnoid hemorrhages). In multivariable adjusted observational Cox regression analyses, the pooled hazard ratios per 5 years younger age at menopause were 1.09 (95% CI, 1.07-1.12) for stroke, 1.09 (95% CI, 1.06-1.13) for ischemic stroke, 1.10 (95% CI, 1.04-1.16) for hemorrhagic stroke, 1.14 (95% CI, 1.08-1.20) for intracerebral hemorrhage, and 1.00 (95% CI, 0.84-1.20) for subarachnoid hemorrhage. When using 2-sample Mendelian randomization analysis, we found no statistically significant association between genetically proxied age at menopause and risk of any type of stroke. Conclusions In our study, earlier age at menopause was related to a higher risk of stroke. We found no statistically significant association between genetically proxied age at menopause and risk of stroke, suggesting no causal relationship.
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Affiliation(s)
- Lena Tschiderer
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtthe Netherlands
- Institute of Health EconomicsMedical University of InnsbruckInnsbruckAustria
| | - Sanne A. E. Peters
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtthe Netherlands
- The George Institute for Global Health, School of Public HealthImperial College LondonLondonUnited Kingdom
- The George Institute for Global HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Yvonne T. van der Schouw
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Anniek C. van Westing
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtthe Netherlands
- Division of Human Nutrition and HealthWageningen UniversityWageningenthe Netherlands
| | - Tammy Y. N. Tong
- Cancer Epidemiology Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
| | - Peter Willeit
- Institute of Health EconomicsMedical University of InnsbruckInnsbruckAustria
- Department of Public Health and Primary CareUniversity of CambridgeCambridgeUnited Kingdom
| | - Lisa Seekircher
- Institute of Health EconomicsMedical University of InnsbruckInnsbruckAustria
| | - Conchi Moreno‐Iribas
- Instituto de Salud Pública y Laboral de NavarraPamplonaSpain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)MadridSpain
- Navarra Institute for Health Research (IdiSNA)PamplonaSpain
| | - José María Huerta
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)MadridSpain
- Department of EpidemiologyMurcia Regional Health Council‐IMIBMurciaSpain
| | - Marta Crous‐Bou
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)–Bellvitge Biomedical Research Institute (IDIBELL)L’Hospitalet de LlobregatBarcelonaSpain
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMA
| | - Martin Söderholm
- Department of NeurologySkåne University Hospital, Lund and MalmöMalmöSweden
- Department of Clinical Sciences, MalmöLund UniversityMalmöSweden
| | - Matthias B. Schulze
- Department of Molecular EpidemiologyGerman Institute of Human Nutrition Potsdam‐RehbrueckeNuthetalGermany
- Institute of Nutritional ScienceUniversity of PotsdamNuthetalGermany
| | - Cecilia Johansson
- Skellefteå Research Unit, Department of Public Health and Clinical MedicineUmeå UniversityUmeåVästerbottenSweden
| | - Sara Själander
- Department of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
| | - Alicia K. Heath
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUnited Kingdom
| | - Alessandra Macciotta
- Centre for Biostatistics, Epidemiology, and Public Health (C‐BEPH), Department of Clinical and Biological SciencesUniversity of TurinTurinItaly
| | | | - Daniel B. Ibsen
- Department of Public HealthAarhus UniversityAarhusDenmark
- Steno Diabetes Center AarhusAarhusDenmark
- MRC Epidemiology UnitUniversity of Cambridge School of Clinical MedicineCambridgeUnited Kingdom
- Department of Nutrition, Exercise and SportsUniversity of CopenhagenFrederiksbergDenmark
| | - Valeria Pala
- Epidemiology and Prevention UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | | | - Stephen Burgess
- Department of Public Health and Primary CareUniversity of CambridgeCambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeCambridgeUnited Kingdom
- MRC Biostatistics Unit, School of Clinical MedicineUniversity of CambridgeCambridgeUnited Kingdom
| | - Angela Wood
- Department of Public Health and Primary CareUniversity of CambridgeCambridgeUnited Kingdom
| | - Rudolf Kaaks
- Division of Cancer EpidemiologyGerman Cancer Research Center, DKFZHeidelbergGermany
| | - Verena Katzke
- Division of Cancer EpidemiologyGerman Cancer Research Center, DKFZHeidelbergGermany
| | - Pilar Amiano
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)MadridSpain
- Ministry of Health of the Basque GovernmentSub Directorate for Public Health and Addictions of GipuzkoaSan SebastianSpain
- Biodonostia Health Research InstituteEpidemiology of Chronic and Communicable Diseases GroupSan SebastianSpain
| | - Miguel Rodriguez‐Barranco
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)MadridSpain
- Escuela Andaluza de Salud Pública (EASP)GranadaSpain
- Instituto de Investigación Biosanitaria ibs.GRANADAGranadaSpain
| | - Gunnar Engström
- Department of Clinical Sciences, MalmöLund UniversityMalmöSweden
| | | | - Anne Tjønneland
- Danish Cancer Society Research CenterCopenhagenDenmark
- Department of Public Health, Section of Environmental Health, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Jytte Halkjær
- Danish Cancer Society Research CenterCopenhagenDenmark
| | | | - John Danesh
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUnited Kingdom
- National Institute for Health and Care Research Cambridge Biomedical Research CentreCambridge University HospitalsCambridgeUnited Kingdom
- The National Institute for Health and Care Research Blood and Transplant Unit (NIHR BTRU) in Donor Health and GenomicsUniversity of CambridgeCambridgeUnited Kingdom
- Human GeneticsWellcome Sanger InstituteSaffron WaldenUnited Kingdom
- Health Data Research UK CambridgeWellcome Genome Campus and University of CambridgeCambridgeUnited Kingdom
- British Heart Foundation Centre of Research Excellence, Division of Cardiovascular MedicineAddenbrooke’s HospitalCambridgeUnited Kingdom
| | - Adam Butterworth
- Department of Public Health and Primary CareUniversity of CambridgeCambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeCambridgeUnited Kingdom
- Health Data Research UK CambridgeWellcome Genome Campus and University of CambridgeCambridgeUnited Kingdom
- NIHR Blood and Transplant Research Unit in Donor Health and BehaviourUniversity of CambridgeCambridgeUnited Kingdom
- BHF Centre of Research Excellence, School of Clinical MedicineAddenbrooke’s HospitalCambridgeUnited Kingdom
| | - N. Charlotte Onland‐Moret
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtthe Netherlands
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Kazzi B, Shankar B, Elder-Odame P, Tokgözoğlu LS, Sierra-Galan LM, Michos ED. A Woman's Heart: Improving Uptake and Awareness of Cardiovascular Screening for Middle-Aged Populations. Int J Womens Health 2023; 15:1171-1183. [PMID: 37520181 PMCID: PMC10377626 DOI: 10.2147/ijwh.s328441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/11/2023] [Indexed: 08/01/2023] Open
Abstract
Mid-life, the years leading up to and following the menopause transition, in women is accompanied by a change in cardiometabolic risk factors, including increases in body weight, changes in body composition, a more insulin-resistant state, and a shift towards a more atherogenic dyslipidemia pattern. Cardiovascular disease (CVD) risk assessment should be performed continually throughout the lifespan, as risk is not stagnant and can change throughout the life course. However, mid-life is a particularly important time for a woman to be evaluated for CVD risk so that appropriate preventive strategies can be implemented. Along with assessing traditional risk factors, ascertainment of a reproductive history is an integral part of a comprehensive CVD risk assessment to recognize unique female-specific or female-predominant factors that modify a woman's risk. When there is uncertainty about CVD risk and the net benefit of preventive pharmacotherapy interventions (such as statins), measuring a coronary artery calcium score can help further refine risk and guide shared decision-making. Additionally, there should be heightened sensitivity around identifying signs and symptoms of ischemic heart disease in women, as these may present differently than in men. Ischemia from coronary microvascular disease and/or vasospasm may be present even without obstructive coronary artery disease and is associated with a heightened risk for major cardiovascular events and reduced quality of life. Therefore, correctly identifying CVD in women and implementing preventive and treatment therapies is paramount. Unfortunately, women are underrepresented in cardiovascular clinical trials, and more data are needed about how to best incorporate novel and emerging risk factors into CVD risk assessment. This review outlines an approach to CVD screening and risk assessment in women using several methods, focusing on the middle-aged population.
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Affiliation(s)
- Brigitte Kazzi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bairavi Shankar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Petal Elder-Odame
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lale S Tokgözoğlu
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Lilia M Sierra-Galan
- Cardiology Department of the Cardiovascular Division, American British Cowdray Medical Center, Mexico City, Mexico
| | - Erin D Michos
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Jeong SM, Yoo JE, Jeon KH, Han K, Lee H, Lee DY, Shin DW. Associations of reproductive factors with incidence of myocardial infarction and ischemic stroke in postmenopausal women: a cohort study. BMC Med 2023; 21:64. [PMID: 36803529 PMCID: PMC9942298 DOI: 10.1186/s12916-023-02757-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 01/27/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND To assess the association between the reproductive factors of age at menarche, age at menopause, and reproductive span and the incidence of myocardial infarction (MI) and ischemic stroke (IS). METHODS We used a population-based retrospective cohort study from the National Health Insurance Service database of Korea including a total of 1,224,547 postmenopausal women. Associations between age at menarche (≤ 12, 13-14 [reference], 15, 16, and ≥ 17 years), age at menopause (< 40, 40-45, 46-50, 51-54 [reference], and ≥ 55 years), and reproductive span (< 30, 30-33, 34-36, 37-40 [reference], and ≥ 41 years) and the incidence of MI and IS were assessed by Cox proportional hazard models with adjustment for traditional cardiovascular risk factors and various reproductive factors. RESULTS During a median follow-up of 8.4 years, 25,181 MI and 38,996 IS cases were identified. Late menarche (≥ 16 years), early menopause (≤ 50 years), and short reproductive span (≤ 36 years) were linearly associated with a 6%, 12-40%, and 12-32% higher risk of MI, respectively. Meanwhile, a U-shaped association between age at menarche and risk of IS was found, with a 16% higher risk in early menarche (≤ 12 years) and a 7-9% higher risk in late menarche (≥ 16 years). Short reproductive span was linearly associated with an increased risk of MI, whereas both shorter and longer reproductive spans were associated with an increased risk of IS. CONCLUSIONS This study demonstrated different patterns of association between age at menarche and incidence of MI and IS: a linear association for MI versus a U-shaped association for IS. Female reproductive factors in addition to traditional cardiovascular risk factors should be considered when assessing overall cardiovascular risk in postmenopausal women.
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Affiliation(s)
- Su-Min Jeong
- Department of Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Family Medicine, Seoul National University Health Service Center, Seoul, Republic of Korea.,Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung Eun Yoo
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Keun Hye Jeon
- Department of Family Medicine, CHA Gumi Medical Center, CHA University, Gumi, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Heesun Lee
- Department of Cardiology, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Yun Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Wook Shin
- Department of Family Medicine/Supportive Care Center, Samsung Medical Center, Seoul, Republic of Korea. .,Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Science and Technology (SAIHST), Sungkyunkwan University, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea.
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7
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Lou Z, Huang Y, Lan Y, Li C, Chu K, Chen P, Xu W, Ma L, Zhou J. Relationship between years since menopause and lipid variation in postmenopausal women: A cross-sectional study. Medicine (Baltimore) 2023; 102:e32684. [PMID: 36637918 PMCID: PMC9839288 DOI: 10.1097/md.0000000000032684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Lipid alteration in postmenopausal women is commonly due to hormonal changes. This study aimed to explore the association between the years since menopause and lipid profiles in postmenopausal women. In this cross-sectional study, a total of 1033 postmenopausal women were recruited from the Women's Hospital of Zhejiang University in China between 2015 and 2022. Each participant was interviewed using questionnaires regarding sociodemographic and reproductive data. Anthropometric measurements, lipid profiles, and reproductive hormone levels were assessed. Participants were divided into 3 groups based on the length of time since menopause: 2, 2 to 5.9, and 6 years. Differences in lipid profiles and reproductive hormones among the groups were compared. Logistic and linear regression analyses were used to examine the relationship between years after menopause and lipid profile. High-density lipoprotein cholesterol (HDL-C) and luteinizing hormone levels were significantly lower in postmenopausal women with time since menopause of ≥6 years than those <2 years (P < .05), whereas low-density lipoprotein cholesterol levels were significantly higher (P < .05). A longer time after menopause was independently associated with lower HDL-C levels (β, -0.059, standard error, 0.023, P = .01) after adjustment for age, body mass index, and other confounders. Compared to women who had menopause for <2 years, those who were postmenopausal for >6 years had lower HDL-C levels after adjustment for age, body mass index, and other covariates (β, -0.123, 95% confidence interval, [-0.221, -0.014], P = .014). Longer time since menopause was associated with an atherogenic lipid profile with appreciably low levels of HDL-C subfraction. Future multicenter studies are necessary to examine postmenopausal population and determine how differences in lipids influence the risk of cardiovascular disease in this group.
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Affiliation(s)
- Zheng Lou
- Department of Gynecology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yizhou Huang
- Department of Gynecology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yibing Lan
- Department of Gynecology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chunming Li
- Department of Gynecology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ketan Chu
- Department of Gynecology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Peiqiong Chen
- Department of Gynecology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenxian Xu
- Department of Gynecology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Linjuan Ma
- Department of Gynecology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianhong Zhou
- Department of Gynecology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- * Correspondence: Jianhong Zhou, Department of Gynecology, Women’s Hospital, Zhejiang University School of Medicine, 1 Xueshi Rd, Hangzhou 310006, People’s Republic of China (e-mail: )
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8
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A longitudinal study of physical activity among Malaysian breast cancer survivors. PLoS One 2022; 17:e0277982. [PMID: 36409745 PMCID: PMC9678261 DOI: 10.1371/journal.pone.0277982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 11/07/2022] [Indexed: 11/22/2022] Open
Abstract
Regular physical activity (PA) after a breast cancer diagnosis is associated with reduced mortality and better quality of life. In this prospective cohort study, we aimed to explore the trends of PA among breast cancer survivors over three years and identify factors associated with low PA. Interviews on 133 breast cancer patients were conducted at baseline, one and three years after the diagnosis of breast cancer at University Malaya Medical Centre in Kuala Lumpur. Physical activity was measured by using the Global Physical Activity Questionnaire. PA was categorised as active (≥ 600 MET-min/week) and inactive (<600 MET-min/week). We used the generalised estimating equation method to examine PA levels and factors affecting PA longitudinally. The survivors' mean age was 56.89 (±10.56) years; half were Chinese (50.4%), and 70.7% were married. At baseline, 48.1% of the patients were active, but the proportion of active patients declined to 39.8% at one year and 35.3% in the third year. The mean total PA decreased significantly from 3503±6838.3 MET-min/week to 1494.0±2679.8 MET-min/week (one year) and 792.5±1364 MET-min/week (three years) (p<0.001). Three years after diagnosis (adjusted odds ratio [AOR]: 1.74, p = 0.021); Malay ethnicity (AOR: 1.86, p = 0.042) and being underweight (AOR: 3.43, p = 0.004) were significantly associated with inactivity. We demonstrated that breast cancer survivors in Malaysia had inadequate PA levels at diagnosis, which decreased over time. Thus, it is vital to communicate about the benefits of PA on cancer outcomes and continue to encourage breast cancer survivors to be physically active throughout the extended survivorship period, especially in the Malay ethnic group and underweight patients.
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9
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Puri P, Sinha A, Mahapatra P, Pati S. Multimorbidity among midlife women in India: well-being beyond reproductive age. BMC Womens Health 2022; 22:117. [PMID: 35413903 PMCID: PMC9004080 DOI: 10.1186/s12905-022-01693-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/24/2022] [Indexed: 12/15/2022] Open
Abstract
Background Currently, inequality in life expectancy across gender makes women outlive men. Adult women transit towards menopause around midlife accompanied by a series of natural physiological changes leading to several conditions such as osteoporosis, depression, and urinary incontinence, which puts them at a higher risk of having multimorbidity. Multimorbidity is often associated with poorer quality of life, leading to deteriorated work productivity and associated economic loss in midlife. Hence, this study aimed to determine the magnitude and correlates of early onset of multimorbidity and explore its linkages with health-related quality of life (HRQoL) among middle-aged women in India. Methods We have utilized data from the first round of the Longitudinal Ageing Study in India, 2017–19. We included women aged 45–65 years (n = 23,951) for analysis. Descriptive data were presented. An ordered logistic regression was conducted and proportional odds were reported to identify the correlates of multimorbidity. To explore the linkages between multimorbidity and selected indicators of HRQoL, an array of regression models were executed. Results Multimorbidity was reported amongst 29.8% of women in midlife. Chandigarh (PR-54.8 PER 100 women) and Punjab (PR-52.8 per 100 women) reported the highest prevalence of multimorbidity. Women with multimorbidity reported compromised HRQoL indicators such as self-rated health, work-limiting health conditions, mobility, and activities of daily living. Conclusions Multimorbidity is increasingly prevalent in midlife women associated with inferior quality of life. The reproductive health programs for women should consist of midlife women focusing on multimorbidity and overall well-being. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01693-2.
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Affiliation(s)
- Parul Puri
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Abhinav Sinha
- Health Technology Assessment in India (HTAIn), ICMR-Regional Medical Research Centre, Bhubaneswar, 751023, Odisha, India
| | - Pranab Mahapatra
- Department of Psychiatry, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sanghamitra Pati
- ICMR-Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar, Odisha, India, 751023.
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10
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Song J, Pan C, Li F, Guo Y, Pei P, Tian X, Wang S, Gao R, Pang Z, Chen Z, Li L. Association between dairy consumption and ischemic heart disease among Chinese adults: a prospective study in Qingdao. Nutr Metab (Lond) 2022; 19:11. [PMID: 35183210 PMCID: PMC8858533 DOI: 10.1186/s12986-022-00645-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous studies linking dairy consumption with ischemic heart disease (IHD) are almost from western countries, with little from China. The present study was to explore the relationship between dairy consumption and IHD among Chinese adults. METHODS The data for the present study was from the prospective cohort study of China Kadoorie Biobank in Qingdao, a total of 33,355 participants in the present study. An interviewer-administered laptop-based questionnaire was used to collect information on the consumption frequency of dairy, incident IHD cases were identified through Disease Surveillance Point System and the new national health insurance databases. Cox regression analyses were performed to estimate adjusted hazard ratios (HRs) and confidence interval for the relationship between the incidence of IHD and dairy consumption. RESULTS The baseline survey reported that 32.4% of males and 34.6% of females consumed dairy regularly (i.e. ≥ 4 days/week). Over an average of 9.2 years follow-up, 2712 new-onset IHD were documented. Compared with participants who never or rarely consume dairy, the HR of consumed dairy regularly was 0.85(0.73-0.98) for males (P < 0.05), while no significant benefits were identified for females. CONCLUSIONS Regular dairy consumption had an inverse association to the onset of IHD among males, with no similar findings for females.
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Affiliation(s)
- Jiahui Song
- Department of Nutrition and Food Hygiene, School of Public Health, Qingdao University, Qingdao, 266071, China
| | - Chi Pan
- Department of Nutrition and Food Hygiene, School of Public Health, Qingdao University, Qingdao, 266071, China
| | - Feifei Li
- Qingdao Municipality Center for Disease Control and Prevention, Qingdao, 266033, China.,Qingdao Institute of Preventive Medicine, Qingdao, 266033, China
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Pei Pei
- Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xiaocao Tian
- Qingdao Municipality Center for Disease Control and Prevention, Qingdao, 266033, China. .,Qingdao Institute of Preventive Medicine, Qingdao, 266033, China.
| | - Shaojie Wang
- Qingdao Municipality Center for Disease Control and Prevention, Qingdao, 266033, China.,Qingdao Institute of Preventive Medicine, Qingdao, 266033, China
| | - Ruqin Gao
- Qingdao Municipality Center for Disease Control and Prevention, Qingdao, 266033, China. .,Qingdao Institute of Preventive Medicine, Qingdao, 266033, China.
| | - Zengchang Pang
- Qingdao Municipality Center for Disease Control and Prevention, Qingdao, 266033, China.,Qingdao Institute of Preventive Medicine, Qingdao, 266033, China
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, 100191, China
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11
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Wang M, Gan W, Kartsonaki C, Guo Y, Lv J, Chen Z, Li L, Yang L, Yu M. Menopausal status, age at natural menopause and risk of diabetes in China: a 10-year prospective study of 300,000 women. Nutr Metab (Lond) 2022; 19:7. [PMID: 35123520 PMCID: PMC8818141 DOI: 10.1186/s12986-022-00643-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/22/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Menopause characteristics have been implicated in future health consequences, yet little is known about its relevance to diabetes. We examined the associations of menopausal status and age at natural menopause with diabetes risk in Chinese women. METHODS We used prospective data of the China Kadoorie Biobank study that recruited 302,522 women aged 30-79 years in 2004-2008 from 10 areas across China. During average 10.8 years of follow-up, 11,459 incident diabetes cases were recorded among 281,319 women without prior diabetes diagnosis at baseline. Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for incident diabetes associated with menopausal status and age at natural menopause. RESULTS Overall, the mean (SD) age at natural menopause was 48.2 (4.4) years among 141,789 post-menopausal women. Naturally peri-, or post-menopausal women were at higher risk of diabetes, with HRs of 1.17 (95% CI 1.06-1.29) and 1.15 (1.06-1.25) compared with pre-menopausal women, adjusting for several potential confounders. Among women who had natural menopause, the HR of diabetes was 1.14 (1.01-1.30), 1.01 (0.93-1.09), 1.10 (1.04-1.16), and 1.10 (1.01-1.20) for menopause at ages less than 40, 40-44, 50-53, and 54 years or older, respectively, relative to 45-49 years. CONCLUSIONS In this study, we found that women with naturally peri-, or post-menopausal status had higher risk of developing diabetes. Besides, among the post-menopausal women, both earlier and later age at natural menopause were associated with increased risk of diabetes.
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Affiliation(s)
- Meng Wang
- grid.433871.aDepartment of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051 China
| | - Wei Gan
- grid.4991.50000 0004 1936 8948Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, Big Data Institute, University of Oxford, Old Road Campus, Roosevelt Drive, Oxfordshire, Oxford, OX3 7FZ UK
| | - Christiana Kartsonaki
- grid.4991.50000 0004 1936 8948Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, Big Data Institute, University of Oxford, Old Road Campus, Roosevelt Drive, Oxfordshire, Oxford, OX3 7FZ UK
| | - Yu Guo
- grid.506261.60000 0001 0706 7839Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, 100864 China
| | - Jun Lv
- grid.11135.370000 0001 2256 9319Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing, 100191 China
| | - Zhengming Chen
- grid.4991.50000 0004 1936 8948Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, Big Data Institute, University of Oxford, Old Road Campus, Roosevelt Drive, Oxfordshire, Oxford, OX3 7FZ UK
| | - Liming Li
- grid.11135.370000 0001 2256 9319Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing, 100191 China
| | - Ling Yang
- grid.4991.50000 0004 1936 8948Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, Big Data Institute, University of Oxford, Old Road Campus, Roosevelt Drive, Oxfordshire, Oxford, OX3 7FZ UK
| | - Min Yu
- grid.433871.aDepartment of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051 China
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12
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Meng Q, Ma M, Zhang W, Bi Y, Cheng P, Yu X, Fu Y, Chao Y, Ji T, Li J, Chen Q, Zhang Q, Li Y, Shan J, Bian H. The gut microbiota during the progression of atherosclerosis in the perimenopausal period shows specific compositional changes and significant correlations with circulating lipid metabolites. Gut Microbes 2022; 13:1-27. [PMID: 33691599 PMCID: PMC7954427 DOI: 10.1080/19490976.2021.1880220] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Atherosclerosis (AS) is exacerbated in the perimenopausal period, which significantly increases the incidence rate of cardiovascular disease. The disruption of the gut microbiota has been associated with AS or menopause, but the specific changes of AS-associated gut microbiota in the perimenopausal period remain largely unknown. As lipid abnormalities are mainly responsible for AS, the relationship between lipid metabolism abnormalities and gut microbiota disruptions during menopause is rarely reported hitherto. In the present study, ApoE-/- mice fed with a high-fat diet (HFD) were subjected to ovariectomy and supplemented with estrogen. The ovariectomized HFD-fed ApoE-/- mice underwent significant AS damage, hepatic lipid damage, hyperlipidemia, and changes of lipid metabolism- and transport-related enzymes. There was significantly higher abundance of some lipid metabolites in the plasma of ovariectomized HFD-fed ApoE-/- mice than in non-ovariectomized ones, including cholesterol esters, triglycerides, phospholipids, and other types of lipids (free fatty acids, acylcarnitine, sphingomyelins, and ceramides). The administration of estrogen significantly reduced the contents of most lipid metabolites. The diversity and composition of gut microbiota evidently changed in ovariectomized HFD-fed ApoE-/- mice, compared to HFD-fed ApoE-/- mice without ovariectomy. In contrast, with estrogen supplementation, the diversity and composition of gut microbiota were restored to approach that of non-ovariectomized HFD-fed ApoE-/- mice, and the relative abundances of some bacteria were even like those of C57BL/6 mice fed with a normal diet. On the other hand, the transplantation of feces from C57BL/6 mice fed with normal diet to ovariectomized HFD-fed ApoE-/- mice was sufficient to correct the hyperlipidemia and AS damage, and to reverse the characteristics changing of lipid metabolomics in ovariectomized HFD-fed ApoE-/- mice. These phenomena were also been observed after transplantation of feces from estrogen-treated ovariectomized HFD-fed ApoE-/- mice to ovariectomized HFD-fed ApoE-/- mice. Moreover, the gut microbiota and lipid metabolites were significantly correlated, demonstrating that the changes of serum lipids may be associated with the gut microbiota disruptions in the perimenopausal period. In conclusion, the gut microbiota during the progression of AS in the perimenopausal period showed specific compositional changes and significant correlations with circulating lipid metabolites. Estrogen supplementation may exert beneficial effects on gut bacteria and lipid metabolism.
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Affiliation(s)
- Qinghai Meng
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Menghua Ma
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Weiwei Zhang
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yunhui Bi
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Peng Cheng
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xichao Yu
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yu Fu
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Ying Chao
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Tingting Ji
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jun Li
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Qi Chen
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Qichun Zhang
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China,Jiangsu Key Laboratory for Pharmacology and Safety Evaluation of Chinese Materia Medica, School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yu Li
- Jiangsu Key Laboratory for Pharmacology and Safety Evaluation of Chinese Materia Medica, School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China,School of Medicine and Life Sciences, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jinjun Shan
- First School of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Huimin Bian
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China,Jiangsu Key Laboratory for Pharmacology and Safety Evaluation of Chinese Materia Medica, School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China,CONTACT Huimin Bian School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing320561, China; Jinjun Shan First School of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023 China
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13
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Schindler LS, Subramaniapillai S, Barth C, van der Meer D, Pedersen ML, Kaufmann T, Maximov II, Linge J, Leinhard OD, Beck D, Gurholt TP, Voldsbekk I, Suri S, Ebmeier KP, Draganski B, Andreassen OA, Westlye LT, de Lange AMG. Associations between abdominal adipose tissue, reproductive span, and brain characteristics in post-menopausal women. Neuroimage Clin 2022; 36:103239. [PMID: 36451350 PMCID: PMC9668664 DOI: 10.1016/j.nicl.2022.103239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/06/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
The menopause transition involves changes in oestrogens and adipose tissue distribution, which may influence female brain health post-menopause. Although increased central fat accumulation is linked to risk of cardiometabolic diseases, adipose tissue also serves as the primary biosynthesis site of oestrogens post-menopause. It is unclear whether different types of adipose tissue play diverging roles in female brain health post-menopause, and whether this depends on lifetime oestrogen exposure, which can have lasting effects on the brain and body even after menopause. Using the UK Biobank sample, we investigated associations between brain characteristics and visceral adipose tissue (VAT) and abdominal subcutaneous adipose tissue (ASAT) in 10,251 post-menopausal females, and assessed whether the relationships varied depending on length of reproductive span (age at menarche to age at menopause). To parse the effects of common genetic variation, we computed polygenic scores for reproductive span. The results showed that higher VAT and ASAT were both associated with higher grey and white matter brain age, and greater white matter hyperintensity load. The associations varied positively with reproductive span, indicating more prominent associations between adipose tissue and brain measures in females with a longer reproductive span. The effects were in general small, but could not be fully explained by genetic variation or relevant confounders. Our findings indicate that associations between abdominal adipose tissue and brain health post-menopause may partly depend on individual differences in cumulative oestrogen exposure during reproductive years, emphasising the complexity of neural and endocrine ageing processes in females.
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Affiliation(s)
- Louise S Schindler
- LREN, Centre for Research in Neurosciences, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland; Department of Psychology, University of Oslo, Oslo, Norway.
| | - Sivaniya Subramaniapillai
- LREN, Centre for Research in Neurosciences, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland; Department of Psychology, University of Oslo, Oslo, Norway
| | - Claudia Barth
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Dennis van der Meer
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway; School of Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University, The Netherlands
| | - Mads L Pedersen
- Department of Psychology, University of Oslo, Oslo, Norway; NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tobias Kaufmann
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatry and Psychotherapy, University of Tübingen, Germany
| | - Ivan I Maximov
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Jennifer Linge
- AMRA Medical AB, Linköping, Sweden; Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden
| | - Olof Dahlqvist Leinhard
- AMRA Medical AB, Linköping, Sweden; Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Dani Beck
- Department of Psychology, University of Oslo, Oslo, Norway; NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tiril P Gurholt
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Irene Voldsbekk
- Department of Psychology, University of Oslo, Oslo, Norway; NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sana Suri
- Department of Psychiatry, University of Oxford, Oxford, UK; Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | | | - Bogdan Draganski
- LREN, Centre for Research in Neurosciences, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland; Dept. of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Ole A Andreassen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway; KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
| | - Lars T Westlye
- Department of Psychology, University of Oslo, Oslo, Norway; NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway; KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
| | - Ann-Marie G de Lange
- LREN, Centre for Research in Neurosciences, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland; Department of Psychology, University of Oslo, Oslo, Norway; Department of Psychiatry, University of Oxford, Oxford, UK
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14
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Mishra SR, Waller M, Chung HF, Mishra GD. Association between reproductive lifespan and risk of incident type 2 diabetes and hypertension in postmenopausal women: findings from a 20-year prospective study. Maturitas 2022; 159:52-61. [DOI: 10.1016/j.maturitas.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 12/24/2021] [Accepted: 01/07/2022] [Indexed: 11/30/2022]
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15
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Gu J, Yue H, Wang C, Zhang H, Hu W, Zhang Z. Vitamin D pathway gene variation rs3740165 is associated with serological uric acid levels in healthy Chinese women. Front Endocrinol (Lausanne) 2022; 13:1059964. [PMID: 36583005 PMCID: PMC9792855 DOI: 10.3389/fendo.2022.1059964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 11/25/2022] [Indexed: 12/15/2022] Open
Abstract
AIM To investigate the relationship between gene polymorphisms involved in the vitamin D metabolic pathway and serum uric acid (UA) levels in Chinese women. METHODS Fifteen key genes within the vitamin D metabolic pathway were screened using 96 single nucleotide polymorphisms in a group of 1,206 (37.96 ± 13.08 years) unrelated healthy Chinese women (aged 20-85 years). Blood and urine tests were performed at the same time. The Wilcoxon Mann-Whitney test was used to compare groups aged ≤50 years and >50 years. The mean serum UA values were computed within each group of homozygous referent, heterozygous, and homozygous variant genotypes for each single nucleotide polymorphism. RESULTS The exclusion process left 1,169 participants (38.16 ± 13.13 years) for analysis. One single nucleotide polymorphism in the CUBN gene (rs3740165) was identified as being significantly associated with serum UA levels in the group aged over 50 years. The wild type (C/C) population had higher serum UA levels in this group (P<0.001). In women aged over 50 years, allele C was associated with a higher risk of hyperuricemia than allele T (odds ratio 2.752, 95% confidence interval 1.458-5.192; P = 0.002). There was also a higher risk of hyperuricemia in genotype TC + CC compared with genotype TT (odds ratio 3.326, 95% confidence interval 1.513-7.313; P = 0.003) in women over 50 years of age. CONCLUSION The results suggest that the CUBN gene contributes to variability in serum UA levels in healthy Chinese Han women over 50 years of age.
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Affiliation(s)
- Jiemei Gu
- Shanghai Clinical Research Center of Bone Disease, Department of Osteoporosis and Bone Diseases, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hua Yue
- Shanghai Clinical Research Center of Bone Disease, Department of Osteoporosis and Bone Diseases, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chun Wang
- Shanghai Clinical Research Center of Bone Disease, Department of Osteoporosis and Bone Diseases, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Zhang
- Shanghai Clinical Research Center of Bone Disease, Department of Osteoporosis and Bone Diseases, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiwei Hu
- Shanghai Clinical Research Center of Bone Disease, Department of Osteoporosis and Bone Diseases, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenlin Zhang
- Shanghai Clinical Research Center of Bone Disease, Department of Osteoporosis and Bone Diseases, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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16
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Hu ZB, Lu ZX, Zhu F. Age at menarche, age at menopause, reproductive years and risk of fatal stroke occurrence among Chinese women: the Guangzhou Biobank Cohort Study. BMC Womens Health 2021; 21:433. [PMID: 34961507 PMCID: PMC8714414 DOI: 10.1186/s12905-021-01579-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background The relationship between women’s reproductive characteristics and stroke events is unclear. We aimed to investigate age at menarche, age at menopause and number of reproductive years in relation to fatal stroke occurrence in the Guangzhou Biobank Cohort Study. Methods In total, 16,504 postmenopausal women without stroke, heart disease or a cancer history at baseline were included and followed up for a median of 12.0 years. After review of available records, 222 stroke deaths were recorded. Cox proportional hazards regression was used to assess the associations between the risk of fatal stroke occurrence and age at menarche, age at menopause and number of reproductive years. Results In the whole cohort, compared with those aged 15 years at menarche, an increased risk of fatal stroke among women at menarche showed respectively in those aged 12 years (aHR (adjusted hazard ratio) = 1.86, 95% confidence interval (CI) 0.96–3.60), aged 13 years (aHR = 1.69, 95% CI 0.98–2.92), aged 17 years (aHR = 1.83, 95% CI 1.10–3.05) and aged ≥ 18 years (aHR = 1.66, 95% CI 1.03–2.70), wherein the associations revealed an atypically U-shaped; similar U-shaped association to the cohort of postmenopausal women born before 1940 released a range of incremental risks of fatal stroke in women at menarche aged ≤ 12 years (aHR = 3.68, 95% CI 1.68–8.05), aged 13 years (aHR = 2.11, 95% CI 1.02–4.34), aged 14 years (aHR = 2.07, 95% CI 1.04), aged 17 years (aHR = 2.30, 95% CI 1.20–4.39) and aged 18 years (aHR = 2.50, 95% CI 1.37–4.57), respectively. Compared with menopausal women aged 51–52 years, those aged < 43 years at menopause had an increased risk for fatal stroke among postmenopausal women born in and after 1940 (aHR = 1.64, 95% CI 0.97–2.78) and postmenopausal women born before 1940 (aHR = 1.97, 95% CI 1.05–3.69). Additionally, compared with those with 32–34 reproductive years, women with ≤ 28 reproductive years had an increased risk for fatal stroke in the whole cohort (aHR = 1.91, 95% CI 1.28–2.86) and the cohort of postmenopausal women born before 1940 (aHR = 1.79, 95% CI 1.15–2.80). Conclusions Younger and older age at menarche, younger age at menopause and fewer reproductive ages were related to an increased risk of fatal stroke in postmenopausal women. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01579-9.
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Su H, Jiang C, Zhang W, Zhu F, Jin Y, Cheng K, Lam T, Xu L. Natural menopausal age and cardiovascular disease risk factors in older Chinese women: Guangzhou Biobank Cohort Study. Menopause 2021; 28:1410-1417. [PMID: 34520415 DOI: 10.1097/gme.0000000000001856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the associations of natural menopausal age with cardiovascular disease risk factors and whether the associations varied by parity in older Chinese women. METHODS Information of demographic characteristics, lifestyles, and reproductive factors was collected by face-to-face interview. Framingham Risk Score was used as an indicator of cardiovascular disease risk, with a score ≥ 10% considered as high cardiovascular disease risk (vs low, dichotomous). Multivariable logistic and linear regressions were used to examine the associations of menopausal age with cardiovascular disease risk factors. RESULTS Of 18,339 women aged 50+ years, the average (standard deviation) age was 61.8 (6.9) years. Compared with women with menopausal age of 45 to 54 years, after adjustment for multiple potential confounders, women with menopausal age <45 years or ≥55 years had higher Framingham Risk Score (0.93%, 95% confidence interval: 0.40-1.46, and 0.69%, 95% confidence interval: 0.18-1.20, respectively). Women with menopausal age <45 or ≥55 years had higher odds of high cardiovascular disease risk (vs low) (odds ratio [95% confidence interval]:1.26 (1.10-1.44) and 1.17 (1.02-1.33), respectively). The associations of menopausal age with the Framingham Risk Score varied by parity (P for interaction ≤0.001). The Framingham Risk Score was higher in those with one to three parity (<45 y: 1.01 [0.43-1.59]; ≥55 y: 1.14 [0.60-1.68]) and lower for parity ≥4 (<45 y: -0.33 [-1.84 to 1.18]; ≥55 y: -2.02 [-3.82 to -0.22]). In nulliparous women, the Framingham Risk Score was highest in menopausal age <45 years (3.97 [1.67-6.26]), but the differences were nonsignificant in menopausal age ≥55 years (0.66 [-1.38 to 2.71]). CONCLUSIONS Both early and late natural menopausal ages were associated with a higher cardiovascular disease risk, and the associations were stronger in those with lower parity.
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Affiliation(s)
- Huimin Su
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Chaoqiang Jiang
- Molecular Epidemiology Research Centre, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Weisen Zhang
- Molecular Epidemiology Research Centre, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Feng Zhu
- Molecular Epidemiology Research Centre, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Yali Jin
- Molecular Epidemiology Research Centre, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Karkeung Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Taihing Lam
- Molecular Epidemiology Research Centre, Guangzhou Twelfth People's Hospital, Guangzhou, China
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Lin Xu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
- School of Public Health, The University of Hong Kong, Hong Kong, China
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Korzets Y, Yariv O, Mutai R, Moore A, Shochat T, Yerushalmi R, Goldvaser H. The impact of endogenous estrogen exposures on the characteristics and outcomes of estrogen receptor positive, early breast cancer. Discov Oncol 2021; 12:26. [PMID: 35201434 PMCID: PMC8777527 DOI: 10.1007/s12672-021-00420-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 08/02/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Menstrual and parity history might impact the risk for breast cancer. Data on the impact of these factors on other tumor characteristics are limited. METHODS A single center retrospective cohort study comprising all women with estrogen receptor (ER) positive, human epidermal growth factor receptor 2 (HER2) negative, early breast cancer whose tumors were sent to OncotypeDX analysis. The prespecified subgroups were investigated: age of menarche (< 12 vs. ≥ 12 years), number of deliveries (0 vs. ≥ 1 childbirth and ≥ 5 childbirth vs. other), age of first delivery (≥ 30 years vs. younger age) and postmenopausal compared to premenopausal. The impact of age of menopause was also assessed categorically, using early (< 45 years) and late age of menopause (> 55 years). Differences in tumor characteristics were evaluated using T-test or Mann Whitney for continuous variables or Fisher's exact test for categorical variables. Outcomes were assessed by Kaplan-Meier survival analysis, with the log-rank test. RESULTS A total of 620 women were included. After median follow-up of 10.4 years, early menopause was associated with significantly worse disease-free survival (HR = 2.26, p = 0.004) and overall-survival (HR = 2.60, p = 0.004), and multiparity was associated with significant worse disease-free survival (HR = 2.16, p = 0.026). These differences remain significant in multivariate analyses. Post-menopausal women were more likely to have stronger ER intensity (p = 0.002) but progesterone receptor (PR) positivity was less frequent (p = 0.009(. Early age of menarche was associated with PR positivity (p = 0.039). No other associations were found between the evaluated subgroups and tumor characteristics. CONCLUSIONS The impact of endogenous estrogen exposure had little effect on breast cancer characteristics of early stage, luminal disease. Early menopause and multiparity were associated with worse outcome.
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Affiliation(s)
- Yasmin Korzets
- Institute of Oncology, Tel Aviv Sourasky Medical Center, Weizmann St 6, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Chaim Levanon St 30, Tel Aviv, Israel
| | - Orly Yariv
- Institute of Oncology, Tel Aviv Sourasky Medical Center, Weizmann St 6, Tel Aviv, Israel
- Institute of Oncology, Rabin Medical Center, Zeev Jabutinsky Rd 39, Petah Tikva, Israel
| | - Raz Mutai
- Institute of Oncology, Tel Aviv Sourasky Medical Center, Weizmann St 6, Tel Aviv, Israel
- Institute of Oncology, Rabin Medical Center, Zeev Jabutinsky Rd 39, Petah Tikva, Israel
| | - Assaf Moore
- Institute of Oncology, Tel Aviv Sourasky Medical Center, Weizmann St 6, Tel Aviv, Israel
- Institute of Oncology, Rabin Medical Center, Zeev Jabutinsky Rd 39, Petah Tikva, Israel
| | - Tzippy Shochat
- Statistical Consulting Unit, Rabin Medical Center, Zeev Jabutinsky Rd 39, Petah Tikva, Israel
| | - Rinat Yerushalmi
- Institute of Oncology, Tel Aviv Sourasky Medical Center, Weizmann St 6, Tel Aviv, Israel
- Institute of Oncology, Rabin Medical Center, Zeev Jabutinsky Rd 39, Petah Tikva, Israel
| | - Hadar Goldvaser
- Shaare Zedek Medical Center, The Oncology Institute, 12 Shmuel Bait St., PO Box 3235, 9103102, Jerusalem, Israel.
- The Faculty of Medicine, The Hebrew University, Ein Kerem, P.O. Box 12271, 9112102, Jerusalem, Israel.
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Reproductive risk factors for angiographic obstructive coronary artery disease among postmenopausal women. ACTA ACUST UNITED AC 2021; 27:1403-1410. [PMID: 32769758 DOI: 10.1097/gme.0000000000001616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Reproductive factors are female-specific coronary artery disease (CAD) risk factors. However, the importance of reproductive factors in angiographic obstructive CAD in postmenopausal women remains uncertain. This study aimed to compare reproductive factors between postmenopausal women with no apparent CAD, nonobstructive CAD, and obstructive CAD and identify reproductive risk factors for obstructive CAD. METHODS In this hospital-based cross-sectional study, 1,474 postmenopausal women, admitted with chest pain and referred for invasive coronary angiography were enrolled between April 2013 and October 2018. RESULTS Adjusted odds ratio (95% CI) for obstructive CAD were 1.81 (1.03-3.17) for multigravidity (three or more pregnancies), 1.77 (1.14-2.76) for early menopause (≤40 y old), and 1.72 (1.26-2.35) for short reproductive life span (≤30 y). Each additional year in age at menopause or reproductive life span was associated with a 4% reduction in obstructive CAD risk in postmenopausal women (odds ratio, 0.96; 95% CI, 0.94-0.99; P = 0.011). The other reproductive factors, including parity, age at first birth, spontaneous abortion, induced abortion, stillbirth, hypertensive disorders of pregnancy, gestational diabetes mellitus, and age at menarche, were not correlated with obstructive CAD risk in postmenopausal women. CONCLUSIONS Multigravidity (three or more pregnancies), early menopause, and a shorter reproductive life span were independent risk factors of angiographic obstructive CAD among postmenopausal women, which suggested that pregnancy and ovarian function may be important for the early identification and prevention of increased risk of female angiographic obstructive CAD.
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Puri P, Kothavale A, Singh S, Pati S. Burden and determinants of multimorbidity among women in reproductive age group: a cross-sectional study based in India. Wellcome Open Res 2021; 5:275. [PMID: 34131591 PMCID: PMC8182697 DOI: 10.12688/wellcomeopenres.16398.2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 01/07/2023] Open
Abstract
Background: India's government is currently running several programs with a sole focus on women's health during their child-bearing years. However, none of these programs incorporate the management of chronic health conditions during the reproductive span. This issue is an emerging public health concern; therefore, the present study aims to identify the patterns and correlates of multimorbidity among women in reproductive age groups in India. Methods: The study utilizes nationally-representative cross-sectional data from the Demographic and Health Survey on 661,811 women in the reproductive age group of 15-49 years. The study uses information on seven chronic morbidities, namely asthma, cancers, heart disease, diabetes, tuberculosis, hypertension, and thyroid disorder. Descriptive, bivariate, and multivariable techniques were utilized to accomplish the study objective. Results: The findings show that 17.4 and 3.5 per 100 women of reproductive age suffered from any one morbidity and multimorbidity, respectively. Hypertension, diabetes, and thyroid disorders were commonly occurring morbidities. The prevalence of having any one morbidity or multimorbidity increased with age. Variables like religion, wealth, parity, menopause, consumption of tobacco and alcohol, body mass index, and type of diet were found to be significantly related to the burden of multimorbidity. The prevalence of multimorbidity was found to be higher for women who belong to the Southern, Eastern, and North-Eastern regions of India. Conclusions: Findings suggest the importance of multimorbidity in the context of women of reproductive age. Inclusion of chronic disease management strategies with maternal and child health services needs to be taken into consideration by the program and policymakers. The annexation of social marketing approaches at the primary level of healthcare would assist policy-makers in educating women about the importance of leading a healthy lifestyle. Practicing dietary diversity can help in maintaining optimal estrogen levels, which would further help in decreasing multimorbidity rates among women in India.
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Affiliation(s)
- Parul Puri
- International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, Maharashtra, 400088, India
| | - Ajinkya Kothavale
- International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, Maharashtra, 400088, India
| | - S.K. Singh
- International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, Maharashtra, 400088, India
| | - Sanghamitra Pati
- ICMR Regional Medical Research Centre, Indian Council of Medical Research, Department of Health Research, Bhubaneswar, Odisha, 751023, India
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Mishra SR, Waller M, Chung HF, Mishra GD. Association of the length of oestrogen exposure with risk of incident stroke in postmenopausal women: Insights from a 20-year prospective study. Int J Cardiol 2020; 328:206-214. [PMID: 33321126 DOI: 10.1016/j.ijcard.2020.12.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 11/20/2020] [Accepted: 12/05/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND To examine the relationship between the length of oestrogen exposure and risk of incident stroke. Also, the additive value of each model was compared for assessing oestrogen exposure and stroke risk in postmenopausal women. STUDY DESIGN AND SETTING Prospective study of 5632 post-menopausal women without a prior history of stroke from 1996 through 2016 in Australian Longitudinal Study on Women's Health. Data on surrogate measures of oestrogen exposure were used to derive five indices of oestrogen exposure including reproductive lifespan (RLS) (age at menopause-age at menarche), endogenous oestrogen and total oestrogen exposure (which included menopausal hormone therapy (MHT use)). The relationships between the length of oestrogen exposure (quartiles) and incident stroke events were examined using multivariable adjusted Cox proportional hazard regression and their predictive accuracy were compared using area under the Receiver Operating Characteristic Curve. RESULTS The mean (SD) for RLS was 37.9(4.3) years. A shorter RLS (≤34 years) was associated with a higher risk of incident stroke after adjustment (HR: 1.85, 95%CI: 1.08, 3.15), compared with 38-40 years. There was 7% decrease in risk of stroke per 1-year increase in RLS (HR: 0.93, 95%CI: 0.89, 0.97). Even though the combination of endogenous oestrogen and exogenous hormones aimed to provide more accurate length of oestrogen exposure, the results showed that each model had similar goodness of fit and did not improve the model of just using RLS as a predictor of incident stroke. CONCLUSIONS A shorter RLS (≤34 years) was associated with higher risk of incident stroke compared to medium RLS. Endogenous oestrogen and of total oestrogen exposure (which included MHT use) did not improve the model of just using RLS as a predictor of incident stroke.
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Affiliation(s)
- Shiva Raj Mishra
- School of Public Health, The University of Queensland, Brisbane, Australia.
| | - Michael Waller
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Hsin-Fang Chung
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Gita D Mishra
- School of Public Health, The University of Queensland, Brisbane, Australia
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22
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Mishra SR, Chung HF, Waller M, Dobson AJ, Greenwood DC, Cade JE, Giles GG, Bruinsma F, Simonsen MK, Hardy R, Kuh D, Gold EB, Crawford SL, Derby CA, Matthews KA, Demakakos P, Lee JS, Mizunuma H, Hayashi K, Sievert LL, Brown DE, Sandin S, Weiderpass E, Mishra GD. Association Between Reproductive Life Span and Incident Nonfatal Cardiovascular Disease: A Pooled Analysis of Individual Patient Data From 12 Studies. JAMA Cardiol 2020; 5:1410-1418. [PMID: 32936210 PMCID: PMC7495334 DOI: 10.1001/jamacardio.2020.4105] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 06/09/2020] [Indexed: 12/22/2022]
Abstract
Importance Early menarche and early menopause are associated with increased risk of cardiovascular disease (CVD) in midlife, but little is known about the association between reproductive life span and the risk of CVD. Objective To investigate the association between the length of reproductive life span and risk of incident CVD events, while also considering the timing of menarche and menopause. Design, Setting, and Participants Individual-level data were pooled from 12 studies participating in the International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease Events consortium. Women provided complete information on the timing of menarche and menopause, nonfatal CVD events, and covariates. Cox proportional hazards models were used to estimate hazard ratios and 95% CIs, adjusted for covariates. The association between reproductive life span and CVD was adjusted for age at menarche and age at menopause separately. Analysis began March 2018 and ended December 2019. Exposures Reproductive life span was calculated by subtracting age at menarche from age at menopause and categorized as younger than 30, 30 to 32, 33 to 35, 36 to 38 (reference group), 39 to 41, 42 to 44, and 45 years or older. Main Outcomes and Measures First nonfatal CVD event, including coronary heart disease and stroke events. Results A total of 307 855 women were included. Overall, the mean (SD) ages at menarche, menopause, and reproductive life span were 13.0 (1.5) years, 50.2 (4.4) years, and 37.2 (4.6) years, respectively. Pooled analyses showed that women with a very short reproductive life span (<30 years) were at 1.71 (95% CI, 1.58-1.84) times higher risk of incident CVD events than women with a reproductive life span of 36 to 38 years after adjustment for covariates. This association remained unchanged when adjusted for age at menarche but was attenuated to 1.26 (95% CI, 1.09-1.46) when adjusted for age at menopause. There was a significant interaction between reproductive life span and age at menarche associated with CVD risk (P < .001). Women who had both short reproductive life span (<33 years) and early menarche (age ≤11 years) had the highest risk of CVD (hazard ratio, 2.06; 95% CI, 1.76-2.41) compared with those with a reproductive life span of 36 to 38 years and menarche at age 13 years. Conclusions and Relevance Short reproductive life span was associated with an increased risk of nonfatal CVD events in midlife, and the risk was significantly higher for women with early age at menarche.
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Affiliation(s)
- Shiva R. Mishra
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Hsin-Fang Chung
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Michael Waller
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Annette J. Dobson
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Darren C. Greenwood
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, United Kingdom
| | - Janet E. Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, United Kingdom
| | - Graham G. Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Fiona Bruinsma
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | | | - Rebecca Hardy
- CLOSER, UCL Institute of Education, London, United Kingdom
| | - Diana Kuh
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, London, United Kingdom
| | - Ellen B. Gold
- Department of Public Health Sciences, University of California, Davis, Davis
| | - Sybil L. Crawford
- Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Carol A. Derby
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Karen A. Matthews
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Panayotes Demakakos
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Jung Su Lee
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideki Mizunuma
- Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan
| | - Kunihiko Hayashi
- School of Health Sciences, Gunma University, Maebashi City, Gunma, Japan
| | | | | | - Sven Sandin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York
| | - Elisabete Weiderpass
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Gita D. Mishra
- School of Public Health, The University of Queensland, Brisbane, Australia
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Puri P, Kothavale A, Singh S, Pati S. Burden and determinants of multimorbidity among women in reproductive age group: a cross-sectional study based in India. Wellcome Open Res 2020; 5:275. [PMID: 34131591 PMCID: PMC8182697 DOI: 10.12688/wellcomeopenres.16398.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 08/23/2023] Open
Abstract
Background: India's government is currently running several programs with a sole focus on women's health during their child-bearing years. However, none of these programs incorporate the management of chronic health conditions during the reproductive span. This issue is an emerging public health concern; therefore, the present study aims to identify the patterns and correlates of multimorbidity among women in reproductive age groups in India. Methods: The study utilizes nationally-representative cross-sectional data from the Demographic and Health Survey on 661,811 women in the reproductive age group of 15-49 years. The study uses information on seven chronic morbidities, namely asthma, cancers, heart disease, diabetes, tuberculosis, hypertension, and thyroid disorder. Descriptive, bivariate, and multivariable techniques were utilized to accomplish the study objective. Results: The findings show that 17.4 and 3.5 per 100 women of reproductive age suffered from any one morbidity and multimorbidity, respectively. Hypertension, diabetes, and thyroid disorders were commonly occurring morbidities. The prevalence of having any one morbidity or multimorbidity increased with age. Variables like religion, wealth, parity, menopause, consumption of tobacco and alcohol, body mass index, and type of diet were found to be significantly related to the burden of multimorbidity. The prevalence of multimorbidity was found to be higher for women who belong to the Southern, Eastern, and North-Eastern regions of India. Conclusions: Findings suggest the importance of multimorbidity in the context of women of reproductive age. Inclusion of chronic disease management strategies with maternal and child health services needs to be taken into consideration by the program and policymakers. The annexation of social marketing approaches at the primary level of healthcare would assist policy-makers in educating women about the importance of leading a healthy lifestyle. Practicing dietary diversity can help in maintaining optimal estrogen levels, which would further help in decreasing multimorbidity rates among women in India.
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Affiliation(s)
- Parul Puri
- International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, Maharashtra, 400088, India
| | - Ajinkya Kothavale
- International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, Maharashtra, 400088, India
| | - S.K. Singh
- International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, Maharashtra, 400088, India
| | - Sanghamitra Pati
- ICMR Regional Medical Research Centre, Indian Council of Medical Research, Department of Health Research, Bhubaneswar, Odisha, 751023, India
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Mishra SR, Chung HF, Waller M, Mishra GD. Duration of estrogen exposure during reproductive years, age at menarche and age at menopause, and risk of cardiovascular disease events, all-cause and cardiovascular mortality: a systematic review and meta-analysis. BJOG 2020; 128:809-821. [PMID: 32965759 DOI: 10.1111/1471-0528.16524] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Little is known about the estrogen exposure measurement and mutual effect of age at menarche and age at menopause in the risk of cardiovascular disease (CVD) events. OBJECTIVES To evaluate estrogen exposure measurement and describe mutual effect of age at menarche and age at menopause in the risk of CVD events. SEARCH STRATEGY Systematic review of literature in PubMed, Embase and Web of Science for studies published up to 28 June 2020. SELECTION CRITERIA Observational studies related to estrogen exposure measurement, including mutual effect of age at menarche and age at menopause and risk of CVD events. DATA COLLECTION AND ANALYSIS Synthesis of evidence was conducted by reviewing individual estimates, followed by meta-analysis. The study received no external funding. MAIN RESULTS A total of 75 studies were included in synthesis of evidence, of which 17 studies were included in meta-analysis. Reproductive lifespan (age at menopause - age at menarche), endogenous estrogen exposure and total estrogen exposure were used for estrogen exposure measurement. Reproductive lifespan was by far the most commonly used method for estrogen exposure measurement. A shorter reproductive lifespan was associated with a higher risk of CVD events; the pooled relative risk (95% CI) was 1.31 (1.25-1.36) for stroke events. Robust epidemiological studies with measurement of estrogen exposure and associated health risk would strengthen the evidence. CONCLUSIONS Reproductive lifespan was the most commonly used method for estrogen exposure measurement in epidemiological studies. A shorter reproductive lifespan was associated with a higher risk of CVD events, particularly stroke. TWEETABLE ABSTRACT A systematic review and meta-analysis found that women with a shorter reproductive lifespan have a higher risk of stroke events.
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Affiliation(s)
- S R Mishra
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - H-F Chung
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - M Waller
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - G D Mishra
- School of Public Health, The University of Queensland, Brisbane, Australia
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Beyene HB, Olshansky G, T. Smith AA, Giles C, Huynh K, Cinel M, Mellett NA, Cadby G, Hung J, Hui J, Beilby J, Watts GF, Shaw JS, Moses EK, Magliano DJ, Meikle PJ. High-coverage plasma lipidomics reveals novel sex-specific lipidomic fingerprints of age and BMI: Evidence from two large population cohort studies. PLoS Biol 2020; 18:e3000870. [PMID: 32986697 PMCID: PMC7544135 DOI: 10.1371/journal.pbio.3000870] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 10/08/2020] [Accepted: 09/01/2020] [Indexed: 12/11/2022] Open
Abstract
Obesity and related metabolic diseases show clear sex-related differences. The growing burden of these diseases calls for better understanding of the age- and sex-related metabolic consequences. High-throughput lipidomic analyses of population-based cohorts offer an opportunity to identify disease-risk-associated biomarkers and to improve our understanding of lipid metabolism and biology at a population level. Here, we comprehensively examined the relationship between lipid classes/subclasses and molecular species with age, sex, and body mass index (BMI). Furthermore, we evaluated sex specificity in the association of the plasma lipidome with age and BMI. Some 747 targeted lipid measures, representing 706 molecular lipid species across 36 classes/subclasses, were measured using a high-performance liquid chromatography coupled mass spectrometer on a total of 10,339 participants from the Australian Diabetes, Obesity and Lifestyle Study (AusDiab), with 563 lipid species being validated externally on 4,207 participants of the Busselton Health Study (BHS). Heat maps were constructed to visualise the relative differences in lipidomic profile between men and women. Multivariable linear regression analyses, including sex-interaction terms, were performed to assess the associations of lipid species with cardiometabolic phenotypes. Associations with age and sex were found for 472 (66.9%) and 583 (82.6%) lipid species, respectively. We further demonstrated that age-associated lipidomic fingerprints differed by sex. Specific classes of ether-phospholipids and lysophospholipids (calculated as the sum composition of the species within the class) were inversely associated with age in men only. In analyses with women alone, higher triacylglycerol and lower lysoalkylphosphatidylcholine species were observed among postmenopausal women compared with premenopausal women. We also identified sex-specific associations of lipid species with obesity. Lysophospholipids were negatively associated with BMI in both sexes (with a larger effect size in men), whilst acylcarnitine species showed opposing associations based on sex (positive association in women and negative association in men). Finally, by utilising specific lipid ratios as a proxy for enzymatic activity, we identified stearoyl CoA desaturase (SCD-1), fatty acid desaturase 3 (FADS3), and plasmanylethanolamine Δ1-desaturase activities, as well as the sphingolipid metabolic pathway, as constituent perturbations of cardiometabolic phenotypes. Our analyses elucidate the effect of age and sex on lipid metabolism by offering a comprehensive view of the lipidomic profiles associated with common cardiometabolic risk factors. These findings have implications for age- and sex-dependent lipid metabolism in health and disease and suggest the need for sex stratification during lipid biomarker discovery, establishing biological reference intervals for assessment of disease risk.
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Affiliation(s)
- Habtamu B. Beyene
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | | | | | - Corey Giles
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Kevin Huynh
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Michelle Cinel
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | | | - Gemma Cadby
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Joseph Hung
- Medical School, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
| | - Jennie Hui
- School of Population and Global Health, University of Western Australia, Perth, Australia
- PathWest Laboratory Medicine of Western Australia, Nedlands, Western Australia
| | - John Beilby
- PathWest Laboratory Medicine of Western Australia, Nedlands, Western Australia
| | - Gerald F. Watts
- Medical School, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
- Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, Perth, Australia
| | | | - Eric K. Moses
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Dianna J. Magliano
- Baker Heart and Diabetes Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Peter J. Meikle
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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26
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Meng Q, Li J, Chao Y, Bi Y, Zhang W, Zhang Y, Ji T, Fu Y, Chen Q, Zhang Q, Li Y, Bian H. β-estradiol adjusts intestinal function via ERβ and GPR30 mediated PI3K/AKT signaling activation to alleviate postmenopausal dyslipidemia. Biochem Pharmacol 2020; 180:114134. [PMID: 32628929 DOI: 10.1016/j.bcp.2020.114134] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 12/12/2022]
Abstract
Decreases in estrogen secretion and estrogen receptor function lead to an increase in the incidence of dyslipidemia and cardiovascular disease (CVD) in postmenopausal women. We previously reported that β-estradiol has a significant regulatory effect on lipids in ApoE-/- mice with bilateral ovariectomy. In the present study, we investigated how β-estradiol regulates intestinal function via estrogen receptors to alleviate postmenopausal dyslipidemia. Ovariectomized ApoE-/- mice were treated with β-estradiol for 90 days, and we found that β-estradiol reduced TC, TG, LDL-c, IL-1β and IL-18 levels in serum and decreased lipid accumulation in the liver. β-estradiol reduced injury and inflammation in the jejunum in ovariectomized mice, and promoted the expression of tight junction-related proteins. Moreover, β-estradiol increased ERα, ERβ, GPR30 and ABCG5 protein expression, and decreased the levels of NPC1L1 and SR-B1 in the jejunum of ovariectomized mice. In Caco-2 cells incubated with cholesterol, β-estradiol up-regulated PI3K/AKT signaling, reduced cholesterol accumulation, suppressed inflammatory signaling, and increased the expression of tight junction-related proteins. ERβ or GPR30 inhibition decreased the protective effect of β-estradiol on cholesterol accumulation, tight junctions, and inflammation in cholesterol incubated Caco-2 cells, while silencing both ERβ and GPR30 completely eliminated the protective effect of β-estradiol. PI3K/AKT inhibition abolished the protective effect of β-estradiol on cholesterol accumulation, tight junction-related protein expression, and inflammation, but had no influence on ERα, ERβ or GPR30 expression in cholesterol incubated Caco-2 cells. Our results provide evidence that β-estradiol regulates intestinal function via ERβ and GPR30 mediated PI3K/AKT signaling activation to alleviate postmenopausal dyslipidemia.
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Affiliation(s)
- Qinghai Meng
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Jun Li
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Ying Chao
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Yunhui Bi
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Weiwei Zhang
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Yuhan Zhang
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Tingting Ji
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Yu Fu
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Qi Chen
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Qichun Zhang
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China; Jiangsu Key Laboratory for Pharmacology and Safety Evaluation of Chinese Materia Medica, School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Yu Li
- School of Medicine and Life Sciences, Nanjing University of Chinese Medicine, Nanjing 210023, China.
| | - Huimin Bian
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China; Jiangsu Key Laboratory for Pharmacology and Safety Evaluation of Chinese Materia Medica, School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China.
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27
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O'Keeffe LM, Kuh D, Fraser A, Howe LD, Lawlor D, Hardy R. Age at period cessation and trajectories of cardiovascular risk factors across mid and later life. Heart 2020; 106:499-505. [PMID: 32098806 PMCID: PMC7079196 DOI: 10.1136/heartjnl-2019-315754] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/15/2019] [Accepted: 11/20/2019] [Indexed: 01/23/2023] Open
Abstract
Objective To examine the association between age at period cessation and trajectories of anthropometry, blood pressure, lipids and glycated haemoglobin (HbA1c) from midlife to age 69 years. Methods We used data from the UK Medical Research Council National Survey of Health and Development to examine the association between age at period cessation and trajectories of systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI) and waist circumference (WC) from 36 to 69 years and trajectories of triglyceride, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and HbA1c from 53 to 69 years. Results We found no evidence that age at period cessation was associated with trajectories of log triglyceride, LDL-C and HDL-C from 53 to 69 years and trajectories of SBP or DBP from 36 to 69 years, regardless of whether period cessation occurred naturally or due to hysterectomy. While we found some evidence of associations of age at period cessation with log BMI, log WC and log HbA1c, patterns were not consistent and differences were small at age 69 years, with confidence intervals that spanned the null value. Conclusion How and when women experience period cessation is unlikely to adversely affect conventional cardiovascular risk factors across mid and later life. Women and clinicians concerned about the impact of type and timing of period cessation on conventional cardiovascular intermediates from midlife should be reassured that the impact over the long term is small.
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Affiliation(s)
- Linda Marie O'Keeffe
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK .,Population Health Science, Bristol Medical School, Bristol, UK.,School of Public Health, University College Cork, Cork, Ireland
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Abigail Fraser
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,Population Health Science, Bristol Medical School, Bristol, UK
| | - Laura D Howe
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,Population Health Science, Bristol Medical School, Bristol, UK
| | - Debbie Lawlor
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,Population Health Science, Bristol Medical School, Bristol, UK
| | - Rebecca Hardy
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK.,CLOSER, UCL Institute of Education, London, UK
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28
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Yang S, Kwak S, Kwon S, Lee HJ, Lee H, Park JB, Lee SP, Kim H, Han K, Kim YJ, Kim HK. Association of Total Reproductive Years With Incident Atrial Fibrillation, and Subsequent Ischemic Stroke in Women With Natural Menopause. Circ Arrhythm Electrophysiol 2019; 12:e007428. [DOI: 10.1161/circep.119.007428] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background:
The association of lifetime exposure to endogenous sex hormone with incident atrial fibrillation (AF) and subsequent ischemic stroke has never been studied.
Methods:
This study involved 4 638 299 natural postmenopausal waomen aged ≥40 years without prior history of AF and with national breast cancer check-up between January 1, 2009 and December 31, 2014. The primary end point was incident AF, and the secondary end point was subsequent ischemic stroke once AF has developed. Cox proportional hazard regression analysis was used to estimate the risk of end points.
Results:
During the mean follow-up of 6.3 years, shorter total reproductive years (<30 years) were associated with 7% increased risk of AF after adjusting for confounding variables (adjusted hazard ratio [aHR], 1.07 [95% CI, 1.05–1.09]). Risk of AF declined progressively with every 5-yearly increment in total reproductive years (
P
-for-trend <0.001). However, the prolonged (≥2 years) use of hormone replacement therapy after menopause was paradoxically associated with a 3% increase in AF risk (aHR, 1.03 [95% CI, 1.01–1.05]). For the secondary end point analysis, the risk of ischemic stroke after AF development significantly decreased with each 5-yearly increment in total reproductive years (with <30 years as reference; aHR, 0.93 [95% CI, 0.88–0.99] for 30–34 years; aHR, 0.84 [95% CI, 0.79–0.89] for 35–39 years; and aHR, 0.88 [95% CI, 0.80–0.97] for ≥40 years,
P
-for-trend <0.001).
Conclusions:
In women with natural menopause, shorter lifetime exposure to endogenous sex hormone, that is, shorter total reproductive years, was significantly associated with a higher risk of AF and subsequent ischemic stroke. Paradoxically, prolonged exogenous hormone replacement therapy increased the risk of incident AF.
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Affiliation(s)
- Seokhun Yang
- Department of Internal Medicine, Seoul National University Hospital, Korea (S.Y., S. Kwak, S.Kwon, H.-J.L., H.L., J.-B.P., S.-P.L., Y.-J.K.)
| | - Soongu Kwak
- Department of Internal Medicine, Seoul National University Hospital, Korea (S.Y., S. Kwak, S.Kwon, H.-J.L., H.L., J.-B.P., S.-P.L., Y.-J.K.)
| | - Soonil Kwon
- Department of Internal Medicine, Seoul National University Hospital, Korea (S.Y., S. Kwak, S.Kwon, H.-J.L., H.L., J.-B.P., S.-P.L., Y.-J.K.)
| | - Hyun-Jung Lee
- Department of Internal Medicine, Seoul National University Hospital, Korea (S.Y., S. Kwak, S.Kwon, H.-J.L., H.L., J.-B.P., S.-P.L., Y.-J.K.)
| | - Heesun Lee
- Department of Internal Medicine, Seoul National University Hospital, Korea (S.Y., S. Kwak, S.Kwon, H.-J.L., H.L., J.-B.P., S.-P.L., Y.-J.K.)
| | - Jun-Bean Park
- Department of Internal Medicine, Seoul National University Hospital, Korea (S.Y., S. Kwak, S.Kwon, H.-J.L., H.L., J.-B.P., S.-P.L., Y.-J.K.)
| | - Seung-Pyo Lee
- Department of Internal Medicine, Seoul National University Hospital, Korea (S.Y., S. Kwak, S.Kwon, H.-J.L., H.L., J.-B.P., S.-P.L., Y.-J.K.)
| | - Hoon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Korea (H.K.)
| | - Kyungdo Han
- Department of Biostatistics, The Catholic University of Korea, Seoul (K.H.)
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University Hospital, Korea (S.Y., S. Kwak, S.Kwon, H.-J.L., H.L., J.-B.P., S.-P.L., Y.-J.K.)
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29
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Zhou H, Zhang C, Ni J, Han X. Prevalence of cardiovascular risk factors in non-menopausal and postmenopausal inpatients with type 2 diabetes mellitus in China. BMC Endocr Disord 2019; 19:98. [PMID: 31601203 PMCID: PMC6787985 DOI: 10.1186/s12902-019-0427-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 09/13/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND To investigate the prevalence of cardiovascular disease (CVD) risk factors and assess the 10-year risk of CVD in non-menopausal and postmenopausal women with type 2 diabetes mellitus (T2DM). METHODS A total of 569 patients with T2DM at a Chinese tertiary hospital were investigated using the Framingham Risk Score (FRS). We evaluated the 10-year risk of CVD, clinical and menopause characteristics in all subjects. RESULTS Among the 569 diabetic patients, the incidence of smoking, dyslipidemia, hypertension, overweight or obesity, and nonalcoholic fatty liver disease (NAFLD) was 0.7, 36.2, 38.1 56.6 and 58.2%, respectively. The usage rate of hypoglycemic agents, antihypertensive agents, lipid modulators and antithrombotic drugs was 88.6, 78.3, 50.0 and 27.1%, respectively. However, only 1.2% of inpatients achieved the three target goals for the control of blood glucose (HbA1c < 7%), blood pressure (systolic blood pressure < 130 mmHg, diastolic blood pressure < 80 mmHg), and blood lipids (total cholesterol < 174 mg/dL). The 10-year risk of CVD was (1.6 ± 1.5%) and tended to increase along with age (F = 27.726, P < 0.001). For all subjects (n = 569), multiple linear regression analysis showed that menopause (β = 0.275, P < 0.001), low-density lipoprotein cholesterol (LDL-C) (β = 0.212, P < 0.001), fasting plasma glucose (FPG) (β = 0.093, P = 0.018) and waist-to-hip-ratio (β = - 0.078, P = 0.047) were risk factors of 10-year risk of CVD, which may explain the variance of 14.3%. In the postmenopausal group (n = 397), LDL-C (β = 0.227, P < 0.001), FPG (β = 0.139, P = 0.003) and time since menopause (β = 0.230, P < 0.001) were found to be associated with CVD, which may explain the variance of 14.6%. CONCLUSION The incidence of dyslipidmia, hypertension, overweight or obesity and NAFLD is high. The level of control of blood glucose, blood pressure, and blood lipids was found to be extremely low and the treatment status was not ideal. Besides menopause, LDL-C, FPG and time since menopause were found to be independent risk factors for the 10-year risk of CVD. Therefore, it is necessary to focus on comprehensive control of multiple risk factors, such as plasma glucose, blood pressure and serum lipid.
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Affiliation(s)
- Huanhuan Zhou
- The First People's Hospital of Changzhou, 185# Juqian Road, Changzhou, 213000, Jiangsu Province, China
| | - Chenghuan Zhang
- The First People's Hospital of Changzhou, 185# Juqian Road, Changzhou, 213000, Jiangsu Province, China
| | - Jingyu Ni
- The First People's Hospital of Changzhou, 185# Juqian Road, Changzhou, 213000, Jiangsu Province, China
| | - Xiaoyun Han
- The First People's Hospital of Changzhou, 185# Juqian Road, Changzhou, 213000, Jiangsu Province, China.
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30
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Savonitto S, Morici N, Franco N, Misuraca L, Lenatti L, Ferri LA, Lo Jacono E, Leuzzi C, Corrada E, Aranzulla TC, Cagnacci A, Colombo D, La Vecchia C, Prati F. Age at menopause, extent of coronary artery disease and outcome among postmenopausal women with acute coronary syndromes. Int J Cardiol 2018; 259:8-13. [DOI: 10.1016/j.ijcard.2018.02.065] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 02/15/2018] [Indexed: 12/24/2022]
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