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Meena D, Huang J, Dib M, Chirinos J, Jia M, Chauhan G, Gill D, Elliott P, Dehghan A, Tzoulaki I. Body Mass Index and Hypertension as Mediators of the Association Between Age at Menarche and Subclinical Atherosclerosis: A Sex-Specific Mendelian Randomization Analysis. J Am Heart Assoc 2024; 13:e032192. [PMID: 38979809 PMCID: PMC11292777 DOI: 10.1161/jaha.123.032192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 05/22/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Early age at menarche (AAM) has been associated with a higher risk of carotid artery intima-media thickness (cIMT), an indicator of subclinical vascular disease, albeit the mechanisms underlying this association remain elusive. A better understanding of the relationship between AAM, modifiable cardiometabolic risk factors, and subclinical atherosclerosis may contribute to improved primary prevention and cardiovascular disease treatment. We aimed to investigate the putative causal role of AAM on cIMT, and to identify and quantify the potentially mediatory effects of cardiometabolic risk factors underlying this relationship. METHODS AND RESULTS We conducted linkage disequilibrium score regression analyses between our exposure of interest, AAM, our outcome of interest, cIMT and potential mediators of the AAM-cIMT association to gauge cross-trait genetic overlap. We considered as mediators the modifiable anthropometric risk factors body mass index (BMI), systolic blood pressure (SBP), lipid traits (total cholesterol, triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol), and glycemic traits (fasting glucose). We then leveraged the paradigm of Mendelian randomization to infer causality between AAM and cIMT, and to identify whether cardiometabolic risk factors served as potential mediators of this effect. Our analyses showed that genetically predicted AAM was inversely associated with cIMT, BMI, SBP, and triglycerides, and positively associated with high-density lipoprotein, low-density lipoprotein, and total cholesterol. We showed that the effect of genetically predicted AAM on cIMT may be partially mediated through BMI (20.1% [95% CI, 1.4% to 38.9%]) and SBP (13.5% [95% CI, 0.5%-26.6%]). Our cluster-specific Mendelian randomization revealed heterogeneous causal effect estimates of age at menarche on BMI and SBP. CONCLUSIONS We highlight supporting evidence for a potential causal association between earlier AAM and cIMT, and almost one third of the effect of AAM on cIMT may be mediated by BMI and SBP. Early intervention aimed at lowering BMI and hypertension may be beneficial in reducing the risk of developing subclinical atherosclerosis due to earlier age at menarche.
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Affiliation(s)
- Devendra Meena
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUnited Kingdom
| | - Jian Huang
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUnited Kingdom
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR)Singapore
- Bioinformatics Institute (BII)Agency for Science, Technology and Research (A*STAR)SingaporeSingapore
| | - Marie‐Joe Dib
- Division of Cardiovascular MedicineHospital of the University of PennsylvaniaPhiladelphiaPAUSA
| | - Julio Chirinos
- Division of Cardiovascular MedicineHospital of the University of PennsylvaniaPhiladelphiaPAUSA
| | - Manyi Jia
- Department of Metabolism Digestion and Reproduction, Section of Computational and Systems MedicineImperial College LondonLondonUnited Kingdom
| | - Ganesh Chauhan
- Department of Genetics & GenomicsRajendra Institute of Medical Sciences (RIMS)RanchiIndia
| | - Dipender Gill
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUnited Kingdom
- British Heart Foundation Centre of Excellence, Imperial College LondonLondonUnited Kingdom
| | - Paul Elliott
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUnited Kingdom
- British Heart Foundation Centre of Excellence, Imperial College LondonLondonUnited Kingdom
- Dementia Research Institute, Imperial College LondonLondonUnited Kingdom
- MRC Centre for Environment and Health, School of Public Health, Imperial College LondonLondonUnited Kingdom
| | - Abbas Dehghan
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUnited Kingdom
- Dementia Research Institute, Imperial College LondonLondonUnited Kingdom
| | - Ioanna Tzoulaki
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUnited Kingdom
- British Heart Foundation Centre of Excellence, Imperial College LondonLondonUnited Kingdom
- Systems Biology, Biomedical Research Foundation Academy of AthensAthensGreece
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Chen IJ, Shoupe D, Karim R, Stanczyk FZ, Kono N, Sriprasert I, Hodis HN, Mack WJ. The association of hysterectomy with or without ovarian conservation with subclinical atherosclerosis progression in healthy postmenopausal women. Menopause 2023; 30:692-702. [PMID: 37192828 PMCID: PMC10313726 DOI: 10.1097/gme.0000000000002192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
OBJECTIVE While the deleterious associations of surgical menopause after bilateral oophorectomy with cardiovascular disease are documented, less is specifically known concerning subclinical atherosclerosis progression. METHODS We used data from 590 healthy postmenopausal women randomized to hormone therapy or placebo in the Early versus Late Intervention Trial with Estradiol (ELITE), which was conducted from July 2005 to February 2013. Subclinical atherosclerosis progression was measured as annual rate of change in carotid artery intima-media thickness (CIMT) over a median 4.8 years. Mixed-effects linear models assessed the association of hysterectomy and bilateral oophorectomy compared with natural menopause with CIMT progression adjusted for age and treatment assignment. We also tested modifying associations by age at or years since oophorectomy or hysterectomy. RESULTS Among 590 postmenopausal women, 79 (13.4%) underwent hysterectomy with bilateral oophorectomy and 35 (5.9%) underwent hysterectomy with ovarian conservation, a median of 14.3 years before trial randomization. Compared with natural menopause, women who underwent hysterectomy with and without bilateral oophorectomy had higher fasting plasma triglycerides while women who underwent bilateral oophorectomy had lower plasma testosterone. The CIMT progression rate in bilaterally oophorectomized women was 2.2 μm/y greater than natural menopause ( P = 0.08); specifically, compared with natural menopause, the associations were significantly greater in postmenopausal women who were older than 50 years at the time of bilateral oophorectomy ( P = 0.014) and in postmenopausal women who underwent bilateral oophorectomy more than 15 years before randomization ( P = 0.015). Moreover, the CIMT progression rate in hysterectomized women with ovarian conservation was 4.6 μm/y greater than natural menopause ( P = 0.015); in particular, compared with natural menopause, the association was significantly greater in postmenopausal women who underwent hysterectomy with ovarian conservation more than 15 years before randomization ( P = 0.018). CONCLUSIONS Hysterectomy with bilateral oophorectomy and ovarian conservation were associated with greater subclinical atherosclerosis progression relative to natural menopause. The associations were stronger for later age and longer time since oophorectomy/hysterectomy. Further research should continue to examine long-term atherosclerosis outcomes related to oophorectomy/hysterectomy.
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Affiliation(s)
- Irene J. Chen
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Donna Shoupe
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Roksana Karim
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Atherosclerosis Research Unit, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Frank Z. Stanczyk
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Naoko Kono
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Intira Sriprasert
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Howard N. Hodis
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Atherosclerosis Research Unit, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Wendy J. Mack
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Atherosclerosis Research Unit, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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Roa-Díaz ZM, Wehrli F, Lambrinoudaki I, Gebhard C, Baumgartner I, Marques-Vidal P, Bano A, Raguindin PF, Muka T. Early menopause and cardiovascular risk factors: a cross-sectional and longitudinal study. Menopause 2023; 30:599-606. [PMID: 37130378 DOI: 10.1097/gme.0000000000002184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVE The aim of the study is to evaluate the cross-sectional and longitudinal association of early natural menopause with changes in cardiovascular risk factors (CVRFs). METHODS Postmenopausal women from the Swiss CoLaus study, reporting age at natural menopause (ANM) and having CVRFs measurements (blood lipids, blood pressure, glucose, homeostatic model assessment for insulin resistance [HOMA-IR], and inflammatory markers) at baseline (2003-2006) and first follow-up (2009-2012) were eligible for analysis. Age at natural menopause was analyzed as a continuous variable and in categories (ANM <45 and ≥45 y old). Linear regression analysis and linear mixed models were used to assess whether ANM is associated cross-sectionally and longitudinally with changes in CVRFs. Models were adjusted for demographic characteristics, lifestyle-related factors, time since menopause, medication, and clinical conditions. RESULTS We analyzed 981 postmenopausal women. The cross-sectional analysis showed that women with ANM younger than 45 years had lower diastolic blood pressure (β = -3.76 mm Hg; 95% confidence interval [CI] = -5.86 to -1.65) compared with women whose ANM was 45 years or older. In the longitudinal analysis, ANM younger than 45 years was associated with changes in log insulin (β = 0.26; 95% CI = 0.08 to 0.45) and log homeostatic model assessment for insulin resistance levels (β = 0.28; 95% CI = 0.08 to 0.48). No associations were found between ANM and other CVRFs. CONCLUSIONS Early menopause may be associated with changes in glucose metabolism, while it may have little to no impact on other CVRFs. Larger longitudinal studies are needed to replicate our findings.
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Affiliation(s)
| | - Faina Wehrli
- From the Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Irene Lambrinoudaki
- Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Catherine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Iris Baumgartner
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
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Hellbach F, Baumeister SE, Wilson R, Wawro N, Dahal C, Freuer D, Hauner H, Peters A, Winkelmann J, Schwettmann L, Rathmann W, Kronenberg F, Koenig W, Meisinger C, Waldenberger M, Linseisen J. Association between Usual Dietary Intake of Food Groups and DNA Methylation and Effect Modification by Metabotype in the KORA FF4 Cohort. Life (Basel) 2022; 12:life12071064. [PMID: 35888152 PMCID: PMC9318948 DOI: 10.3390/life12071064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022] Open
Abstract
Associations between diet and DNA methylation may vary among subjects with different metabolic states, which can be captured by clustering populations in metabolically homogenous subgroups, called metabotypes. Our aim was to examine the relationship between habitual consumption of various food groups and DNA methylation as well as to test for effect modification by metabotype. A cross-sectional analysis of participants (median age 58 years) of the population-based prospective KORA FF4 study, habitual dietary intake was modeled based on repeated 24-h diet recalls and a food frequency questionnaire. DNA methylation was measured using the Infinium MethylationEPIC BeadChip providing data on >850,000 sites in this epigenome-wide association study (EWAS). Three metabotype clusters were identified using four standard clinical parameters and BMI. Regression models were used to associate diet and DNA methylation, and to test for effect modification. Few significant signals were identified in the basic analysis while many significant signals were observed in models including food group-metabotype interaction terms. Most findings refer to interactions of food intake with metabotype 3, which is the metabotype with the most unfavorable metabolic profile. This research highlights the importance of the metabolic characteristics of subjects when identifying associations between diet and white blood cell DNA methylation in EWAS.
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Affiliation(s)
- Fabian Hellbach
- Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilian University of Munich, Marchioninistr. 15, 81377 Munich, Germany; (N.W.); (J.L.)
- Epidemiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany; (C.D.); (D.F.); (C.M.)
- Correspondence: ; Tel.: +49-821-598-6473
| | - Sebastian-Edgar Baumeister
- Institute of Health Services Research in Dentistry, Medical Faculty, University of Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany;
| | - Rory Wilson
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764 Neuherberg, Germany; (R.W.); (A.P.); (M.W.)
- Research Unit Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Nina Wawro
- Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilian University of Munich, Marchioninistr. 15, 81377 Munich, Germany; (N.W.); (J.L.)
- Epidemiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany; (C.D.); (D.F.); (C.M.)
| | - Chetana Dahal
- Epidemiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany; (C.D.); (D.F.); (C.M.)
| | - Dennis Freuer
- Epidemiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany; (C.D.); (D.F.); (C.M.)
| | - Hans Hauner
- Else Kröner-Fresenius-Center for Nutritional Medicine, TUM School of Life Sciences, Technical University of Munich, 85354 Freising, Germany;
- Institute of Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764 Neuherberg, Germany; (R.W.); (A.P.); (M.W.)
- Research Unit Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
- German Center for Diabetes Research (DZD e.V.), Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Auf’m Hennekamp 65, 40225 Düsseldorf, Germany;
| | - Juliane Winkelmann
- Institute of Neurogenomic, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764 Neuherberg, Germany;
| | - Lars Schwettmann
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764 Neuherberg, Germany;
- Department of Economics, Martin Luther University Halle-Wittenberg, 06099 Halle, Germany
| | - Wolfgang Rathmann
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Auf’m Hennekamp 65, 40225 Düsseldorf, Germany;
| | - Florian Kronenberg
- Department of Genetics and Pharmacology, Institute of Genetic Epidemiology, Medical University of Innsbruck, Schöpfstr. 41, 6020 Innsbruck, Austria;
| | - Wolfgang Koenig
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Pettenkoferstr. 8A & 9, 80336 Munich, Germany;
- German Heart Centre Munich, Technical University Munich, Lazarettstr. 36, 80636 Munich, Germany
- Institute of Epidemiology and Medical Biometry, University of Ulm, Helmholtzstr. 22, 89081 Ulm, Germany
| | - Christa Meisinger
- Epidemiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany; (C.D.); (D.F.); (C.M.)
| | - Melanie Waldenberger
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764 Neuherberg, Germany; (R.W.); (A.P.); (M.W.)
- Research Unit Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Auf’m Hennekamp 65, 40225 Düsseldorf, Germany;
| | - Jakob Linseisen
- Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilian University of Munich, Marchioninistr. 15, 81377 Munich, Germany; (N.W.); (J.L.)
- Epidemiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany; (C.D.); (D.F.); (C.M.)
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Tschiderer L, Peters SA, Willeit P. Menopause and cardiovascular risk: insights from analyses of imaging markers. Future Cardiol 2022; 18:601-604. [PMID: 35678307 DOI: 10.2217/fca-2022-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Lena Tschiderer
- Clinical Epidemiology Team, Medical University of Innsbruck, Innsbruck, 6020, Austria.,Julius Center for Health Sciences & Primary Care, University Medical Center Utrecht, Utrecht, 3584 CX, The Netherlands
| | - Sanne Ae Peters
- Julius Center for Health Sciences & Primary Care, University Medical Center Utrecht, Utrecht, 3584 CX, The Netherlands.,The George Institute for Global Health, School of Public Health, Imperial College London, London, W12 0BZ, UK.,The George Institute for Global Health, University of New South Wales, Sydney, 2042, New South Wales, Australia
| | - Peter Willeit
- Clinical Epidemiology Team, Medical University of Innsbruck, Innsbruck, 6020, Austria.,Department of Public Health & Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
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Bartosiewicz A, Łuszczki E, Nagórska M, Oleksy Ł, Stolarczyk A, Dereń K. Risk Factors of Metabolic Syndrome among Polish Nurses. Metabolites 2021; 11:metabo11050267. [PMID: 33922860 PMCID: PMC8145067 DOI: 10.3390/metabo11050267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/13/2021] [Accepted: 04/21/2021] [Indexed: 02/08/2023] Open
Abstract
The metabolic syndrome, also known as syndrome X or the insulin resistance, is defined by the World Health Organization as a pathologic condition characterized by abdominal obesity, insulin resistance, hypertension, and hyperlipidemia. Both all over the world and in Poland, there is a shortage of nurses; most of those employed are in the pre-retirement age. However, the requirements in this profession and the patient’s right to care at the highest level remain unchanged and do not take into account the poor condition or age of working nurses, so special attention should be paid to the state of health in this professional group. There is an emphasis on the importance of the adopted attitude toward health and the resulting behaviors, such as regular weight control, following dietary recommendations, regular physical activity and participation in preventive examinations. The aim of the study was to assess the frequency of the occurrence of the metabolic syndrome, its individual components and determining the factors influencing its development in Polish nurses. The research conducted among the nurses in question included DXA (Dual Energy X-ray Absorptiometry) measurements, assessment of glucose concentration, lipid profile, blood pressure and a questionnaire survey. Almost half of the surveyed nurses have metabolic syndrome, which significantly increases the risk of developing cardiovascular diseases or diabetes. After multivariate analysis, it was found that being overweight and obesity were significant factors influenced the MS (metabolic syndrome) occurrence among Polish nurses. Being overweight increases the chances of MS occurrence 8.58 times in relation to BMI (Body Mass Index) <25, obesity increases the chances of MS occurrence 8.085 times in relation to BMI <25, and obesity class II/III increases the chances of MS occurrence 16.505 times in relation to BMI <25. Preventive and supportive measures for this professional group are needed.
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Affiliation(s)
- Anna Bartosiewicz
- Institute of Health Sciences, Medical College of Rzeszów University, 35-959 Rzeszów, Poland; (E.Ł.); (K.D.)
- Correspondence: ; Tel.: +48-17-851-6811
| | - Edyta Łuszczki
- Institute of Health Sciences, Medical College of Rzeszów University, 35-959 Rzeszów, Poland; (E.Ł.); (K.D.)
| | - Małgorzata Nagórska
- Institute of Medical Sciences, Medical College of Rzeszow University, 35-959 Rzeszow, Poland;
| | - Łukasz Oleksy
- Orthopaedic and Rehabilitation Department, Medical University of Warsaw, 02-091 Warsaw, Poland; (Ł.O.); (A.S.)
| | - Artur Stolarczyk
- Orthopaedic and Rehabilitation Department, Medical University of Warsaw, 02-091 Warsaw, Poland; (Ł.O.); (A.S.)
| | - Katarzyna Dereń
- Institute of Health Sciences, Medical College of Rzeszów University, 35-959 Rzeszów, Poland; (E.Ł.); (K.D.)
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Barua L, Banik PC, Islam SMS, Faruque M. Application of country‐specific Globorisk score to estimate next 10 years risk of cardiovascular diseases and its associated predictors among postmenopausal rural women of Bangladesh: A cross‐sectional study in a primary care setting. LIFESTYLE MEDICINE 2021. [DOI: 10.1002/lim2.32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Lingkan Barua
- Department of Noncommunicable Diseases Bangladesh University of Health Sciences Dhaka Bangladesh
| | - Palash Chandra Banik
- Department of Noncommunicable Diseases Bangladesh University of Health Sciences Dhaka Bangladesh
| | | | - Mithila Faruque
- Department of Noncommunicable Diseases Bangladesh University of Health Sciences Dhaka Bangladesh
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Maher GM, Ryan L, McCarthy FP, Hughes A, Park C, Fraser A, Howe LD, Kearney PM, O'Keeffe LM. Puberty timing and markers of cardiovascular structure and function at 25 years: a prospective cohort study. BMC Med 2021; 19:78. [PMID: 33761960 PMCID: PMC7992788 DOI: 10.1186/s12916-021-01949-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/23/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Whether earlier onset of puberty is associated with higher cardiovascular risk in early adulthood is not well understood. Our objective was to examine the association between puberty timing and markers of cardiovascular structure and function at age 25 years. METHODS We conducted a prospective birth cohort study using data from the Avon Longitudinal Study of Parents and Children (ALSPAC). Participants were born between April 1, 1991, and December 31, 1992. Exposure of interest was age at peak height velocity (aPHV), an objective and validated growth-based measure of puberty onset. Outcome measures included cardiovascular structure and function at age 25 years: carotid intima-media thickness (CIMT), left ventricular mass index (LVMI) and relative wall thickness (RWT), pulse wave velocity (PWV) and systolic blood pressure (SBP). Multiple imputation was used to impute missing data on covariates and outcomes. Linear regression was used to examine the association between aPHV and each measure of cardiac structure and function, adjusting for maternal age, gestational age, household social class, maternal education, mother's partner's education, breastfeeding, parity, birthweight, maternal body mass index, maternal marital status, maternal prenatal smoking status and height and fat mass at age 9. All analyses were stratified by sex. RESULTS A total of 2752-4571 participants were included in the imputed analyses. A 1-year older aPHV was not strongly associated with markers of cardiac structure and function in males and females at 25 years and most results spanned the null value. In adjusted analyses, a 1-year older aPHV was associated with 0.003 mm (95% confidence interval (CI) 0.00001, 0.006) and 0.0008 mm (95% CI - 0.002, 0.003) higher CIMT; 0.02 m/s (95% CI - 0.05, 0.09) and 0.02 m/s (95% CI - 0.04, 0.09) higher PWV; and 0.003 mmHg (95% CI - 0.60, 0.60) and 0.13 mmHg (95% CI - 0.44, 0.70) higher SBP, among males and females, respectively. A 1-year older aPHV was associated with - 0.55 g/m2.7 (95% CI - 0.03, - 1.08) and - 0.89 g/m2.7 (95% CI - 0.45, - 1.34) lower LVMI and - 0.001 (95% CI - 0.006, 0.002) and - 0.002 (95% CI - 0.006, 0.002) lower RWT among males and females. CONCLUSIONS Earlier puberty is unlikely to have a major impact on pre-clinical cardiovascular risk in early adulthood.
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Affiliation(s)
- Gillian M Maher
- INFANT Research Centre, University College Cork, Cork, Ireland.
- School of Public Health, University College Cork, Cork, Ireland.
| | - Lisa Ryan
- School of Public Health, University College Cork, Cork, Ireland
| | - Fergus P McCarthy
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Alun Hughes
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, Gower Street, London, WC1E 6BT, UK
- MRC Unit for Lifelong Health and Ageing at University College London, London, UK
| | - Chloe Park
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, Gower Street, London, WC1E 6BT, UK
| | - Abigail Fraser
- Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK
| | - Laura D Howe
- Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK
| | | | - Linda M O'Keeffe
- School of Public Health, University College Cork, Cork, Ireland
- Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK
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Bubach S, Horta BL, Gonçalves H, Assunção MCF. Early age at menarche and metabolic cardiovascular risk factors: mediation by body composition in adulthood. Sci Rep 2021; 11:148. [PMID: 33420216 PMCID: PMC7794383 DOI: 10.1038/s41598-020-80496-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 08/28/2020] [Indexed: 02/06/2023] Open
Abstract
Evidence suggests that early menarche increases cardiometabolic risk, and adiposity would be a possible mediator of this association. We assessed the association between age at menarche and metabolic cardiovascular risk factors and estimated the indirect effect of body composition in adulthood. In 1982, all hospital births in the city of Pelotas/Brazil, were identified and live births were examined and have been prospectively followed. At 30 years, information on age at menarche and metabolic cardiovascular risk factors was available for 1680 women. Mediation analysis was performed using G-computation to estimate the direct effect of age at menarche and the indirect effect of body composition. The prevalence of age at menarche < 12 years was 24.5% and was associated with higher mean diastolic blood pressure [β: 1.98; 95% CI: 0.56, 3.40], total cholesterol (β: 8.28; 95% CI: 2.67, 13.88), LDL-cholesterol (β: 6.53; 95% CI: 2.00, 11.07), triglycerides (β: 0.11; 95% CI: 0.03, 0.19). For diastolic blood pressure, total cholesterol, LDL-cholesterol, triglycerides, body composition assessed by fat mass index captured from 43.8 to 98.9% of the effect of early menarche, except to systolic blood pressure, HDL-cholesterol, C-reactive-protein. Suggesting that the effect of menarche age < 12 years on some metabolic cardiovascular risk factors is mediated partially by body composition in adulthood.
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Affiliation(s)
- Susana Bubach
- Department of Health Sciences, Federal University of Espírito Santo, São Mateus, 29932-540, Brazil.
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, 29932-540, Brazil.
| | - Bernardo Lessa Horta
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, 29932-540, Brazil
| | - Helen Gonçalves
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, 29932-540, Brazil
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van Bommel MHD, de Jong MA, Steenbeek MP, Bots ML, van Westerop LLM, Hopman MTE, Hoogerbrugge N, de Hullu JA, Maas AHEM. No signs of subclinical atherosclerosis after risk-reducing salpingo-oophorectomy in BRCA1/2 mutation carriers. J Cardiol 2020; 77:570-575. [PMID: 33229237 DOI: 10.1016/j.jjcc.2020.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/16/2020] [Accepted: 10/18/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND BRCA1/2 mutation carriers are generally exposed to early menopause due to risk-reducing salpingo-oophorectomy (RRSO) around the age of 40 years. This risk-reducing intervention is based on a 10-40% life-time risk of ovarian cancer in this population. Although effective, premature and acute menopause induces non-cancer related morbidity in both the short and long term. Little is known about the impact of RRSO on the cardiovascular system. METHODS This cross-sectional study explored the relationship between time since RRSO and signs of subclinical atherosclerosis, as measured by carotid intima-media thickness (CIMT) and pulse wave velocity (PWV), in 165 BRCA1/2 mutation carriers. All participants, aged 40 to 63 years, underwent RRSO before the age of 45 years, and at least 5 years ago. Cardiovascular risk factors were assessed by questionnaires and a single screening visit. Data were analyzed using linear regression models. RESULTS Mean CIMT was 692.7 μm (SD 87.0), and mean central PWV 6.40 m/s (SD 1.42). After adjustment for age and several relevant cardiovascular risk factors, time since RRSO was not associated with CIMT (β=0.68 μm; 95% CI -4.02, 5.38) and PWV (β=44 mm/s; 95% CI -32, 120). Compared to women of a reference group from the general population, lower systolic blood pressure [mean difference 12 mmHg; 95% confidence interval (CI) 10, 14] was found in BRCA1/2 mutation carriers. CONCLUSIONS We found that, in BRCA1/2 mutation carriers, at 5 to 24 years follow-up, time since RRSO is not related to development of subclinical atherosclerosis. However, the follow-up period in these relatively young women might have been too short.
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Affiliation(s)
- Majke H D van Bommel
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands.
| | - Marieke Arts de Jong
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Miranda P Steenbeek
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Michiel L Bots
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Liselore L M van Westerop
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Maria T E Hopman
- Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Nicoline Hoogerbrugge
- Department of Human Genetics, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Joanne A de Hullu
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
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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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12
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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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Cortés YI, Parikh N, Allison MA, Criqui MH, Suder N, Barinas-Mitchell E, Wassel CL. Women's Reproductive History and Pre-Clinical Peripheral Arterial Disease in Late Life: The San Diego Population Study. J Womens Health (Larchmt) 2019; 28:1105-1115. [PMID: 30508411 PMCID: PMC6703238 DOI: 10.1089/jwh.2018.7080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective: Reproductive events have been linked with increased cardiovascular risk in women, but whether they are associated with pre-clinical peripheral arterial disease (PAD) has been understudied. We evaluated associations between reproductive factors and later-life ankle-brachial index (ABI), femoral artery intima-media thickness (fIMT), and femoral plaques. Methods: Cross-sectional analysis of 707 multiethnic women who participated in a follow-up exam of the San Diego Population Study in 2007-2011. To assess associations between reproductive factors (age at menarche, parity, age at menopause, surgical menopause, hormone therapy) with ABI, and Doppler ultrasound measurements of common and superficial fIMT, linear regression was used; for femoral plaque presence, logistic regression was used. Models were adjusted for age, race/ethnicity, and cardiometabolic factors. We tested interactions of reproductive factors with menopause type (natural vs. surgical). Results: Women were on average 71 years old, and 56% were non-Hispanic White. Reproductive factors were not associated with fIMT, femoral plaque presence, or ABI. There were significant interactions between menopause type (surgical vs. natural) and oral contraceptive use (-β: 0.04, p = 0.03) for ABI, as well as between menopause type and parity (β: 0.11, p = 0.05) and age at menopause (β: 0.001, p = 0.05) for fIMT. Among women with natural menopause, oral contraceptive use was associated with higher ABI (β: 0.03, p = 0.007) and older age at natural menopause was related to greater fIMT (β: 0.009, p = 0.06). Among women with surgical menopause, nulliparity was marginally associated with greater fIMT (β: 0.33, p = 0.07). Conclusions: Reproductive history may not be independently associated with later-life lower extremity atherosclerosis in women. Studies are necessary to confirm findings and examine pregnancy-related exposures in relation to pre-clinical PAD.
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Affiliation(s)
- Yamnia I. Cortés
- School of Nursing, PhD Division, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nisha Parikh
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California
| | - Matthew A. Allison
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, San Diego, California
| | - Michael H. Criqui
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, San Diego, California
| | - Natalie Suder
- Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Emma Barinas-Mitchell
- Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
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The relationship between pubertal timing and markers of vascular and cardiac structure and function in men and women aged 60-64 years. Sci Rep 2019; 9:11037. [PMID: 31363129 PMCID: PMC6667431 DOI: 10.1038/s41598-019-47164-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 07/02/2019] [Indexed: 01/19/2023] Open
Abstract
Earlier age at menarche has been associated with higher risk of coronary heart disease, but the mechanisms underlying the association remain unclear. We assessed the relationship of pubertal timing, in both men (n = 672) and women (n = 713), with vascular (carotid intima-media thickness (cIMT), pulse wave velocity (PWV)) and cardiac (left ventricular (LV) structure and function) measures recorded at age 60–64 yrs in a British birth cohort study. Regression models found that earlier menarche was associated with higher (more adverse) LV mass, LV end diastolic volume and left atrial volume, but not with other cardiac measures, cIMT or PWV. Associations were attenuated after adjustment for either adult or childhood BMI (e.g. mean difference in LV mass per year later menarche: −4.2 g (95% CI:−7.0,−1.4) reducing to −2.2 g (95% CI:−4.7,0.4) after adjustment for adult BMI). There were no associations among men, despite those fully mature at 15 yrs having higher blood pressure than the least mature group by 10.21 mmHg (95% CI:19.45,0.98). Any effect of pubertal timing on vascular and cardiac structure and function is likely to be small and primarily confounded by pre-pubertal BMI and/or mediated through adult adiposity.
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15
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Yang L, Lin L, Kartsonaki C, Guo Y, Chen Y, Bian Z, Xie K, Jin D, Li L, Lv J, Chen Z. Menopause Characteristics, Total Reproductive Years, and Risk of Cardiovascular Disease Among Chinese Women. Circ Cardiovasc Qual Outcomes 2018; 10:CIRCOUTCOMES.117.004235. [PMID: 29117982 PMCID: PMC5704734 DOI: 10.1161/circoutcomes.117.004235] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 10/17/2017] [Indexed: 12/26/2022]
Abstract
Supplemental Digital Content is available in the text. Background— Previous studies, mostly of Western women, have reported inconsistent findings on the association of menopause characteristics (status, age, and time since menopause) and total reproductive years with risk of cardiovascular disease (CVD). Methods and Results— The China Kadoorie Biobank recruited 302 632 women in 2004 to 2008 from 10 regions across China. During 9-year follow-up, 19 393 incident cases of stroke, 18 611 of ischemic heart disease, and 4978 CVD deaths occurred. Cox regression yielded adjusted hazard ratios relating each menopause characteristic and total reproductive years to CVD risk. Among 274 233 women with no prior CVD at baseline, 134 010 were naturally postmenopausal women (mean [SD] age at menopause of 48.6 [4.0] years and total reproductive years 32.7 [4.4]). Compared with premenopausal women, naturally peri- or postmenopausal women were at a higher risk of either fatal or nonfatal CVD. Among women who had had menopause, inverse associations were observed between age at menopause and risks of CVD mortality, incident ischemic heart disease, stroke, and subtypes of stroke, with 1.5% higher risk of CVD death (P<0.001), 0.7% for incident ischemic heart disease (P=0.002), and 0.5% for incident stroke (P=0.02) for every 1 year lower age at menopause. Compared with women who had menopause at age 48 to 50 years, lower age at menopause (ie, <43 years) was associated with 14% higher risk of CVD death and 6% higher risks of both incident ischemic heart disease and stroke. Higher risks of both fatal and nonfatal CVD were also found in women with 5 to 10, 10 to 15, 15 to 20, or >20 years since menopause compared with <5 years since menopause. Total reproductive years were inversely associated with risks of both fatal and nonfatal CVD, with 1.4% lower risk of CVD death per additional reproductive year (P<0.001). Conclusions— Women with younger age at menopause, longer time since menopause, or fewer total reproductive years had a higher risk of CVD.
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Affiliation(s)
- Ling Yang
- From the Medical Research Council Population Health Research Unit (L.Y., C.K., Y.C.) and Clinical Trial Service Unit and Epidemiological Studies Unit (L.Y., C.K., Y.C., Z.C.), University of Oxford, United Kingdom; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China (L. Lin, L. Li, J.L.); Chinese Academy of Medical Sciences, Beijing (Y.G., Z.B.); NCDs Prevention and Control Department, Tongxiang CDC, China (K.X.); and NCDs Prevention and Control Department, Hunan CDC, Changsha, China (D.J.).
| | - Liling Lin
- From the Medical Research Council Population Health Research Unit (L.Y., C.K., Y.C.) and Clinical Trial Service Unit and Epidemiological Studies Unit (L.Y., C.K., Y.C., Z.C.), University of Oxford, United Kingdom; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China (L. Lin, L. Li, J.L.); Chinese Academy of Medical Sciences, Beijing (Y.G., Z.B.); NCDs Prevention and Control Department, Tongxiang CDC, China (K.X.); and NCDs Prevention and Control Department, Hunan CDC, Changsha, China (D.J.)
| | - Christiana Kartsonaki
- From the Medical Research Council Population Health Research Unit (L.Y., C.K., Y.C.) and Clinical Trial Service Unit and Epidemiological Studies Unit (L.Y., C.K., Y.C., Z.C.), University of Oxford, United Kingdom; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China (L. Lin, L. Li, J.L.); Chinese Academy of Medical Sciences, Beijing (Y.G., Z.B.); NCDs Prevention and Control Department, Tongxiang CDC, China (K.X.); and NCDs Prevention and Control Department, Hunan CDC, Changsha, China (D.J.)
| | - Yu Guo
- From the Medical Research Council Population Health Research Unit (L.Y., C.K., Y.C.) and Clinical Trial Service Unit and Epidemiological Studies Unit (L.Y., C.K., Y.C., Z.C.), University of Oxford, United Kingdom; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China (L. Lin, L. Li, J.L.); Chinese Academy of Medical Sciences, Beijing (Y.G., Z.B.); NCDs Prevention and Control Department, Tongxiang CDC, China (K.X.); and NCDs Prevention and Control Department, Hunan CDC, Changsha, China (D.J.)
| | - Yiping Chen
- From the Medical Research Council Population Health Research Unit (L.Y., C.K., Y.C.) and Clinical Trial Service Unit and Epidemiological Studies Unit (L.Y., C.K., Y.C., Z.C.), University of Oxford, United Kingdom; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China (L. Lin, L. Li, J.L.); Chinese Academy of Medical Sciences, Beijing (Y.G., Z.B.); NCDs Prevention and Control Department, Tongxiang CDC, China (K.X.); and NCDs Prevention and Control Department, Hunan CDC, Changsha, China (D.J.)
| | - Zheng Bian
- From the Medical Research Council Population Health Research Unit (L.Y., C.K., Y.C.) and Clinical Trial Service Unit and Epidemiological Studies Unit (L.Y., C.K., Y.C., Z.C.), University of Oxford, United Kingdom; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China (L. Lin, L. Li, J.L.); Chinese Academy of Medical Sciences, Beijing (Y.G., Z.B.); NCDs Prevention and Control Department, Tongxiang CDC, China (K.X.); and NCDs Prevention and Control Department, Hunan CDC, Changsha, China (D.J.)
| | - Kaixu Xie
- From the Medical Research Council Population Health Research Unit (L.Y., C.K., Y.C.) and Clinical Trial Service Unit and Epidemiological Studies Unit (L.Y., C.K., Y.C., Z.C.), University of Oxford, United Kingdom; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China (L. Lin, L. Li, J.L.); Chinese Academy of Medical Sciences, Beijing (Y.G., Z.B.); NCDs Prevention and Control Department, Tongxiang CDC, China (K.X.); and NCDs Prevention and Control Department, Hunan CDC, Changsha, China (D.J.)
| | - Donghui Jin
- From the Medical Research Council Population Health Research Unit (L.Y., C.K., Y.C.) and Clinical Trial Service Unit and Epidemiological Studies Unit (L.Y., C.K., Y.C., Z.C.), University of Oxford, United Kingdom; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China (L. Lin, L. Li, J.L.); Chinese Academy of Medical Sciences, Beijing (Y.G., Z.B.); NCDs Prevention and Control Department, Tongxiang CDC, China (K.X.); and NCDs Prevention and Control Department, Hunan CDC, Changsha, China (D.J.)
| | - Liming Li
- From the Medical Research Council Population Health Research Unit (L.Y., C.K., Y.C.) and Clinical Trial Service Unit and Epidemiological Studies Unit (L.Y., C.K., Y.C., Z.C.), University of Oxford, United Kingdom; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China (L. Lin, L. Li, J.L.); Chinese Academy of Medical Sciences, Beijing (Y.G., Z.B.); NCDs Prevention and Control Department, Tongxiang CDC, China (K.X.); and NCDs Prevention and Control Department, Hunan CDC, Changsha, China (D.J.)
| | - Jun Lv
- From the Medical Research Council Population Health Research Unit (L.Y., C.K., Y.C.) and Clinical Trial Service Unit and Epidemiological Studies Unit (L.Y., C.K., Y.C., Z.C.), University of Oxford, United Kingdom; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China (L. Lin, L. Li, J.L.); Chinese Academy of Medical Sciences, Beijing (Y.G., Z.B.); NCDs Prevention and Control Department, Tongxiang CDC, China (K.X.); and NCDs Prevention and Control Department, Hunan CDC, Changsha, China (D.J.)
| | - Zhengming Chen
- From the Medical Research Council Population Health Research Unit (L.Y., C.K., Y.C.) and Clinical Trial Service Unit and Epidemiological Studies Unit (L.Y., C.K., Y.C., Z.C.), University of Oxford, United Kingdom; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China (L. Lin, L. Li, J.L.); Chinese Academy of Medical Sciences, Beijing (Y.G., Z.B.); NCDs Prevention and Control Department, Tongxiang CDC, China (K.X.); and NCDs Prevention and Control Department, Hunan CDC, Changsha, China (D.J.)
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Bhuiyan AR, Srinivasan SR, Chen W, Fernandez C, Xu JH, Berenson GS. Timing of menarche related to carotid artery intima-media thickness in black and white young adult women: the Bogalusa Heart Study. Ann Epidemiol 2015; 25:414-9. [PMID: 25840807 PMCID: PMC4433574 DOI: 10.1016/j.annepidem.2015.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 01/07/2015] [Accepted: 02/04/2015] [Indexed: 12/29/2022]
Abstract
PURPOSE The early onset of menarche is related to the adulthood risk of cardiovascular (CV) disease. This study examines the relation of early onset of menarche to carotid artery intima-media thickness (IMT), which is a surrogate marker of CV disease, among asymptomatic young adult women in a black-white community. METHODS A cohort of 461 women (31% black, 69% white) aged 24 to 43 years (mean of 35.6 years) were participants in the Bogalusa Heart Study. The age at menarche was retrospectively collected. In addition to CV risk factor variable measurements B-mode ultrasound images of the far walls of carotid artery segments were obtained. The multivariate linear regression model along with mediating effect by Sobel test was applied to analyze menarcheal age effect on carotid artery IMT, adjusting for covariates. RESULTS Waist to height ratio was significantly greater (P = .01) in early menarcheal age (<11 years) versus menarcheal age (≥11 years) in both black and white women. Homeostasis model assessment of insulin resistance (HOMA-IR) was significantly greater (P = .01) in early menarcheal age (<11 years) versus menarcheal age (≥11 years) in white women and also similar direction in black women. Internal carotid artery IMT was the same in early menarcheal age (<11 years) versus menarcheal age (≥11 years) in white women but higher (P = .02) in black women. Given as previously mentioned these different associations, the mediation analysis by race was performed. The effect of early menarcheal age (<11 years) versus menarcheal age (≥11 years) was mediated by waist to height ratio and HOMA-IR in white women after adjusting for parental education and age. The mediating effect of waist to height ratio (Sobel test = -2.26 and P = .02) and HOMA-IR (Sobel test = -1.85 and P = .06) on internal carotid artery IMT was noted in white women. The direct effect of early menarcheal age (<11 years) versus menarcheal age (≥11 years) on internal carotid artery IMT (β = -0.150, P = .01) was observed in black women. CONCLUSIONS The observed deleterious effect of early onset of menarche on carotid artery IMT in asymptomatic black and white younger adult women has biological, social, and public health implications.
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Affiliation(s)
- Azad R Bhuiyan
- Epidemiology and Biostatistics, School of Health Sciences, College of Public Service, Jackson State University, Jackson, MS.
| | - Sathanur R Srinivasan
- Epidemiology Department, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| | - Wei Chen
- Epidemiology Department, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| | - Camilo Fernandez
- Epidemiology Department, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| | - Ji-Hua Xu
- Epidemiology Department, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| | - Gerald S Berenson
- Epidemiology Department, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
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Maturana MA, Franz RF, Metzdorf M, da Silva TR, Spritzer PM. Subclinical cardiovascular disease in postmenopausal women with low/medium cardiovascular risk by the Framingham risk score. Maturitas 2015; 81:311-6. [DOI: 10.1016/j.maturitas.2015.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 03/03/2015] [Accepted: 03/13/2015] [Indexed: 10/23/2022]
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