1
|
Mruczyk K, Molska M, Wójciak RW, Śliwicka E, Cisek-Woźniak A. Associated between cognition, brain-derived neurotrophic factor (BDNF) and macronutrients in normal and overweight postmenopausal women. Exp Gerontol 2024; 192:112449. [PMID: 38704127 DOI: 10.1016/j.exger.2024.112449] [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: 04/04/2024] [Revised: 04/26/2024] [Accepted: 05/01/2024] [Indexed: 05/06/2024]
Abstract
BDNF is a protein associated with cognitive dysfunction. The aim of the study was to determine the relationship between BDNF and cognitive functions and the intake of macronutrients in postmenopausal women. For this purpose, 72 postmenopausal women were recruited to the study and divided into two subgroups: overweight/obese and normal weight. Using a 3-day food record, nutrition was assessed. The markers studied were the level of BDNF, which was determined from the venous blood serum collected from women, and selected cognitive functions. We observed that in the normal BMI group macronutrient intake was correlated with BDNF levels, and only total fat and carbohydrate intake were inversely correlated with BDNF levels. There were inverse correlations observed among selected parameters of cognitive functioning. In the Ov/Ob group, macronutrient intake correlated with the BDNF level for several variables, e.g. vice versa with total protein, fat and carbohydrate intake, as well as dietary cholesterol. It has also been noted that there are links between the BDNF factor and excessive body weight.
Collapse
Affiliation(s)
- Kinga Mruczyk
- Department of Dietetics, Faculty of Physical Culture in Gorzów Wlkp., Poznan University of Physical Education, Estkowskiego 13, 66-400 Gorzów Wielkopolski, Poland.
| | - Marta Molska
- Department of Dietetics, Faculty of Physical Culture in Gorzów Wlkp., Poznan University of Physical Education, Estkowskiego 13, 66-400 Gorzów Wielkopolski, Poland.
| | - Rafał W Wójciak
- Department of Clinical Psychology, University of Medical Sciences, Poznań, Poland.
| | - Ewa Śliwicka
- Department of Physiology and Biochemistry, Poznan University of Physical Education, Królowej Jadwigi 27/39, 61-871, Poznań, Poland.
| | - Angelika Cisek-Woźniak
- Department of Dietetics, Faculty of Physical Culture in Gorzów Wlkp., Poznan University of Physical Education, Estkowskiego 13, 66-400 Gorzów Wielkopolski, Poland.
| |
Collapse
|
2
|
Yan Y, Lu H, Lin S, Zheng Y. Reproductive factors and risk of cardiovascular diseases and all-cause and cardiovascular mortality in American women: NHANES 2003-2018. BMC Womens Health 2024; 24:222. [PMID: 38581038 PMCID: PMC10996084 DOI: 10.1186/s12905-024-03055-6] [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] [Received: 09/17/2023] [Accepted: 03/27/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND The evidence regarding the association of reproductive factors with cardiovascular diseases (CVDs) is limited. AIMS To investigate the relationship of reproductive factors with the risk of CVDs, as well as all-cause and cardiovascular mortality. METHODS This study included 16,404 adults with reproductive factors from the National Health and Nutrition Examination Survey (NHANES) and followed up until 31 December 2019. Logistic models and restricted cubic spline models were used to assess the association of reproductive factors with CVDs. COX proportional hazards models and restricted cubic spline models, with adjustment for potential confounding, were employed to analyze the relation between reproductive factors and cardiovascular and all-cause death. RESULTS There is a nonlinear relationship between age at menarche and CVDs. Age at menopause ≤ 11(OR 1.36, 95% CI 1.10-1.69) was associated with an increased risk of CVDs compared to ages 12-13 years. Age at Menopause ≤ 44 (OR 1.69, 95% CI 1.40-2.03) was associated with increased CVDs compared to age 35-49 years. Number of pregnancies ≥ 5(OR 1.26, 95% CI 1.02-1.55) was associated with an increased risk of CVDs compared to one pregnancy. In continuous variable COX regression models, a later age at menopause (HR 0.98, 95% CI 0.97-0.99) and a longer reproductive lifespan (HR 0.98, 95% CI 0.97-0.99) were associated with a decreased risk of all-cause death. A later age at menopause (HR 0.98, 95% CI 0.97-0.99) and a longer reproductive lifespan (HR 0.98, 95% CI 0.97-0.99) were associated with a decreased risk of cardiac death. CONCLUSIONS Female reproductive factors are significant risk factors for CVDs American women.
Collapse
Affiliation(s)
- Yufeng Yan
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle road, Qinhuai District, Nanjing, Jiangsu, 210008, China
| | - Hongjing Lu
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle road, Qinhuai District, Nanjing, Jiangsu, 210008, China
| | - Song Lin
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle road, Qinhuai District, Nanjing, Jiangsu, 210008, China.
| | - Yaguo Zheng
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle road, Qinhuai District, Nanjing, Jiangsu, 210008, China.
| |
Collapse
|
3
|
Behboudi-Gandevan S, Moe CF, Skjesol I, Arntzen EC, Bidhendi-Yarandi R. The J shaped association of age at menarche and cardiovascular events: systematic review and meta-analysis. Sci Rep 2024; 14:2695. [PMID: 38302648 PMCID: PMC10834967 DOI: 10.1038/s41598-024-53011-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/25/2024] [Indexed: 02/03/2024] Open
Abstract
This study aimed to evaluate the association between age at menarche and cardiovascular (CV) events through a systematic review and meta-analysis of observational studies. A comprehensive literature search covering studies published from January 1, 2000, to October 31, 2023, was conducted in PubMed, MEDLINE, Embase, and Scopus. Twenty-nine observational studies involving 4,931,160 adult women aged 18 years or older were included. The meta-analysis revealed a J-shaped association between age at menarche and CV events. Individuals with menarche at 12-13 years exhibited the lowest risk, while those with younger (≤ 11 years) or older ages (14-15 years and ≥ 16 years) showed an increased risk. Notably, individuals with age at menarche of 16 years and older had the highest risk of CV events. The pooled odds of CV mortality in age at menarche categories 14-15 years and ≥ 16 years were 37% (OR: 1.37, 95% CI 1.14-1.64, I2: 76.9%) and 64% (OR: 1.64, 95% CI 1.20-2.24, I2: 87%) higher than referent age at menarche 12-13 years. No statistically significant difference was found in CV mortality risk between individuals with age at menarche ≤ 11 years and those with age at menarche 12-13 years. The ORs for coronary heart disease were significantly higher for age at menarche ≥ 16 years (35% increase), while no significant difference was found for age at menarche ≤ 11 years or 14-15 years compared to age at menarche 12-13 years. Regarding stroke, the ORs for age at menarche ≤ 11, 14-15, and ≥ 16 years were significantly higher (7%, 24%, and 94% increase, respectively) compared to age at menarche 12-13 years. Dose-response meta-analysis and one-stage random-effect cubic spline models confirmed the J-shaped risk pattern. Meta-regression indicated that age and BMI were not significant sources of heterogeneity. Sensitivity analyses and the absence of publication bias further supported the robustness of the findings. This study concludes that age at menarche is independently associated with CV events, with a J-shaped pattern. The findings underscore the significance of considering menarche age as an independent risk factor for CV events. Further research is warranted to validate these findings and explore potential underlying mechanisms.
Collapse
Affiliation(s)
| | | | - Ingunn Skjesol
- Faculty of Nursing and Health Sciences, Nord University, Namsos, Norway
| | - Ellen Christin Arntzen
- Faculty of Nursing and Health Sciences, Nord University, Post Box: 1490, 8049, Bodø, Norway
| | - Razieh Bidhendi-Yarandi
- Department of Biostatistics and Epidemiology, School of Social Health, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| |
Collapse
|
4
|
Xing Z, Alman AC, Kirby RS. Premature Menopause and All-Cause Mortality and Life Span Among Women Older Than 40 Years in the NHANES I Epidemiologic Follow-Up Study: Propensity Score Matching Analysis. J Womens Health (Larchmt) 2023; 32:950-959. [PMID: 37439866 DOI: 10.1089/jwh.2023.0189] [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] [Indexed: 07/14/2023] Open
Abstract
Objective: Findings from studies of the long-term effect of premature menopause on risks of all-cause mortality in women are equivocal. We used the approach of propensity score matching to examine the causal association of premature menopause with all-cause mortality and life span among women older than 40 years. Methods: The data were from the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study. We calculated the propensity score of premature menopause using a logistic regression model, then matched premature menopause with nonpremature menopause according to the score and the ratio of 1:1. We estimated mortality hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox proportional hazard models. We also analyzed and plotted the relationship between age at menopause and reproductive life span with all-cause mortality and life span. Results: The mean age of 1,210 women was 55.4 ± 10.8 years at baseline. The unadjusted and adjusted HRs of all-cause mortality for women with premature menopause were 1.46 (95% CI: 1.08-1.96) and 1.53 (95% CI: 1.13-2.08), respectively, compared to nonpremature menopause. Nonlinear associations were found between age at menopause, reproductive life span, all-cause mortality, and life span. Menopausal age <37.5 years of age or reproductive life span <24 years increased the risk of all-cause mortality. Women with menopausal age <39 years of age or reproductive life span <24 years had a lower mean life span than the overall average of 76 years. Conclusions: Premature menopause significantly increased all-cause mortality risk and shortened life span in women. As women's age at menopause or reproductive life span increases, their overall life span also tends to increase.
Collapse
Affiliation(s)
- Zailing Xing
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Amy C Alman
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Russell S Kirby
- Chiles Center, College of Public Health, University of South Florida, Tampa, Florida, USA
| |
Collapse
|
5
|
Sato W, Nomura K, Satoh M, Hara A, Tsubota-Utsugi M, Murakami T, Asayama K, Tatsumi Y, Kobayashi Y, Hirose T, Inoue R, Totsune T, Kikuya M, Hozawa A, Metoki H, Imai Y, Watanabe H, Ohkubo T. Female Reproductive Events and Subclinical Atherosclerosis of the Brain and Carotid Arteriopathy: the Ohasama Study. J Atheroscler Thromb 2023; 30:956-978. [PMID: 36198521 PMCID: PMC10406647 DOI: 10.5551/jat.63592] [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: 04/03/2022] [Accepted: 08/26/2022] [Indexed: 08/04/2023] Open
Abstract
AIMS Few studies have investigated the subclinical atherosclerotic changes in the brain and carotid artery, and in East Asian populations. We sought to investigate whether gravidity, delivery, the age at menarche and menopause and estrogen exposure period are associated with subclinical atherosclerosis of the brain and carotid arteriopathy. METHODS This cross-sectional study formed part of a cohort study of Ohasama residents initiated in 1986. Brain atherosclerosis and carotid arteriopathy were diagnosed as white matter hyperintensity (WMH) and lacunae evident on brain magnetic resonance imaging (MRI) and carotid intimal media thickness (IMT) or plaque revealed by ultrasound, respectively. The effect of the reproductive events on brain atherosclerosis and carotid arteriopathy was investigated using logistic regression and general linear regression models after adjusting for covariates. RESULTS Among 966 women aged ≥ 55 years in 1998, we identified 622 and 711 women (mean age: 69.2 and 69.7 years, respectively) who underwent either MRI or carotid ultrasound between 1992-2008 or 1993-2018, respectively. The highest quartile of gravidity (≥ 5 vs. 3) and delivery (≥ 4 vs. 2), and the highest and second highest (3 vs. 2) quartiles of delivery were associated with an increased risk of WMH and carotid artery plaque, respectively. Neither of age at menarche, menopause, and estrogen exposure period estimated by subtracting age at menarche from age at menopause was associated with atherosclerotic changes of brain and carotid arteries. CONCLUSIONS Higher gravidity and delivery are associated with subclinical atherosclerosis of the brain and carotid plaque.
Collapse
Affiliation(s)
- Wakana Sato
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Kyoko Nomura
- Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, Akita, Japan
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Michihiro Satoh
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Azusa Hara
- Division of Drug Development and Regulatory Science, Faculty of Pharmacy, Keio University, Tokyo, Japan
| | - Megumi Tsubota-Utsugi
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Takahisa Murakami
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Division of Aging and Geriatric Dentistry, Department of RehabilitationDentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Yukako Tatsumi
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Yuki Kobayashi
- Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, Akita, Japan
| | - Takuo Hirose
- Department of Endocrinology and Applied Medical Science, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryusuke Inoue
- Department of Medical Information Technology Center, Tohoku University Hospital, Sendai, Japan
| | - Tomoko Totsune
- Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Masahiro Kikuya
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Atsushi Hozawa
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Hirohito Metoki
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Yutaka Imai
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Hiroyuki Watanabe
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| |
Collapse
|
6
|
王 晓, 穆 英, 郭 振, 周 玉, 张 勇, 李 宏, 刘 建. [Secular trends of age at menarche and age at menopause in women born since 1951 from a county of Shandong Province, China]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2023; 55:502-510. [PMID: 37291927 PMCID: PMC10258047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To describe the secular trends of age at menarche and age at natural menopause of women from a county of Shandong Province. METHODS Based on the data of the Premarital Medical Examination and the Cervical Cancer and Breast Cancer Screening of the county, the secular trends of age at menarche in women born in 1951 to 1998 and age at menopause in women born in 1951 to 1975 were studied. Joinpoint regression was used to identify potential inflection points regarding the trend of age at menarche. Average hazard ratios (AHR) of early menopause among women born in different generations were estimated by performing multivariate weighted Cox regression. RESULTS The average age at menarche was (16.43±1.89) years for women born in 1951 and (13.99±1.22) years for women born in 1998. The average age at menarche was lower for urban women than that for rural women, and the higher the education level, the lower the average age at menarche. Joinpoint regression analysis identified three inflection points: 1959, 1973 and 1993. The average age at menarche decreased annually by 0.03 (P < 0.001), 0.08 (P < 0.001), and 0.03 (P < 0.001) years respectively for women born during 1951-1959, 1960-1973, and 1974-1993, while it remained stable for those born during 1994-1998 (P=0.968). As for age at menopause, compared with women born during 1951-1960, those born during 1961-1965, 1966-1970 and 1971-1975 showed a gradual decrease in the risk of early menopause and a tendency to delay the age at menopause. The stratified analysis presented that the risk of early menopause gradually decreased and the age of menopause showed a significant delay among those with education level of junior high school and below, but this trend was not obvious among those with education level of senior high school and above, where the risk of early menopause decreased and then increased among those with education level of college and above, and the corresponding AHRs were 0.90 (0.66-1.22), 1.07 (0.79-1.44) and 1.14 (0.79-1.66). CONCLUSION The age at menarche for women born since 1951 gradually declined until 1994 and leveled off, with a decrease of nearly 2.5 years in these years. The age at menopause for women born between 1951 and 1975 was generally delayed over time, but the trend of first increase and then decrease was observed among those with relatively higher education levels. In the context of the increasing delay in age at marriage and childbearing and the decline of fertility, this study highlights the necessity of the assessment and monitoring of women' s basic reproductive health status, especially the risk of early menopause.
Collapse
Affiliation(s)
- 晓伟 王
- 北京大学生育健康研究所,国家卫生健康委员会生育健康重点实验室,北京 100191Institute of Reproductive and Child Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China
- 北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 英超 穆
- 桓台县妇幼保健院,山东淄博 256400Women & Children's Health Care Hospital of Huantai, Zibo 256400, Shandong, China
| | - 振宇 郭
- 北京大学生育健康研究所,国家卫生健康委员会生育健康重点实验室,北京 100191Institute of Reproductive and Child Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China
- 北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 玉博 周
- 北京大学生育健康研究所,国家卫生健康委员会生育健康重点实验室,北京 100191Institute of Reproductive and Child Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China
- 北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 勇 张
- 桓台县妇幼保健院,山东淄博 256400Women & Children's Health Care Hospital of Huantai, Zibo 256400, Shandong, China
| | - 宏田 李
- 北京大学生育健康研究所,国家卫生健康委员会生育健康重点实验室,北京 100191Institute of Reproductive and Child Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China
- 北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
- 北京大学人工智能研究院智慧公众健康研究中心,北京 100191Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing 100191, China
| | - 建蒙 刘
- 北京大学生育健康研究所,国家卫生健康委员会生育健康重点实验室,北京 100191Institute of Reproductive and Child Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China
- 北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
- 北京大学人工智能研究院智慧公众健康研究中心,北京 100191Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing 100191, China
| |
Collapse
|
7
|
Changes in cardiovascular disease risk factors during menopausal transition in Japanese women: the Circulatory Risk in Communities Study (CIRCS). Menopause 2023; 30:88-94. [PMID: 36318736 PMCID: PMC9812420 DOI: 10.1097/gme.0000000000002081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We aimed to longitudinally clarify the changes in cardiovascular disease risk factors associated with menopause in Japanese women in the 2000s. METHODS Of the 4,596 women who underwent health examinations between 2007 and 2012 in three communities of the Circulatory Risk in Communities Study, 263 women who reported going through menopause during that period were included in the study. We randomly selected 1,665 men as control subjects who participated in a health examination at least once between 2001 and 2009 and at least once between 2010 and 2018 by 1:1 pair-matching for age, community, and examination year. The health examination data from 3 to 6 years before (2001-2009) and after menopause age (2010-2018) were compared in terms of body mass index, systolic and diastolic blood pressure levels, serum total cholesterol, high-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, triglycerides, uric acid, hemoglobin A 1c , hemoglobin, aspartate aminotransferase, alanine aminotransferase, and current smoker status. RESULTS Compared with the men, the women showed a greater increase in serum total cholesterol (+16.7 vs -3.1 mg/dL, P < 0.001), non-high-density lipoprotein cholesterol (+15.9 vs -6.3 mg/dL, P < 0.001), fasting triglycerides (+1.2 vs +1.0 mg/dL, P = 0.027), triglycerides regardless of fasting status (+1.2 vs -0.9 mg/dL, P < 0.001), uric acid (+0.5 vs +0.2 mg/dL, P = 0.008), hemoglobin (+0.9 vs -0.3 g/dL, P < 0.001), aspartate aminotransferase (+2.9 vs -2.7 IU/L, P < 0.001), and alanine aminotransferase (+2.9 vs -2.6 IU/L, P < 0.001). No differences were found in the changes in body mass index, systolic and diastolic blood pressures, and hemoglobin A 1c between the women and the matched men. CONCLUSIONS Menopause may be a crucial factor related to changes in serum total cholesterol, non-high-density lipoprotein cholesterol, triglycerides, uric acid, hemoglobin, and liver enzymes.
Collapse
|
8
|
Chen L, Hu Z, Wang X, Song Y, Chen Z, Zhang L, Zheng C, Vallis J, Zhou H, Cao X, Tian Y, Cai J, Gu R, Huang Y, Wang Z. Age at Menarche and Menopause, Reproductive Lifespan, and Risk of Cardiovascular Events Among Chinese Postmenopausal Women: Results From a Large National Representative Cohort Study. Front Cardiovasc Med 2022; 9:870360. [PMID: 36158833 PMCID: PMC9500155 DOI: 10.3389/fcvm.2022.870360] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background At present, the association between age at menarche and menopause, reproductive lifespan, and cardiovascular disease (CVD) risk among Chinese postmenopausal women is not clear, and some related researches are contradictory. Methods A total of 6,198 Chinese postmenopausal women with a mean age of 63.6 years were enrolled at baseline in 2012-2015 and followed up for 5 years. A standardized questionnaire was used to collect relevant information by well-trained interviewers. Physical examination of the participants was performed by trained medical staff. CVD events were observed during follow-up. Cox proportional hazards models were used to estimate hazard ratios between reproductive characteristics and CVD events. Results Age at menarche was positively associated with CVD events (HR, 1.106; 95%CI, 1.047-1.167). There was a negative association between age at menopause and CVD risk in postmenopausal women with comorbidity (HR, 0.952; 95%CI, 0.909-0.996). Reproductive lifespan was negatively associated with CVD events (HR, 0.938; 95%CI, 0.880-0.999). The CVD risk increased by 10.6% for every 1-year increase in age at menarche. The CVD risk reduced by 6.2% for every 1-year increase in age at menopause in women with comorbidity. The CVD risk reduced by 3.8% for every 1-year increase in reproductive lifespan. Conclusions Based on the large prospective study with a nationally representative sample, Chinese postmenopausal women with late age at menarche and shorter reproductive lifespan have higher risk of CVD events.
Collapse
Affiliation(s)
- Lu Chen
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zhen Hu
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xin Wang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yuxin Song
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zuo Chen
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Linfeng Zhang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Congyi Zheng
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jillian Vallis
- PGY3 General Surgery, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Haoqi Zhou
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xue Cao
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yixin Tian
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jiayin Cai
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Runqing Gu
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yilin Huang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zengwu Wang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|
9
|
Xu Z, Chung HF, Dobson AJ, Wilson LF, Hickey M, Mishra GD. Menopause, hysterectomy, menopausal hormone therapy and cause-specific mortality: cohort study of UK Biobank participants. Hum Reprod 2022; 37:2175-2185. [PMID: 35690930 PMCID: PMC9433845 DOI: 10.1093/humrep/deac137] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 05/24/2022] [Indexed: 11/17/2022] Open
Abstract
STUDY QUESTION What is the association between menopausal hormone therapy (MHT) and cause-specific mortality? SUMMARY ANSWER Self-reported MHT use following early natural menopause, surgical menopause or premenopausal hysterectomy is associated with a lower risk of breast cancer mortality and is not consistently associated with the risk of mortality from cardiovascular disease or other causes. WHAT IS KNOWN ALREADY Evidence from the Women's Health Initiative randomized controlled trials showed that the use of estrogen alone is not associated with the risk of cardiovascular mortality and is associated with a lower risk of breast cancer mortality, but evidence from the Million Women Study showed that use of estrogen alone is associated with a higher risk of breast cancer mortality. STUDY DESIGN, SIZE, DURATION Cohort study (the UK Biobank), 178 379 women, recruited in 2006-2010. PARTICIPANTS/MATERIALS, SETTING, METHODS Postmenopausal women who had reported age at menopause (natural or surgical) or hysterectomy, and information on MHT and cause-specific mortality. Age at natural menopause, age at surgical menopause, age at hysterectomy and MHT were exposures of interest. Natural menopause was defined as spontaneous cessation of menstruation for 12 months with no previous hysterectomy or oophorectomy. Surgical menopause was defined as the removal of both ovaries prior to natural menopause. Hysterectomy was defined as removal of the uterus before natural menopause without bilateral oophorectomy. The study outcome was cause-specific mortality. MAIN RESULTS AND THE ROLE OF CHANCE Among the 178 379 women included, 136 790 had natural menopause, 17 569 had surgical menopause and 24 020 had hysterectomy alone. Compared with women with natural menopause at the age of 50-52 years, women with natural menopause before 40 years (hazard ratio (HR): 2.38, 95% CI: 1.64, 3.45) or hysterectomy before 40 years (HR: 1.60, 95% CI: 1.23, 2.07) had a higher risk of cardiovascular mortality but not cancer mortality. MHT use was associated with a lower risk of breast cancer mortality following surgical menopause before 45 years (HR: 0.17, 95% CI: 0.08, 0.36), at 45-49 years (HR: 0.15, 95% CI: 0.07, 0.35) or at ≥50 years (HR: 0.28, 95% CI: 0.13, 0.63), and the association between MHT use and the risk of breast cancer mortality did not differ by MHT use duration (<6 or 6-20 years). MHT use was also associated with a lower risk of breast cancer mortality following natural menopause before 45 years (HR: 0.59, 95% CI: 0.36, 0.95) or hysterectomy before 45 years (HR: 0.49, 95% CI: 0.32, 0.74). LIMITATIONS, REASONS FOR CAUTION Self-reported data on age at natural menopause, age at surgical menopause, age at hysterectomy and MHT. WIDER IMPLICATIONS OF THE FINDINGS The current international guidelines recommend women with early menopause to use MHT until the average age at menopause. Our findings support this recommendation. STUDY FUNDING/COMPETING INTEREST(S) This project is funded by the Australian National Health and Medical Research Council (NHMRC) (grant numbers APP1027196 and APP1153420). G.D.M. is supported by NHMRC Principal Research Fellowship (APP1121844), and M.H. is supported by an NHMRC Investigator Grant (APP1193838). There are no competing interests. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- Zhiwei Xu
- The University of Queensland, School of Public Health, NHMRC Centre for Research Excellence on Women and Non-communicable Diseases (CRE WaND), Brisbane, Australia
| | - Hsin-Fang Chung
- The University of Queensland, School of Public Health, Brisbane, Australia
| | - Annette J Dobson
- The University of Queensland, School of Public Health, Brisbane, Australia
| | - Louise F Wilson
- The University of Queensland, School of Public Health, NHMRC Centre for Research Excellence on Women and Non-communicable Diseases (CRE WaND), Brisbane, Australia
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne and the Royal Women's Hospital, Melbourne, Australia
| | - Gita D Mishra
- The University of Queensland, School of Public Health, NHMRC Centre for Research Excellence on Women and Non-communicable Diseases (CRE WaND), Brisbane, Australia
| |
Collapse
|
10
|
Lohner V, Pehlivan G, Sanroma G, Miloschewski A, Schirmer MD, Stöcker T, Reuter M, Breteler MMB. The Relation Between Sex, Menopause, and White Matter Hyperintensities: The Rhineland Study. Neurology 2022; 99:e935-e943. [PMID: 35768207 DOI: 10.1212/wnl.0000000000200782] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 04/11/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Mounting evidence implies that there are sex differences in white matter hyperintensity (WMH) burden in the elderly. Questions remain regarding possible differences in WMH burden between men and women of younger age, sex-specific age trajectories and effects of (un)controlled hypertension, and the effect of menopause on WMH. Therefore, our aim is to investigate these sex differences and age-dependencies in WMH load across the adult life span, and to examine the effect of menopause. METHODS This cross-sectional analysis was based on participants of the population-based Rhineland Study (30 - 95 years) who underwent brain MRI. We automatically quantified WMH using T1-weighted, T2-weighted and FLAIR images. Menopausal status was self-reported. We examined associations of sex and menopause with WMH load (logit-transformed and z-standardised) using linear regression models, while adjusting for age, age-squared, and vascular risk factors. We checked for an age*sex and (un)controlled hypertension*sex interaction and stratified for menopausal status comparing men with premenopausal women (persons aged ≤ 59 years), men with postmenopausal women (persons aged ≥ 45 years), and pre- with postmenopausal women (age range 45 - 59 years). RESULTS Of 3410 participants with a mean age of 54.3 years (SD = 13.7), 1973 (57.9%) were women, of which 1167 (59.1%) were postmenopausal. We found that the increase in WMH load accelerates with age and in a sex-dependent way. Premenopausal women and men of similar age did not differ in WMH burden. WMH burden was higher and accelerated faster in postmenopausal women compared to men of similar age. Additionally, we observed changes related to menopause, in that postmenopausal women had more WMH than premenopausal women of similar age.. Women with uncontrolled hypertension had a higher WMH burden compared to men, which was unrelated to menopausal status. DISCUSSION After menopause, women displayed a higher burden of WMH than contemporary premenopausal women and men, and an accelerated increase in WMH. Sex-specific effects of uncontrolled hypertension on WMH were not related to menopause. Further studies are warranted to investigate menopause-related physiological changes, that may inform on causal mechanisms involved in cerebral small vessel disease progression.
Collapse
Affiliation(s)
- Valerie Lohner
- Population Health Sciences, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Gökhan Pehlivan
- Population Health Sciences, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Gerard Sanroma
- Population Health Sciences, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Anne Miloschewski
- Statistics and Machine Learning, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Markus D Schirmer
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston.,Clinic for Neuroradiology, University Hospital Bonn, Germany
| | - Tony Stöcker
- MR Physics, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Department of Physics and Astronomy, University of Bonn, Bonn, Germany
| | - Martin Reuter
- Image Analysis, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, Massachusetts.,Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Monique M B Breteler
- Population Health Sciences, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany .,Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), Faculty of Medicine, University of Bonn, Germany
| |
Collapse
|
11
|
Huang Z, Chang X, Wang L, Liu J, Heng CK, Khor CC, Yuan JM, Koh WP, Dorajoo R. Interaction between cigarette smoking and genetic polymorphisms on the associations with age of natural menopause and reproductive lifespan: the Singapore Chinese Health Study. Hum Reprod 2022; 37:1351-1359. [PMID: 35413122 PMCID: PMC9156846 DOI: 10.1093/humrep/deac075] [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] [Received: 10/21/2021] [Revised: 03/09/2022] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION Are there genetic variants that interact with smoking to reduce reproductive lifespan in East-Asian women? SUMMARY ANSWER Our study corroborates several recently identified genetic loci associated with reproductive lifespan and highlights specific genetic predispositions that may interact with smoking status to adversely affect reproductive lifespan in East-Asian women. WHAT IS KNOWN ALREADY Epidemiological data as well as evaluations on genetic predisposition to smoke indicate on the importance of smoking in adverse effects on reproductive lifespan in women. However, there are no previous smoking and gene interaction studies for reproductive traits in East-Asian women. STUDY DESIGN, SIZE, DURATION This population-based prospective cohort study comprised 11 643 East-Asian Chinese women with overlapping genome-wide genotyping and reproductive data. PARTICIPANTS/MATERIALS, SETTING, METHODS We performed a genome-wide association study for reproductive lifespan in women (n = 11 643) from the Singapore Chinese Health Study (SCHS) and carried out a genome-wide interaction study to identify loci that interacted with smoking status to affect age of natural menopause and reproductive-time. MAIN RESULTS AND THE ROLE OF CHANCE Two known loci associated with menopause, rs113430717 (near HMCES, chromosome 3, Pmeta = 5.72 × 10-15) and rs3020136 (near RAD21, chromosome 8, Pmeta = 1.38 × 10-8) were observed beyond genome-wide levels of association with age at menopause in this study. For reproductive lifespan, the genome-wide association observed at rs79784106 (chromosome 3, Pmeta = 5.05 × 10-12) was in linkage disequilibrium with the menopause lead single-nucleotide polymorphism (SNP) (rs113430717). Four additional loci, first reported to be associated with menopause, were also associated with reproductive lifespan in our study (PAdj between 7.42 × 10-5 to 4.51 × 10-3). A significant interaction was observed between smoking and an East-Asian specific SNP, rs140146885, for reduced reproductive lifespan, per copy of the minor C allele (beta = -1.417 years, Pinteraction = 2.31 × 10-10). This interaction was successfully replicated in additional independent samples (beta = -1.389 years, Pinteraction = 6.78 × 10-3). Another known variant associated with menopause, rs11031006 (near FSHB), was also observed to interact with smoking status to reduce age at menopause in our dataset (beta = -0.450 years, Padj = 0.042). LIMITATIONS, REASONS FOR CAUTION The modest sample size of the replication datasets used likely affected the statistical power to firmly replicate all identified novel loci observed in our smoking interaction analyses. WIDER IMPLICATIONS OF THE FINDINGS Age of natural menopause and reproductive lifespan have clear genetic predispositions with distinct ethnic differences, and they may be adversely truncated by lifestyle factors such as smoking, which can pose a significant impact on the reproductive lifespan and future health outcomes in women. STUDY FUNDING/COMPETING INTEREST(S) The Singapore Chinese Health Study is funded by the National Medical Research Council, Singapore (NMRC/CIRG/1456/2016), National Institutes of Health (R01 CA144034 and UM1 CA182876) and National Research Foundation, Singapore (Project Number 370062002). W.-P.K. is supported by the National Medical Research Council, Singapore (MOH-CSASI19nov-0001). The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. The authors do not report conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- Zhongwei Huang
- Institute of Molecular and Cell Biology, Agency of Science Research and Technology, Singapore, Singapore
- Department of Obstetrics & Gynaecology, National University Health Systems, Singapore, Singapore
- NUS Bia-Echo Asia Centre of Reproductive Longevity and Equality, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Xuling Chang
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Khoo Teck Puat—National University Children’s Medical Institute, National University Health System, Singapore, Singapore
- Department of Infectious Diseases, The University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Ling Wang
- Genome Institute of Singapore, Agency of Science Research and Technology, Singapore, Singapore
| | - Jianjun Liu
- Genome Institute of Singapore, Agency of Science Research and Technology, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chew-Kiat Heng
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Khoo Teck Puat—National University Children’s Medical Institute, National University Health System, Singapore, Singapore
| | - Chiea-Chuen Khor
- Genome Institute of Singapore, Agency of Science Research and Technology, Singapore, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Jian-Min Yuan
- Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Woon-Puay Koh
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute of Clinical Sciences, Agency of Science Research and Technology, Singapore, Singapore
| | - Rajkumar Dorajoo
- Genome Institute of Singapore, Agency of Science Research and Technology, Singapore, Singapore
- Health Services and Systems Research, Duke-NUS Medical School Singapore, Singapore, Singapore
| |
Collapse
|
12
|
Costanian C, Farah R, Salameh R, Meisner BA, Aoun Bahous S, Sibai AM. The Influence of Female Reproductive Factors on Longevity: A Systematized Narrative Review of Epidemiological Studies. Gerontol Geriatr Med 2022; 8:23337214221138663. [DOI: 10.1177/23337214221138663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/22/2022] [Accepted: 10/27/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose: This systematized review presents a synthesis of epidemiological studies that examine the association between female reproductive factors and longevity indicators. Methods: A comprehensive literature search was conducted using four bibliographic databases: OVID Medline, Web of Science, PubMed, and Google Scholar, including English language articles published until March 2022. Results from the search strategy yielded 306 articles, 37 of which were included for review based on eligibility criteria. Results were identified within the following nine themes: endogenous androgens and estrogens, age at first childbirth, age at last childbirth, parity, reproductive lifespan, menopause-related factors, hormone therapy use, age at menarche, and offspring gender. Results: Evidence that links reproductive factors and long lifespan is limited. Several female reproductive factors are shown to be significantly associated with longevity, yet findings remain inconclusive. The most consistent association was between parity (fertility and fecundity) and increased female lifespan. Age at first birth and parity were consistently associated with increased longevity. Associations between age at menarche and menopause, premature menopause, reproductive lifespan, offspring gender and longevity are inconclusive. Conclusion: There is not enough evidence to consider sex a longevity predictor. To understand the mechanisms that predict longevity outcomes, it is imperative to consider sex-specific within-population differences.
Collapse
Affiliation(s)
| | | | | | | | | | - Abla M. Sibai
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| |
Collapse
|
13
|
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]
|
14
|
Mishra SR, Waller M, Chung HF, Mishra GD. Epidemiological studies of the association between reproductive lifespan characteristics and risk of Type 2 diabetes and hypertension: A systematic review. Maturitas 2021; 155:14-23. [PMID: 34876245 DOI: 10.1016/j.maturitas.2021.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 08/16/2021] [Accepted: 09/19/2021] [Indexed: 12/23/2022]
Abstract
Some reproductive factors are found to be associated with metabolic outcomes in women; however, little is known about reproductive lifespan characteristics and the mutual effect of age at menarche and age at menopause on cardiovascular risk. This systematic review evaluated reproductive lifespan characteristics and describes the mutual effect of age at menarche and age at menopause on the risk of type 2 diabetes (T2DM) and hypertension at midlife. PubMed, EMBASE, and Web of Science were screened for studies published up to September 1, 2020. The individual effect estimates were reviewed and synthesized without meta-analysis due to methodological and clinical or conceptual diversity in reported studies. Of the 3033 identified studies, 20 were included in the final synthesis: 6 reported reproductive life span; 12 reported age at menarche, and 7 reported age at menopause. Synthesis of two cohorts, with a median follow-up of 9-11 years, showed that a shorter reproductive lifespan was positively associated with T2DM, yielding 6-15% higher risk of T2DM for a one-year decrease in reproductive lifespan. A few studies also demonstrated that women who experienced early menarche (four of six studies) and early menopause (two of five studies) were positively associated with risk of T2DM. The association between reproductive lifespan and hypertension was unclear due to the limited availability of studies. Our findings suggest that a shorter reproductive lifespan is associated with T2DM risk in postmenopausal women, especially those with early menarche and early menopause. Large cohort studies are needed to assess the association between reproductive lifespan and incident hypertension in midlife.
Collapse
Affiliation(s)
- Shiva R Mishra
- Center for Longitudinal and Lifecourse Research, School of Public Health, The University of Queensland, Brisbane, 266 Herston Rd, Herston QLD 4006, Australia.
| | - Michael Waller
- Center for Longitudinal and Lifecourse Research, School of Public Health, The University of Queensland, Brisbane, 266 Herston Rd, Herston QLD 4006, Australia
| | - Hsin-Fang Chung
- Center for Longitudinal and Lifecourse Research, School of Public Health, The University of Queensland, Brisbane, 266 Herston Rd, Herston QLD 4006, Australia
| | - Gita D Mishra
- Center for Longitudinal and Lifecourse Research, School of Public Health, The University of Queensland, Brisbane, 266 Herston Rd, Herston QLD 4006, Australia
| |
Collapse
|
15
|
Song M, Wang YM, Wang R, Xu SJ, Yu LL, Wang L, Zhao XC, Wang XY. Prevalence and risks of mild cognitive impairment of Chinese community-dwelling women aged above 60 years: A cross-sectional study. Arch Womens Ment Health 2021; 24:903-911. [PMID: 34075456 DOI: 10.1007/s00737-021-01137-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/20/2021] [Indexed: 01/10/2023]
Abstract
Evidence has shown that risks of cognitive impairment differ between genders. This cross-sectional study sought to determine the prevalence of mild cognitive impairment (MCI) in Chinese community-dwelling women aged above 60 years and identify risks of MCI by multivariate logistic regression analysis. Totally, 1760 Chinese community-dwelling women entered the study. Cognitive function was assessed with Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). MCI was diagnosed by Petersen's criteria. Sociodemographic information, past medical conditions, and age at menopause were screened. The primary study outcome was prevalence of MCI. MCI was diagnosed in 378 (21.5%) women. Older age was a significant risk of MCI (OR 1.621, 95%CI 1.386-1.894; P < 0.001). Low education was associated a 4-fold increase in the risk of MCI (OR 4.036, 95%CI 3.168-5.142). Furthermore, current depression was associated with 2.6-fold increase in the risk of MCI (OR 2.618, 95%CI 1.499-4.587, P = 0.001). Moreover, frequent physical exercise and more leisure and social time activities were associated with significantly reduced risks of MCI, while poor financial status was associated with a significantly increased risk of MCI. Slightly more than 20% of Chinese women aged above 60 years had MCI, and independent risks included older age, low education status, and current depression, highlighting the importance of screening for and removing or minimizing risks of MCI in this specific population.
Collapse
Affiliation(s)
- Mei Song
- Department of Psychiatry, the First Hospital of Hebei Medical University, Shijiazhuang, 050031, China
- Institute of Mental Health, Brain Aging and Cognitive Neuroscience Laboratory, Hebei Medical University, Shijiazhuang, 050031, China
| | - Yu-Mei Wang
- Department of Psychiatry, the First Hospital of Hebei Medical University, Shijiazhuang, 050031, China
- Institute of Mental Health, Brain Aging and Cognitive Neuroscience Laboratory, Hebei Medical University, Shijiazhuang, 050031, China
| | - Ran Wang
- Department of Psychiatry, the First Hospital of Hebei Medical University, Shijiazhuang, 050031, China
- Institute of Mental Health, Brain Aging and Cognitive Neuroscience Laboratory, Hebei Medical University, Shijiazhuang, 050031, China
| | - Shun-Jiang Xu
- Department of Psychiatry, the First Hospital of Hebei Medical University, Shijiazhuang, 050031, China
- Institute of Mental Health, Brain Aging and Cognitive Neuroscience Laboratory, Hebei Medical University, Shijiazhuang, 050031, China
| | - Lu-Lu Yu
- Department of Psychiatry, the First Hospital of Hebei Medical University, Shijiazhuang, 050031, China
- Institute of Mental Health, Brain Aging and Cognitive Neuroscience Laboratory, Hebei Medical University, Shijiazhuang, 050031, China
| | - Lan Wang
- Department of Psychiatry, the First Hospital of Hebei Medical University, Shijiazhuang, 050031, China
- Institute of Mental Health, Brain Aging and Cognitive Neuroscience Laboratory, Hebei Medical University, Shijiazhuang, 050031, China
| | - Xiao-Chuan Zhao
- Department of Psychiatry, the First Hospital of Hebei Medical University, Shijiazhuang, 050031, China
- Institute of Mental Health, Brain Aging and Cognitive Neuroscience Laboratory, Hebei Medical University, Shijiazhuang, 050031, China
| | - Xue-Yi Wang
- Department of Psychiatry, the First Hospital of Hebei Medical University, Shijiazhuang, 050031, China.
- Institute of Mental Health, Brain Aging and Cognitive Neuroscience Laboratory, Hebei Medical University, Shijiazhuang, 050031, China.
| |
Collapse
|
16
|
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.
Collapse
|
17
|
Lozano-Esparza S, Jansen EC, Hernandez-Ávila JE, Zamora-Muñoz S, Stern D, Lajous M. Menarche characteristics in association with total and cause-specific mortality: a prospective cohort study of Mexican teachers. Ann Epidemiol 2021; 62:59-65. [PMID: 34166807 DOI: 10.1016/j.annepidem.2021.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/10/2021] [Accepted: 06/14/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE We evaluated the relation between age at menarche and time to menstrual regularity with all-cause and cause specific mortality in a cohort of Mexican women. METHODS We followed 113,540 women from the Mexican Teachers' Cohort. After a mean follow-up time of 9.2 years, 1,355 deaths were identified. We estimated hazard ratios from Cox regression models for total mortality and a competitive risk models for cause-specific mortality adjusting for year of birth and childhood factors. RESULTS Women with extreme age of menarche were at increased risk of all-cause mortality (HR [95% CI]: <11 years 1.50 [1.20, 1.87]; 14 years 1.19 [0.97, 1.43]) relative to those with menarche at 13 years. Extreme ages at menarche had higher risk of mortality for diabetes (HR: <11 years 1.66 [0.90, 3.05]; 14 years 1.47 [0.90, 2.40]), breast cancer (HR: <11 years 1.34 [0.56, 3.20]), and other cancer (HR:<11 years 1.65 [1.10, 2.48]) compared to menarche at 13 years. Women who took three or more years to achieve menstrual regularity had a higher risk of all-cause mortality compared to those who took less (HR: 1.27 [1.01, 1.58]). CONCLUSIONS Extreme ages at menarche and longer time to reach menstrual regularity were associated with an increased rate of all-cause and cause-specific mortality.
Collapse
Affiliation(s)
- Susana Lozano-Esparza
- Department of Epidemiology, University of Washington, Seattle, WA; Center for Research on Population Health, National Institute of Public Health, Mexico City, Mexico
| | - Erica C Jansen
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, MI
| | | | - Salvador Zamora-Muñoz
- Institute for Research in Applied Mathematics and Systems, National Autonomous University of Mexico, Mexico City, Mexico
| | - Dalia Stern
- CONACyT - Center for Research on Population Health, National Institute of Public Health, Cuernavaca, Mexico.
| | - Martin Lajous
- Center for Research on Population Health, National Institute of Public Health, Mexico City, Mexico; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
| |
Collapse
|
18
|
Liang Z, Ma H, Song Q, Sun D, Zhou T, Heianza Y, Chen D, Qi L. Joint Associations of Actual Age and Genetically Determined Age at Menarche With Risk of Mortality. JAMA Netw Open 2021; 4:e2115297. [PMID: 34190994 PMCID: PMC8246309 DOI: 10.1001/jamanetworkopen.2021.15297] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
IMPORTANCE Previous studies have shown an association between actual age at menarche and risk of all-cause mortality; however, the results are inconsistent, and no study has analyzed the joint associations between genetic susceptibility and actual age at menarche with the risk of mortality in prospective cohorts. OBJECTIVES To investigate joint associations of actual age and genetically determined age at menarche with risk of all-cause mortality. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study was conducted using data from the UK Biobank population across the United Kingdom from March 13, 2006, to October 1, 2010. A total of 264 546 women aged between 39 and 71 years with actual menarcheal age were included in this study; 246 676 of these women had genetic data available. Actual age at menarche was obtained from the touchscreen questionnaire at recruitment from 2006 to 2010. Genetically determined age at menarche was assessed by a genetic risk score. Statistical analysis was performed from August 22 to December 12, 2019. EXPOSURE Age at menarche. MAIN OUTCOMES AND MEASURES A multivariable Cox proportional hazards regression model was used to assess associations of actual or genetically determined age at menarche with risk of all-cause mortality. RESULTS The mean (SD) age of the study population at baseline was 56.4 (8.0) years, and the mean (SD) age at menarche included in the analyses was 13.0 (1.6) years. During a median of 9.0 years (range, 8.3-9.7 years) of follow-up, 7761 deaths were documented among the women with actual age at menarche, and 7054 deaths were documented among the women with genetically determined age at menarche. Both the actual age at menarche and the genetically determined age at menarche showed a U-shaped association with the risk of all-cause mortality (lowest actual age [<12 years] vs reference age [15 years]: hazard ratio [HR], 1.16 [95% CI, 1.07-1.26]; highest actual age [≥16 years] vs reference age [15 years]: HR, 1.17 [95% CI, 1.05-1.31]; P < .001 for quadratic trend; genetic risk score [GRS] of 1 vs reference score [GRS of 4]: HR, 1.10 [95% CI, 1.01-1.19; GRS of 6 vs reference score [GRS of 4]: HR, 1.09 [95% CI, 1.00-1.18]; P = .03 for quadratic trend). Significant interactions were also found between actual age at menarche and genetically determined age at menarche with all-cause mortality (HR of mortality associated with age of menarche <12 year was 1.24 [95% CI, 1.10-1.40] in the GRS of 1 group and 1.44 [95% CI, 1.21-1.72] in the GRS of 6 group; P = .001 for interaction). Women with mismatch of actual age and genetically determined age at menarche had the highest mortality risks; participants with the lowest genetic risk score and the highest age at menarche had an HR of 2.12 (95% CI, 1.58-2.83), and participants with the highest GRS and the lowest age at menarche had an HR of 1.44 (95% CI, 1.21-1.72). CONCLUSIONS AND RELEVANCE The results suggest that both actual age and genetically determined age at menarche exhibit U-shaped associations with all-cause mortality. Women with mismatch of actual age and genetically determined age at menarche may have the highest risk of all-cause mortality.
Collapse
Affiliation(s)
- Zhaoxia Liang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
- Department of Obstetrics and Gynecology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Hao Ma
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Qiying Song
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Dianjianyi Sun
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Tao Zhou
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Yoriko Heianza
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Danqing Chen
- Department of Obstetrics and Gynecology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
19
|
Hägg S, Jylhävä J. Sex differences in biological aging with a focus on human studies. eLife 2021; 10:e63425. [PMID: 33982659 PMCID: PMC8118651 DOI: 10.7554/elife.63425] [Citation(s) in RCA: 152] [Impact Index Per Article: 50.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 05/04/2021] [Indexed: 02/06/2023] Open
Abstract
Aging is a complex biological process characterized by hallmark features accumulating over the life course, shaping the individual's aging trajectory and subsequent disease risks. There is substantial individual variability in the aging process between men and women. In general, women live longer than men, consistent with lower biological ages as assessed by molecular biomarkers, but there is a paradox. Women are frailer and have worse health at the end of life, while men still perform better in physical function examinations. Moreover, many age-related diseases show sex-specific patterns. In this review, we aim to summarize the current knowledge on sexual dimorphism in human studies, with support from animal research, on biological aging and illnesses. We also attempt to place it in the context of the theories of aging, as well as discuss the explanations for the sex differences, for example, the sex-chromosome linked mechanisms and hormonally driven differences.
Collapse
Affiliation(s)
- Sara Hägg
- Department of Medical Epidemiology and Biostatistics, Karolinska InstitutetStockholmSweden
| | - Juulia Jylhävä
- Department of Medical Epidemiology and Biostatistics, Karolinska InstitutetStockholmSweden
| |
Collapse
|
20
|
Gottschalk MS, Eskild A, Hofvind S, Gran JM, Bjelland EK. Temporal trends in age at menarche and age at menopause: a population study of 312 656 women in Norway. Hum Reprod 2021; 35:464-471. [PMID: 31990353 PMCID: PMC7048709 DOI: 10.1093/humrep/dez288] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 12/04/2019] [Accepted: 12/09/2019] [Indexed: 12/13/2022] Open
Abstract
STUDY QUESTION Have mean age at menarche or mean age at natural menopause changed from the 1939 birth cohort to the 1964 birth cohort? SUMMARY ANSWER We estimated a minor decrease in mean age at menarche and an increase by nearly 3 years in mean age at natural menopause. WHAT IS KNOWN ALREADY In the Western world, age at menarche decreased across birth cohorts from the early 1800s until the 1950s. Whether mean age at menarche has continued to decrease in birth cohorts after the 1950s remains uncertain. It is also uncertain whether mean age at natural menopause has changed across birth cohorts. STUDY DESIGN, SIZE, DURATION We performed a retrospective population study of 312 656 women who were born in Norway during the years 1936–1964. PARTICIPANTS/MATERIALS, SETTING, METHODS The data were obtained by two self-administered questionnaires from women who participated in the Norwegian breast cancer screening program (BreastScreen Norway) during the years 2006–2014. We used flexible parametric survival models with restricted cubic splines to estimate mean age at menarche, mean age at menopause and mean number of years between menarche and menopause according to the women’s year of birth. The women who were still having menstrual periods contributed with follow-up time until the time of data collection, and the women who had reported surgical removal of the uterus and/or both ovaries prior to natural menopause contributed with follow-up time until the time of surgery. MAIN RESULTS AND THE ROLE OF CHANCE The mean age at menarche was 13.42 years (95% CI: 13.40–13.44 years) among women born during 1936–1939, and it was 13.24 years (95% CI: 13.22–13.25 years) among women born during 1960–1964. The mean age at natural menopause increased from 50.31 years (95% CI: 50.25–50.37 years) among women born during 1936–1939 to 52.73 years (95% CI: 52.64–52.82 years) among women born during 1960–1964. The mean number of years between menarche and menopause increased from 36.83 years (95% CI: 36.77–36.89 years) to 40.22 years (95% CI: 40.11–40.34 years). LIMITATIONS, REASONS FOR CAUTION Information about age at menarche and age at menopause was based on self-reports. WIDER IMPLICATIONS OF THE FINDINGS Late menopause is associated with increased risk of breast cancer but also with increased life expectancy. Thus, higher mean age at menopause may partly explain the increase in breast cancer incidence after menopause and the increase in life expectancy in recent time. Also, a longer interval between menarche and menopause could suggest that the number of years of female fecundity has increased. STUDY FUNDING/COMPETING INTEREST(S) This work was funded by the South-Eastern Norway Regional Health Authority [grant number 2016112 to M.S.G.] and by the Norwegian Cancer Society [grant number 6863294-2015 to E.K.B.]. The authors declare no conflicts of interest.
Collapse
Affiliation(s)
- M S Gottschalk
- Department of Obstetrics and Gynecology, Akershus University Hospital, P.O. Box 1000, N-1478 Lørenskog, Norway
| | - A Eskild
- Department of Obstetrics and Gynecology, Akershus University Hospital, P.O. Box 1000, N-1478 Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, P.O. Box 1171, Blindern, N-0318 Oslo, Norway
| | - S Hofvind
- Department of Mammography Screening, Cancer Registry of Norway, P.O. Box 5313, Majorstuen, N-0304 Oslo, Norway
| | - J M Gran
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, University of Oslo, P.O. Box 1122, Blindern, 0372 Oslo, Norway
| | - E K Bjelland
- Department of Obstetrics and Gynecology, Akershus University Hospital, P.O. Box 1000, N-1478 Lørenskog, Norway
| |
Collapse
|
21
|
Meta-analysis: Early Age at Natural Menopause and Risk for All-Cause and Cardiovascular Mortality. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6636856. [PMID: 33816624 PMCID: PMC7987413 DOI: 10.1155/2021/6636856] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 02/10/2021] [Accepted: 03/01/2021] [Indexed: 11/18/2022]
Abstract
Aims The aim of this meta-analysis was to comprehensively evaluate the association of early age at natural menopause with the risk for all-cause and cardiovascular mortality. Methods Literature retrieval was done on August 4, 2020. Article selection and data extraction were completed independently and in duplicate. Early age at natural menopause was grouped into premature menopause (<40 years), early menopause (40-44 years), and relatively early menopause (45-49 years). Effect-size estimates are summarized as hazard ratio (HR) or relative risk (RR) with 95% confidence interval (CI). Results Sixteen articles involving 321,233 women were meta-analyzed. Overall analyses revealed a statistically significant association of early age at natural menopause with all-cause mortality risk (HRadjusted = 1.08, 95% CI: 1.03 to 1.14, P = 0.002; RRadjusted = 1.05, 95% CI 1.01 to 1.08, P = 0.005), but not with cardiovascular mortality risk. In dose-response analyses, the association with all-cause mortality was significant for premature menopause with (HRadjusted = 1.10; 95% CI: 1.01 to 1.21; P = 0.034) and without (RRadjusted = 1.34; 95% CI: 1.08 to 1.66; P = 0.007) considering follow-up intervals. As for cardiovascular mortality, marginal significance was noted for premature menopause after considering follow-up intervals (HR = 1.09; 95% CI: 1.00-1.19; P = 0.045). Subgroup analyses indicated that gender, country, and follow-up periods were possible causes of heterogeneity. There was an overall low probability of publication bias. Conclusions Our findings indicate that premature menopause is a promising independent risk factor for both all-cause and cardiovascular mortality.
Collapse
|
22
|
Pubertal Growth, IGF-1, and Windows of Susceptibility: Puberty and Future Breast Cancer Risk. J Adolesc Health 2021; 68:517-522. [PMID: 32888770 PMCID: PMC7902462 DOI: 10.1016/j.jadohealth.2020.07.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Risk markers for breast cancer include earlier onset of menarche (age at menarche [AAM]) and peak height velocity (PHV). Insulin-like growth factor-1 (IGF-1) is associated with pubertal milestones, as well as cancer risk. This study examined the relationships between pubertal milestones associated with breast cancer risk and hormone changes in puberty. METHODS This is a longitudinal study of pubertal maturation in 183 girls, recruited at ages 6-7, followed up between 2004 and 2018. Measures included age at onset of puberty, and adult height attained; PHV; AAM; adult height, and serum IGF-1, and estrone-to-androstenedione (E:A) ratio. RESULTS PHV was greatest in early, and least in late maturing girls; length of the pubertal growth spurt was longest in early, and shortest in late maturing girls. Earlier AAM was related to greater PHV. IGF-1 concentrations tracked significantly during puberty; higher IGF-1 was related to earlier age of PHV, earlier AAM, greater PHV, and taller adult height. Greater E:A ratio was associated with earlier AAM. CONCLUSIONS Factors driving the association of earlier menarche and pubertal growth with breast cancer risk may be explained through a unifying concept relating higher IGF-1 concentrations, greater lifelong estrogen exposure, and longer pubertal growth period, with an expanded pubertal window of susceptibility.
Collapse
|
23
|
Age at first childbirth as a predictor of health outcomes later in life among women. ACTA ACUST UNITED AC 2020; 27:1099-1100. [PMID: 32881831 DOI: 10.1097/gme.0000000000001642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
24
|
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.
Collapse
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
| |
Collapse
|
25
|
Giordano Imbroll M, Gruppetta M. A current perspective into young female sex hormone replacement: a review. Expert Rev Endocrinol Metab 2020; 15:405-414. [PMID: 32893689 DOI: 10.1080/17446651.2020.1816820] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Hormone replacement in females with hypogonadism is advocated to address the various clinical aspects of estrogen deficiency. AREAS COVERED This article focuses on hormone replacement in young females with hypogonadism, including a rationale as to why hormone replacement in such patients differs from treatment in postmenopausal females, a summary of symptoms encountered by females with hypogonadism and a comprehensive discussion of the various treatment options available, specifically focusing on the latest advances in the subject. A Medline search was conducted using different combinations of relevant keywords, giving preference to recent publications. EXPERT OPINION Whilst traditionally oral contraceptive pills (containing ethynyl estradiol) were commonly used as a form of hormone replacement, it is now increasingly recognized that this is not the optimal treatment option. Physiological hormone replacement with transdermal estradiol is found to be superior. Evidence suggests that micronized progesterone may be associated with fewer side effects, although its effect on endometrial protection is not yet proven. Synthetic progestins confer varying degrees of androgenic and thromboembolic properties which should be kept in mind when prescribing individualized treatment. Further studies in different sub-cohorts of female patients with hypogonadism might help address the specific needs of individual patients.
Collapse
Affiliation(s)
- Miriam Giordano Imbroll
- Department of Medicine, Faculty of Medicine and Surgery, University of Malta, Mater Dei Hospital , Msida, Malta
- Department of Medicine, Mater Dei Hospital , Msida, Malta
| | - Mark Gruppetta
- Department of Medicine, Faculty of Medicine and Surgery, University of Malta, Mater Dei Hospital , Msida, Malta
- Department of Medicine, Mater Dei Hospital , Msida, Malta
| |
Collapse
|
26
|
Zhang L, Li Y, Dong X, Zhou W, Wang C, Mao Z, Yang X, Fan M, Han S, Li L. Effect of the Age at Menarche and Menopause Status Interaction on Type 2 Diabetes: The Henan Rural Cohort Study. J Clin Endocrinol Metab 2020; 105:5698216. [PMID: 31912872 DOI: 10.1210/clinem/dgz328] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/03/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The aims of this study were to evaluate the effect of age at menarche (AM) on type 2 diabetes mellitus (T2DM) and to assess whether the fasting plasma glucose (FPG) and homeostasis model assessment (HOMA) index responses to AM and menopause status interact in Chinese rural adults. METHODS A cross-sectional, population-based study including 23 138 participants was performed. Logistic regression and multivariable linear regression were performed to investigate the relationship between AM and glucose status. Generalized linear model was used to calculate the interaction term of AM and menopause status on FPG and the HOMA index. Interaction plot was used to interpret the significant interaction effect. RESULTS Women in the later menarche age group (≥18 years) had a 17.7% lower risk of T2DM (95% confidence interval [CI]: 0.712-0.951, P = .008), after adjusting for multiple variables. Further adjustment for body mass index (BMI) completely attenuated this association (odds ratio = 0.884, 95% CI: 0.764-1.024, P = .099). A significant interaction effect of AM and menopause status on T2DM (P = .004) was observed. The adverse effects of menopausal status on FPG and HOMA-2 of insulin resistance decreased with increasing menarche age, and the age ranges were limited to <18 and 9 to 19 years, respectively. CONCLUSIONS Later menarche was associated with a lower risk of T2DM, and the association appears to be mediated by BMI. More importantly, the adverse effect of menopause status on T2DM was decreased along with increasing menarche age.
Collapse
Affiliation(s)
- Lulu Zhang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Yuqian Li
- Department of Clinical Pharmacology, School of Pharmaceutical Science, Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaokang Dong
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Wen Zhou
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Chongjian Wang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Zhenxing Mao
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Xiu Yang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Mengying Fan
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Shengna Han
- Department of Pharmacology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Linlin Li
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| |
Collapse
|
27
|
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.
Collapse
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
| |
Collapse
|
28
|
Zhu Q, Fu S, Zhang Q, Tian J, Zhao Y, Yao Y. Female Fertility Has a Negative Relationship With Longevity in Chinese Oldest-Old Population: A Cross-Sectional Study. Front Endocrinol (Lausanne) 2020; 11:616207. [PMID: 33613452 PMCID: PMC7887279 DOI: 10.3389/fendo.2020.616207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 12/14/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Despite research efforts in this field for more than a century, the relationship between female fertility and longevity is unclear. This study was designed to investigate this relationship in Chinese oldest-old population. METHODS The China Hainan Centenarian Cohort Study was performed in 18 cities and counties of Hainan. A total of 1,226 females, including 758 centenarian women and 468 women aged 80-99 years, were enrolled in this study. Using a standardized protocol, in-person interviews and blood analyses were conducted by a well-trained research team through home visits. RESULTS Centenarian women had significantly lower number of children (NOC) and higher initial childbearing age (ICA) and last childbearing age (LCA) than women aged 80-99 years (p < 0.05 for all). Multivariate logistic regression analysis showed that NOC and testosterone (T) levels were positively associated with women aged 80-99 years, when centenarian women was considered as reference (p < 0.05 for all). ICA, LCA, and estradiol (E2) levels were negatively associated with women aged 80-99 years, when centenarian women was considered as reference (p < 0.05 for all). CONCLUSIONS The centenarians had crucial characteristics of less and delayed childbearing, indicating a negative relationship between female fertility and longevity in Chinese oldest-old population. Serum E2 levels were positively associated and serum T levels were negatively associated with longevity. The less and late childbearing might be a significant factor of longevity, and successful aging might be promoted by reducing and delaying female childbearing.
Collapse
Affiliation(s)
- Qiao Zhu
- Central Laboratory, Hainan Hospital of Chinese People’s Liberation Army General Hospital, Sanya, China
| | - Shihui Fu
- Department of Cardiology, Hainan Hospital of Chinese People’s Liberation Army General Hospital, Sanya, China
| | - Qian Zhang
- Department of Neurology, Hainan Hospital of Chinese People’s Liberation Army General Hospital, Sanya, China
| | - Jinwen Tian
- Department of Cardiology, Hainan Hospital of Chinese People’s Liberation Army General Hospital, Sanya, China
- *Correspondence: Jinwen Tian, ; Yali Zhao, ; Yao Yao,
| | - Yali Zhao
- Central Laboratory, Hainan Hospital of Chinese People’s Liberation Army General Hospital, Sanya, China
- *Correspondence: Jinwen Tian, ; Yali Zhao, ; Yao Yao,
| | - Yao Yao
- Center for Healthy Aging and Development Studies, Raissun Institute for Advanced Studies, National School of Development, Peking University, Beijing, China
- Center for the Study of Aging and Human Development and Geriatrics Division, Medical School of Duke University, Durham, NC, United States
- *Correspondence: Jinwen Tian, ; Yali Zhao, ; Yao Yao,
| |
Collapse
|
29
|
Age at menarche and risk of all-cause and cardiovascular mortality: a systematic review and dose-response meta-analysis. Menopause 2019; 26:670-676. [PMID: 30562317 DOI: 10.1097/gme.0000000000001289] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The evidence between age at menarche and mortality risk is controversial. We aimed to quantify the dose-response association of age at menarche and risk of all-cause and cardiovascular disease (CVD) mortality based on cohort studies. METHODS PubMed, EMBASE, Web of Science, and Scopus databases were searched up to March 15, 2018 for relevant articles. Random-effects models and restricted cubic splines were used for this meta-analysis. RESULTS Twelve cohort studies, with 79,363 deaths and 2,341,769 participants, met the inclusion criteria. With each 1-year increase in menarche age, the relative risk (RR) was reduced for all-cause mortality (RR: 0.977, 95% confidence interval [CI]: 0.970-0.984), CVD mortality (RR: 0.993, 95% CI: 0.975-1.011), ischemic heart disease (IHD) mortality (RR: 0.969, 95% CI: 0.947-0.993), and stroke mortality (RR: 0.983, 95% CI: 0.954-1.012). We found a nonlinear dose-response association (Pnonlinearity = 0.001) between age at menarche and all-cause mortality, with the lowest risk observed at menarche age 15 years (RR: 0.849 95% CI: 0.800-0.901), but no evidence of a nonlinear association between menarche age and CVD mortality (Pnonlinearity = 0.543), IHD mortality (Pnonlinearity = 0.310), or stroke mortality (Pnonlinearity = 0.824). CONCLUSIONS Age at menarche is inversely associated with all-cause and IHD mortality.
Collapse
|
30
|
Zhang X, Liu L, Song F, Song Y, Dai H. Ages at menarche and menopause, and mortality among postmenopausal women. Maturitas 2019; 130:50-56. [PMID: 31706436 DOI: 10.1016/j.maturitas.2019.10.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/19/2019] [Accepted: 10/13/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Although both age at menarche and age at menopause may independently affect the risk of cardiovascular diseases and all-cause mortality, their joint association with mortality is less clear. The objectives of this study were to address the relationship between ages at menarche and at menopause with mortality among postmenopausal women. STUDY DESIGN The study included 75,359 U.S. postmenopausal women aged 50-78 years from the Prostate, Lung, Colorectal, and Ovarian (PLCO) cohort. Information on ages at menarche and menopause was self-reported and collected at baseline, by questionnaire. MAIN OUTCOME MEASURES All-cause, cardiovascular and cancer mortality. RESULTS After a median follow-up of 13 years, we identified 7826 deaths among 75,359 women in the PLCO cohort. Compared with women with an age at menarche of 12-13 years and an age at menopause of 45-54 years, the adjusted hazard ratios (95% confidence interval) for all-cause mortality for women with early menarche (≤11 years) and menopause (≤44 years) and those with late menarche (≥14 years) and menopause (≥55 years) were 1.20 (1.09, 1.32) and 0.82 (0.71, 0.96), respectively. This association remained significant in a sensitivity analysis that excluded women who did not undergo natural menopause. The indexes for the additive effect of the combined association showed no excess risk due to an interaction. CONCLUSIONS Early menarche and early menopause seemed to have an exactly additive effect on all-cause mortality. The findings suggest that it is important to evaluate ages at both menarche and menopause rather than to consider either variable on its own in assessing the risk of mortality.
Collapse
Affiliation(s)
- Xi Zhang
- Clinical Research Unit, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Luyang Liu
- Department of Epidemiology and Biostatistics, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin, PR China
| | - Fengju Song
- Department of Epidemiology and Biostatistics, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin, PR China
| | - Yiqing Song
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | - Hongji Dai
- Department of Epidemiology and Biostatistics, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin, PR China.
| |
Collapse
|
31
|
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.
Collapse
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.
| |
Collapse
|
32
|
Zhang L, Li Y, Zhou W, Wang C, Dong X, Mao Z, Huo W, Tian Z, Fan M, Yang X, Li L. Mediation effect of BMI on the relationship between age at menarche and hypertension: The Henan Rural Cohort Study. J Hum Hypertens 2019; 34:448-456. [PMID: 31477825 DOI: 10.1038/s41371-019-0247-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 07/20/2019] [Accepted: 08/01/2019] [Indexed: 12/18/2022]
|
33
|
Brandts L, van Poppel FWA, van den Brandt PA. Female reproductive factors and the likelihood of reaching the age of 90 years. The Netherlands Cohort Study. Maturitas 2019; 125:70-80. [PMID: 31133221 DOI: 10.1016/j.maturitas.2019.04.213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 04/05/2019] [Accepted: 04/10/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of this study was to prospectively assess the relationship between several reproductive factors in women and the likelihood of reaching the age of 90 years (achieving longevity). STUDY DESIGN For this study, data from the oldest birth cohort (1916-17) of the prospective Netherlands Cohort Study (NLCS) were used. These participants filled in a baseline questionnaire in 1986 (at age 68-70 years). Follow-up for vital status information until the age of 90 years (2006-07) was >99.9% complete. MAIN OUTCOME MEASURES Multivariable-adjusted Cox regression analyses with a fixed follow-up time were based on 2,697 women with complete exposure and co-variable data to calculate risk ratios (RR) of reaching age 90. RESULTS No associations were observed between the likelihood of reaching the age of 90 years, and age at menarche, age at menopause, parity, menstrual lifespan, and oral contraceptive use after adjustment for potential confounders. A later age at first childbirth pointed towards a higher chance of achieving longevity (age ≥30 vs. 20-24; RR,1.17; 95%CI,0.98-1.39). Ever-use of hormone replacement therapy (HRT) was significantly associated with a higher chance of achieving longevity compared with never HRT-users, but only in women who had had an early menopause (<50 years)(RR,1.32; 95% CI, 1.07-1.61). CONCLUSION Age at first childbirth, and ever-use of HRT in women with an early menopause (<50 years) were associated with the likelihood of reaching the age of 90 years.
Collapse
Affiliation(s)
- Lloyd Brandts
- Maastricht University Medical Centre, GROW- School for Oncology and Developmental Biology, Department of Epidemiology, Maastricht, the Netherlands.
| | - Frans W A van Poppel
- Netherlands Interdisciplinary Demographic Institute (NIDI)/ Royal Netherlands Academy of Arts and Sciences (KNAW), The Hague, the Netherlands
| | - Piet A van den Brandt
- Maastricht University Medical Centre, GROW- School for Oncology and Developmental Biology, Department of Epidemiology, Maastricht, the Netherlands; Maastricht University Medical Centre, CAPHRI- School for Public Health and Primary Care, Department of Epidemiology, Maastricht, the Netherlands
| |
Collapse
|
34
|
Effect of Interaction between Early Menarche and Genetic Polymorphisms on Triglyceride. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:9148920. [PMID: 30931082 PMCID: PMC6410422 DOI: 10.1155/2019/9148920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 11/06/2018] [Accepted: 11/10/2018] [Indexed: 01/24/2023]
Abstract
Early menarche has been associated with increased risk of metabolic syndrome. Therefore, investigating the association of each component of metabolic syndrome with age at menarche, and interactions between them, might lead to a better understanding of metabolic syndrome pathogenesis. In this study, we evaluated age at menarche for risk of metabolic syndrome and associations with its components. As a result, the risk of MetS incidence was significantly increased only at ≤12 years of age at menarche (OR = 1.91, P < 0.05). Women with early menarche (≤12 years) had significantly higher levels of triglycerides (β coefficient = 37.83, P = 0.02). In addition, hypertriglyceridemia was significantly increased at early menarche with 1.99 (95% CI: 1.16–3.41, P < 0.01). With GWAS-based pathway analysis, we found the type 2 diabetes mellitus, stress-activated protein kinase signaling, and Jun amino-terminal kinase cascade pathways (all nominal P < 0.001, all FDR < 0.05) to be significantly involved with early menarche on triglyceride levels. These findings may help us understand the role of early menarche on triglyceride and interaction between gene and early menarche on triglyceride for the development of metabolic syndrome.
Collapse
|
35
|
Richardson A, Haridass SA, Ward E, Ayres J, Baskind NE. Investigation and treatment of premature ovarian insufficiency: A multi-disciplinary review of practice. Post Reprod Health 2018; 24:155-162. [PMID: 30392440 DOI: 10.1177/2053369118811233] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To assess compliance with the European Society for Human Reproduction and Embryology (ESHRE) guidelines on the investigation and management of women with premature ovarian insufficiency at the Leeds Teaching Hospitals NHS Trust (LTHT) and to determine whether this varies depending on the clinical setting in which the women present. STUDY DESIGN A retrospective review of all females diagnosed with premature ovarian insufficiency between 1 July 2016 and 30 June 2017, presenting to one of the following clinics: reproductive medicine, specialist menopause, general gynaecology, oncology long-term follow-up, general endocrinology or paediatric endocrinology. MAIN OUTCOME MEASURES Proportion of patients who had the necessary investigations performed and relevant treatment options discussed. RESULTS 103 women were included in the study. Overall, 40.6% had a karyotype. Screening for the Fragile-X pre-mutation, thyroid peroxidase and 21-hydroxylase antibodies occurred in 7.4%, 11.1% and 13.6% of women, respectively. Only 35.9% had their bone mineral density measured. There was significant variation in the performance of a karyotype (p < 0.001) and thyroid peroxidase antibodies (p < 0.01) between the different clinical settings. Overall, lifestyle advice was offered to 30.1%. Estrogen replacement, contraception, fertility options and bone protection were discussed with 76.0%, 38.4%, 59.0% and 75.0%, respectively. Psychological support was offered to 25.2%. There was significant variation for all apart from contraception. CONCLUSION The investigation and treatment of women with premature ovarian insufficiency at the LTHT is not consistent with the ESHRE guidelines and requires improvement. Furthermore, there is significant variation in management depending on the department to which the patient initially presents.
Collapse
Affiliation(s)
- A Richardson
- Department of Obstetrics and Gynaecology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - S A Haridass
- Department of Endocrinology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - E Ward
- Department of Endocrinology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J Ayres
- Department of Obstetrics and Gynaecology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - N E Baskind
- Department of Obstetrics and Gynaecology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| |
Collapse
|
36
|
Otsuki S, Saito E, Sawada N, Abe SK, Hidaka A, Yamaji T, Shimazu T, Goto A, Iwasaki M, Iso H, Mizoue T, Shibuya K, Inoue M, Tsugane S. Female reproductive factors and risk of all-cause and cause-specific mortality among women: The Japan Public Health Center–based Prospective Study (JPHC study). Ann Epidemiol 2018; 28:597-604.e6. [DOI: 10.1016/j.annepidem.2018.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 05/15/2018] [Accepted: 06/03/2018] [Indexed: 10/28/2022]
|
37
|
Roman Lay AA, do Nascimento CF, de Oliveira Duarte YA, Porto Chiavegatto Filho AD. Age at natural menopause and mortality: A survival analysis of elderly residents of São Paulo, Brazil. Maturitas 2018; 117:29-33. [PMID: 30314558 DOI: 10.1016/j.maturitas.2018.08.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/25/2018] [Accepted: 08/30/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To conduct a survival analysis according to age at natural menopause (NM) in a representative sample of elderly women from the municipality of São Paulo, Brazil. STUDY DESIGN We analyzed data from the Health, Well-Being and Aging study (SABE), a cohort that started in 2000. Mortality data up to September 2016 were obtained by linkage from the Program for Mortality Information of São Paulo (PRO-AIM). MAIN OUTCOME MEASURES We used Cox regression to analyze all-cause and cause-specific mortality rates for cardiovascular diseases, respiratory diseases and cancer, according to age at menopause, categorized as <40, 41-44, 45-49, 50-54 (reference) and ≥55. RESULTS After 16 years of follow-up, there were 444 deaths, of which 199 were from cardiovascular diseases, 73 from respiratory diseases and 65 from cancer. After adjustment for socioeconomic, reproductive and lifestyle factors, having an early menopause (at age 41-44) was associated with an increased risk of all-cause mortality (HR = 1.48, 95% IC: 1.03, 2.14) relative to NM at 50-54 years. Women aged 41-44 and 45-49 at NM had twice the risk of cancer mortality of the reference group. We did not find significant associations between age at NM and cause-specific mortality for respiratory and cardiovascular diseases. CONCLUSIONS Our findings suggest that early menopause is associated with all-cause mortality in the largest city of Latin America. In addition, earlier age at NM was associated with cancer mortality. These results suggest that age at NM may be a biomarker for mortality, irrespective of country of residence.
Collapse
Affiliation(s)
- Alejandra Andrea Roman Lay
- Department of Epidemiology, School of Public Health, University of São Paulo, Brazil; Faculty of Health Sciences, University of Tarapacá, Chile.
| | | | | | | |
Collapse
|
38
|
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.
Collapse
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.)
| | | |
Collapse
|
39
|
Bjelland EK, Hofvind S, Byberg L, Eskild A. The relation of age at menarche with age at natural menopause: a population study of 336 788 women in Norway. Hum Reprod 2018; 33:1149-1157. [PMID: 29635353 PMCID: PMC5972645 DOI: 10.1093/humrep/dey078] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/16/2018] [Accepted: 03/20/2018] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Is age at menarche associated with age at menopause or with duration of the reproductive period (interval between menarche and menopause)? SUMMARY ANSWER The association of age at menarche with age at menopause was weak and non-linear, and the duration of the reproductive period decreased by increasing age at menarche. WHAT IS KNOWN ALREADY It remains uncertain whether age at menarche is associated with age at menopause. Some studies report that women with early menarche also have early menopause. Other studies report that women with early menarche have late menopause, or they report no association. The duration of the reproductive period may be an indicator of the cumulative endogenous exposure to estrogens and progestogens during life course and is associated with risk of breast cancer and endometrial cancer. STUDY DESIGN, SIZE, DURATION A retrospective cohort study of 336 788 women, aged 48-71 years, in the BreastScreen Norway during the years 2006-2014 was performed. PARTICIPANTS/MATERIALS, SETTING, METHODS Information about age at menarche and menopausal status was obtained by self-administered questionnaires. We used time to event approaches to estimate the associations. MAIN RESULTS AND THE ROLE OF CHANCE Median age at menopause was 51 years in most menarche groups. Women with menarche at age 16 years or age ≥ 17 years had menopause 1 year later [median: 52 years, interquartile range (IQR): 49-54 years] than women with menarche at age 13 years (median: 51 years, IQR: 49-54 years, reference) (crude hazard ratio (HR) = 0.95; 95% CI: 0.93-0.97 and 0.95; 95% CI: 0.92-0.99, Pnon-linearity < 0.001). The reproductive period decreased with increasing age at menarche (Pnon-linearity < 0.001), and women with menarche at age ≤ 9 years had 9 years longer median reproductive period than women with menarche at age ≥ 17 years (median: 43 versus 34 years). Adjustment for year of birth did not change the HR estimates notably. LARGE SCALE DATA Not applicable. LIMITATIONS, REASONS FOR CAUTION Information about age at menarche and age at menopause was based on self-reports. Particularly for age at menarche, the long time interval between the event and data collection may have caused imprecise reporting. WIDER IMPLICATIONS OF THE FINDINGS Our study suggests that age at menarche is a strong indicator for the duration of women's reproductive period. Our findings should encourage studies of the independent role of duration of the reproductive period on the risk of breast cancer and endometrial cancer, since these cancers have been associated with exposure to estrogens and progestogens. STUDY FUNDING/COMPETING INTEREST(S) The present study was funded by the Norwegian Cancer Society [Grant number 6863294-2015]. The authors declare no conflicts of interest.
Collapse
Affiliation(s)
- E K Bjelland
- Department of Obstetrics and Gynecology, Akershus University Hospital, P.O. Box 1000, N-1478 Lørenskog, Norway
- Department of Public Health and Caring Sciences, Uppsala University, P.O. Box 564, SE-75122 Uppsala, Sweden
| | - S Hofvind
- Department of Mammography Screening, Cancer Registry of Norway, P.O. Box 5313, Majorstuen, N-0304 Oslo, Norway
| | - L Byberg
- Department of Surgical Sciences, Uppsala University, P.O. Box 564, SE-75122 Uppsala, Sweden
| | - A Eskild
- Department of Obstetrics and Gynecology, Akershus University Hospital, P.O. Box 1000, N-1478 Lørenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, P.O. Box 1000, N-1478 Lørenskog, Norway
| |
Collapse
|
40
|
Lundblad MW, Jacobsen BK. Is age at menarche associated with total mortality? The Tromsø Study. Int J Womens Health 2018; 10:203-209. [PMID: 29750056 PMCID: PMC5935086 DOI: 10.2147/ijwh.s158706] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Early age at menarche (AAM) has been associated with increased mortality and morbidity, including premature death from all causes, breast cancer and cardiovascular diseases. The aim of this study was to examine the association between AAM and all-cause mortality. Subjects and methods A total of 12,409 women aged 25–94 years who took part in the fourth Tromsø Study in Norway during 1994–1995 were included in this prospective population-based study with a mean 18.7 years of follow-up. Multivariate Cox proportional hazard analysis was used to investigate the association between AAM and all-cause mortality with adjustment for known confounders (age, body mass index, physical activity, level of education and smoking history). Results During the 18.7 years of follow-up, a total of 2,203 women died. There was no association between AAM and all-cause mortality before or after adjusting for possible confounding factors. Conclusion This prospective study of 12,409 women did not find any association between AAM and all-cause mortality
Collapse
Affiliation(s)
| | - Bjarne K Jacobsen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| |
Collapse
|
41
|
Association of age at menarche with obesity and hypertension among southwestern Chinese women: a new finding. Menopause 2018; 25:546-553. [DOI: 10.1097/gme.0000000000001027] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
42
|
Lundblad MW, Jacobsen BK. The reproducibility of self-reported age at menarche: The Tromsø Study. BMC WOMENS HEALTH 2017; 17:62. [PMID: 28830397 PMCID: PMC5568259 DOI: 10.1186/s12905-017-0420-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 08/08/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Previous studies of the reproducibility of self-reported age at menarche have been limited because of small study samples, short follow-up and the limited age span of the women included. METHODS The present study assessed the reproducibility of age at menarche in 6731 women with a wide variation of age when giving the information about age at menarche. The women reported age at menarche in a self-administered questionnaire, both in 1986-1987 and 1994-1995. They were all residents of Tromsø, Norway, and aged 25-73 in 1994-1995. In order to investigate the agreement between self-reported age at menarche at the two points in time, Pearson's correlation coefficient was applied to assess the linear correlation between the reported menarcheal age at the two occasions. Analyses were stratified for age. A Bland-Altman plot was produced and limits of agreement computed. RESULTS We found a high correlation and a strong agreement between self-reported age at menarche in 1986-1987 and 1994-1995. The overall Pearson's correlation coefficient was 0.84 and was not attenuated by increasing age of the women. The Bland-Altman plot showed a strong agreement in self-reported age at menarche. The mean difference between self-reported age at menarche was 0.01 years with limits of agreement -1.52 to 1.54. CONCLUSION We found high reproducibility of self-reported age at menarche. The mean menarcheal age in the two surveys was identical (13.2 years) with 95% of the women reporting the same age at menarche or with a difference of 1 year. Only 0.7% of the women reported age at menarche with a difference of more than 2 years in 1986-1987 and 1994-1995.
Collapse
Affiliation(s)
| | - Bjarne K Jacobsen
- Department of Community Medicine, UiT- The Arctic University of Norway, Tromsø, Norway
| |
Collapse
|
43
|
Abstract
Background Patterns of symptom clustering in midlife women may suggest common underlying mechanisms or may identify women at risk of adverse health outcomes or, conversely, likely to experience healthy aging. This paper assesses symptom clustering in the Study of Women’s Health Across the Nation (SWAN) longitudinally by stage of reproductive aging and estimates the probability of women experiencing specific symptom clusters. We also evaluate factors that influence the likelihood of specific symptom clusters and assess whether symptom clustering is associated with women’s self-reported health status. Methods This analysis includes 3289 participants in the multiethnic SWAN cohort who provided information on 58 symptoms reflecting a broad range of physical, psychological and menopausal symptoms at baseline and 7 follow-up visits over 16 years. We conducted latent transition analyses to assess symptom clustering and to model symptomatology across the menopausal transition (pre, early peri-, late peri- and post-menopausal). Joint multinomial logistic regression models were used to identify demographic characteristics associated with premenopausal latent class membership. A partial proportional odds regression model was used to assess the association between latent class membership and self-reported health status. Results We identified six latent classes that ranged from highly symptomatic (LC1) across most measured symptoms, to moderately symptomatic across most measured symptoms (LC2), to moderately symptomatic for a subset of symptoms (vasomotor symptoms, pain, fatigue, sleep disturbances and physical health symptoms) (LC3 and LC5) with one class (LC3) including interference in life activities because of physical health symptoms, to numerous milder symptoms, dominated by fatigue and psychological symptoms (LC4), to relatively asymptomatic (LC6). In pre-menopause, 10% of women were classified in LC1, 16% in LC2, 14% in LC3 and LC4, 26% in LC5, and 20% in LC6. Intensity of vasomotor and urogenital symptoms as well as sexual desire) differed minimally by latent class. Classification into the two most symptomatic classes was strongly associated with financial strain, White race/ethnicity, obesity and smoking status. Over time, women were most likely to remain within the same latent class as they transitioned through menopause stages (range 39–76%), although some women worsened or improved. The probability of moving between classes did not differ substantially by menopausal stage. Women in the highly symptomatic classes more frequently rated their health as fair to poor compared to women in the least symptomatic class. Conclusion Clear patterns of symptom clustering were present early in midlife, tended to be stable over time, and were strongly associated with self-perceived health. Notably, vasomotor symptoms tended to cluster with sleep disturbances and fatigue, were present in each of the moderate to highly symptomatic classes, but were not a defining characteristic of the symptom clusters. Clustering of midlife women by symptoms may suggest common underlying mechanisms amenable to interventions. Given that one-quarter of midlife women were highly or moderately symptomatic across all domains in the pre-menopause, addressing symptom burden in early midlife is likely critical to ameliorating risk in the most vulnerable populations. Electronic supplementary material The online version of this article (doi:10.1186/s40695-017-0021-y) contains supplementary material, which is available to authorized users.
Collapse
|
44
|
Luijken J, van der Schouw YT, Mensink D, Onland-Moret NC. Association between age at menarche and cardiovascular disease: A systematic review on risk and potential mechanisms. Maturitas 2017; 104:96-116. [PMID: 28923182 DOI: 10.1016/j.maturitas.2017.07.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 07/20/2017] [Indexed: 10/19/2022]
Abstract
Age at menarche (AAM) has been reported to be associated with the risk of cardiovascular disease (CVD), but the shape of and the mechanisms behind this association remain unclear. We reviewed the data on the association between AAM and different subtypes of CVD, and used shared genetic loci to identify possible mechanisms underlying this association using shared genetic association. We searched the databases of PubMed, Web of Science and Embase through to April 2017. We included articles with any clinically manifest CVD endpoint and for any ethnicity. We identified single nucleotide polymorphisms (SNPs) for AAM in genome-wide association studies (GWAS) in Caucasians through PubMed and HuGE Navigator, and searched whether these SNPs or any of their proxies were associated with any CVD-related trait. Eight studies in Caucasian populations reported an inverse linear relation between AAM and CVD risk, whereas one large study reported a significant U-shaped relation between them. Data from Asian populations were contradictory and inconclusive. In total, 122 AAM SNPs were identified at a genome-wide significance level (p<5×10-8). Of those, 18 were also associated with various CVD-related traits, primarily body mass index (BMI), obesity, and height. In conclusion, early AAM and possibly also late AAM increase the risk of CVD in Caucasian populations. Weight and height may be part of the mechanism underlying the relation between AAM and CVD risk in Caucasians. Data on other ethnicities are too limited for meaningful analysis and conclusions.
Collapse
Affiliation(s)
- Janneke Luijken
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Daniëlle Mensink
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands; Cardialysis, Rotterdam, The Netherlands
| | - N Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
45
|
Agaba P, Meloni S, Sule H, Ocheke A, Agaba E, Idoko J, Kanki P. Factors associated with early menopause among women in Nigeria. J Virus Erad 2017; 3:145-151. [PMID: 28758022 PMCID: PMC5518243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Effective antiretroviral therapy has prolonged the survival of patients with HIV. Accordingly, studies of the consequences of ageing are increasingly important. We determined the prevalence of early menopause (EM) and its associated factors in a cohort of HIV-infected and HIV-negative controls in Jos, Nigeria. METHODS HIV-infected women accessing care in an ambulatory setting and their negative counterparts from the general population were included. Menopause was defined as having gone one year since the last menstrual period. EM was defined as the onset of menopause at ≤45 years of age. Baseline characteristics were compared and logistic regression analyses were used to determine factors independently associated with EM. RESULTS Out of a total of 253 women included, 58 attained menopause early, giving an EM prevalence of 22.9% (95% confidence interval [CI] 17.9-28.6%). Women with EM were younger (P<0.001) and had been infected with HIV for a shorter period (P=0.007). Baseline CD4+ cell count (P=0.66) and viral load (P=0.15) were similar among those with and without EM. For all subjects, HIV infection (adjusted odds ratio [AOR}=10.95, 95% CI 1.39-86.33) and sexual activity (AOR=2.37, 95% CI 1.24-4.52) were associated with EM while early menarche (AOR=14.88, 95% CI 1.37-161.10) and sexual activity (AOR=2.02, 95% CI 1.03-3.96) were independently associated with EM. CONCLUSION Over a quarter of our postmenopausal women attained menopause early. No HIV-related factor predicted EM in this study. A better understanding of ageing in these women is important to determine a more appropriate disease-management approach during this period of life.
Collapse
Affiliation(s)
- Patricia Agaba
- Department of Family Medicine,
University of Jos/Jos University Teaching Hospital,
Nigeria,APIN Centre, Jos University Teaching Hospital,
Jos,
Nigeria,Corresponding author: Patricia A Agaba,
Department of Family Medicine,
University of Jos/Jos University Teaching Hospital,
2 Murtela Mohammed Way,
PMB 2076,
Jos,
Plateau State,
Nigeria
,
| | - Seema Meloni
- Department of Immunology and Infectious Diseases,
Harvard TH Chan School of Public Health,
Boston,
MA,
USA
| | - Halima Sule
- Department of Family Medicine,
University of Jos/Jos University Teaching Hospital,
Nigeria,APIN Centre, Jos University Teaching Hospital,
Jos,
Nigeria
| | - Amaka Ocheke
- Department of Obstetrics & Gynaecology,
University of Jos/Jos University Teaching Hospital,
Nigeria
| | - Emmanuel Agaba
- Department of Medicine,
University of Jos/Jos University Teaching Hospital,
Nigeria
| | - John Idoko
- Department of Medicine,
University of Jos/Jos University Teaching Hospital,
Nigeria
| | - Phyllis Kanki
- Department of Immunology and Infectious Diseases,
Harvard TH Chan School of Public Health,
Boston,
MA,
USA
| |
Collapse
|
46
|
Agaba P, Meloni S, Sule H, Ocheke A, Agaba E, Idoko J, Kanki P. Factors associated with early menopause among women in Nigeria. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30333-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
47
|
Gentry-Maharaj A, Glazer C, Burnell M, Ryan A, Berry H, Kalsi J, Woolas R, Skates SJ, Campbell S, Parmar M, Jacobs I, Menon U. Changing trends in reproductive/lifestyle factors in UK women: descriptive study within the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). BMJ Open 2017; 7:e011822. [PMID: 28264823 PMCID: PMC5353253 DOI: 10.1136/bmjopen-2016-011822] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE There has been considerable interest in the impact of reproductive factors on health but there are little data on how these have varied over time. We explore trends in reproductive/lifestyle factors of postmenopausal British women by analysing self-reported data from participants of the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). DESIGN Prospective birth cohort analysis. SETTING Population cohort invited between 2001 and 2005 from age-sex registers of 27 Primary Care Trusts in England, Wales and Northern Ireland and recruited through 13 National Health Service Trusts. PARTICIPANTS 202 638 postmenopausal women aged 50-74 years at randomisation to UKCTOCS between April 2001 and October 2005. INTERVENTIONS Women were stratified into the following six birth cohorts (1925-1929, 1930-1934, 1935-1939, 1940-1944, 1945-1949, 1950-1955) based on year of birth. Self-reported data on reproductive factors provided at recruitment were explored using tabular and graphical summaries to examine for differences between the birth cohorts. OUTCOME MEASURES Trends in mean age at menarche and menopause, use of oral contraceptives, change in family size, infertility treatments, tubal ligation and hysterectomy rates. RESULTS Women born between 1935 and 1955 made up 86% of the cohort. Median age at menarche decreased from 13.4 for women born between 1925 and 1929 to 12.8 for women born between 1950 and 1955. Increased use of the oral contraceptives, infertility treatments and smaller family size was observed in the younger birth cohorts. Tubal ligation rates increased for those born between 1925 and 1945, but this increase did not persist in subsequent cohorts. Hysterectomy rates (17-20%) did not change over time. CONCLUSIONS The trends seen in this large cohort are likely to reflect the reproductive history of the UK female postmenopausal population of similar age. Since these are risk factors for hormone-related cancers, these trends are important in understanding the changing incidence of these cancers. TRIAL REGISTRATION NUMBER International Standard Randomised Controlled Trial Number: 22488978.
Collapse
Affiliation(s)
| | - Clara Glazer
- Department of Women's Cancer, Institute for Women's Health, UCL, LondonUK
- Department of Occupational and Environmental Medicine, Frederiksberg-Bispebjerg University Hospital, Copenhagen, Denmark
| | - Matthew Burnell
- Department of Women's Cancer, Institute for Women's Health, UCL, LondonUK
| | - Andy Ryan
- Department of Women's Cancer, Institute for Women's Health, UCL, LondonUK
| | - Hannah Berry
- Department of Women's Cancer, Institute for Women's Health, UCL, LondonUK
| | - Jatinderpal Kalsi
- Department of Women's Cancer, Institute for Women's Health, UCL, LondonUK
| | - Robert Woolas
- Department of Gynaecological Oncology, Queen Alexandra Hospital, Portsmouth, UK
| | - Steve J Skates
- Massachusetts General Hospital Biostatistics, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Mahesh Parmar
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Ian Jacobs
- Department of Women's Cancer, Institute for Women's Health, UCL, LondonUK
- Centre for Women's Health, Institute of Human Development, University of Manchester, Manchester, UK
- University of New South Wales, Sydney, New South Wales, Australia
| | - Usha Menon
- Department of Women's Cancer, Institute for Women's Health, UCL, LondonUK
| |
Collapse
|
48
|
Shadyab AH, Macera CA, Shaffer RA, Jain S, Gallo LC, Gass MLS, Waring ME, Stefanick ML, LaCroix AZ. Ages at menarche and menopause and reproductive lifespan as predictors of exceptional longevity in women: the Women's Health Initiative. Menopause 2017; 24:35-44. [PMID: 27465713 PMCID: PMC5177476 DOI: 10.1097/gme.0000000000000710] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of the present study was to investigate associations between reproductive factors and survival to age 90 years. METHODS This was a prospective study of postmenopausal women from the Women's Health Initiative recruited from 1993 to 1998 and followed until the last outcomes evaluation on August 29, 2014. Participants included 16,251 women born on or before August 29, 1924 for whom survival to age 90 during follow-up was ascertained. Women were classified as having survived to age 90 (exceptional longevity) or died before age 90. Multivariable logistic regression models were used to evaluate associations of ages at menarche and menopause (natural or surgical) and reproductive lifespan with longevity, adjusting for demographic, lifestyle, and reproductive characteristics. RESULTS Participants were on average aged 74.7 years (range, 69-81 y) at baseline. Of 16,251 women, 8,892 (55%) survived to age 90. Women aged at least 12 years at menarche had modestly increased odds of longevity (odds ratio [OR], 1.09; 95% CI, 1.00-1.19). There was a significant trend toward increased longevity for later age at menopause (natural or surgical; Ptrend = 0.01), with ORs (95% CIs) of 1.19 (1.04-1.36) and 1.18 (1.02-1.36) for 50 to 54 and at least 55 compared with less than 40 years, respectively. Later age at natural menopause as a separate exposure was also significantly associated with increased longevity (Ptrend = 0.02). Longer reproductive lifespan was significantly associated with increased longevity (Ptrend = 0.008). The odds of longevity were 13% (OR 1.13; 95% CI, 1.03-1.25) higher in women with more than 40 compared with less than 33 reproductive years. CONCLUSIONS Reproductive characteristics were associated with late-age survival in older women.
Collapse
Affiliation(s)
- Aladdin H Shadyab
- 1San Diego State University/University of California San Diego Joint-Doctoral Program in Public Health (Epidemiology), San Diego, CA 2Division of Epidemiology, Graduate School of Public Health, San Diego State University, San Diego, CA 3Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, La Jolla, CA 4Department of Psychology, San Diego State University, San Diego, CA 5The North American Menopause Society, Emeritus, Cleveland, OH 6Departments of Quantitative Health Sciences and Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA 7Department of Medicine, Stanford Center for Prevention Research, Stanford University School of Medicine, Stanford, CA 8Division of Epidemiology, Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, La Jolla, CA
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Yang L, Li L, Millwood IY, Peters SAE, Chen Y, Guo Y, Bian Z, Chen X, Chen L, Feng S, Lv S, Pang Z, Woodward M, Chen Z. Age at menarche and risk of major cardiovascular diseases: Evidence of birth cohort effects from a prospective study of 300,000 Chinese women. Int J Cardiol 2016; 227:497-502. [PMID: 27836305 PMCID: PMC5176087 DOI: 10.1016/j.ijcard.2016.10.115] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 10/30/2016] [Indexed: 11/25/2022]
Abstract
Background Previous studies of mostly Western women have reported inconsistent findings on the association between age at menarche and risk of cardiovascular disease (CVD). Little is known about the association in China where there has been a large intergenerational decrease in women's mean age at menarche. Methods The China Kadoorie Biobank recruited 302,632 women aged 30–79 (mean 50.5) years in 2004–8 from 10 diverse regional sites across China. During 7 years follow-up, 14,111 incident cases of stroke, 14,093 of coronary heart disease (CHD), and 3200 CVD deaths were reported among 281,491 women who had no prior history of CVD at baseline. Cox regression yielded adjusted hazard ratios (HRs) relating age at menarche to CVD risks. Results The mean (SD) age of menarche was 15.4 (1.9) years, decreasing from 16.2 (2.0) among women born before 1940 to 14.7 (1.6) for those born during the 1960s–1970s. The patterns of association between age at menarche and CVD risk appeared to differ between different birth cohorts, with null associations in older generations but U-shaped or weak positive associations in younger women, especially those born after the 1960s. After minimizing the potential confounding effects from major CVD risk factors, both early and late menarche, compared with menarche at age 13 years, were associated with increased risk of CVD morbidity and mortality, which was more pronounced in younger generations. Conclusion Among Chinese women the associations between age at menarche and risk of CVD differed by birth cohort, suggesting other factors may underpin the association.
Collapse
Affiliation(s)
- Ling Yang
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Oxford, UK.
| | - Liming Li
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China; Department of Public Health, Beijing University, Beijing, China.
| | - Iona Y Millwood
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Oxford, UK
| | - Sanne A E Peters
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Yiping Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Oxford, UK
| | - Yu Guo
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China
| | - Xiaofang Chen
- Pengzhou CDC NCDs Prevention and Control Department, Penzhou, Sichuan, China
| | - Lingli Chen
- Tongxiang CDC NCDs Prevention and Control Department, Tongxiang, Zhejiang, China
| | - Shixian Feng
- Henan CDC NCDs Prevention and Control Department, Zhengzhou, Henan, China
| | - Silu Lv
- Licang CDC, Qingdao, Shandong, China
| | - Zhigang Pang
- Heilongjiang CDC NCDs Prevention and Control Department, Harbin, Heilongjiang, China
| | - Mark Woodward
- The George Institute for Global Health, University of Oxford, Oxford, UK; The George Institute for Global Health, University of Sydney, Australia; Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Oxford, UK
| | | |
Collapse
|
50
|
Merritt MA, Riboli E, Murphy N, Kadi M, Tjønneland A, Olsen A, Overvad K, Dossus L, Dartois L, Clavel-Chapelon F, Fortner RT, Katzke VA, Boeing H, Trichopoulou A, Lagiou P, Trichopoulos D, Palli D, Sieri S, Tumino R, Sacerdote C, Panico S, Bueno-de-Mesquita HB, Peeters PH, Lund E, Nakamura A, Weiderpass E, Quirós JR, Agudo A, Molina-Montes E, Larrañaga N, Dorronsoro M, Cirera L, Barricarte A, Olsson Å, Butt S, Idahl A, Lundin E, Wareham NJ, Key TJ, Brennan P, Ferrari P, Wark PA, Norat T, Cross AJ, Gunter MJ. Reproductive factors and risk of mortality in the European Prospective Investigation into Cancer and Nutrition; a cohort study. BMC Med 2015; 13:252. [PMID: 26515238 PMCID: PMC4627614 DOI: 10.1186/s12916-015-0484-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 09/09/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Reproductive events are associated with important physiologic changes, yet little is known about how reproductive factors influence long-term health in women. Our objective was to assess the relation of reproductive characteristics with all-cause and cause-specific mortality risk. METHODS The analysis was performed within the European Investigation into Cancer and Nutrition prospective cohort study, which enrolled >500,000 women and men from 1992 to 2000, who were residing in a given town/geographic area in 10 European countries. The current analysis included 322,972 eligible women aged 25-70 years with 99 % complete follow-up for vital status. We assessed reproductive characteristics reported at the study baseline including parity, age at the first birth, breastfeeding, infertility, oral contraceptive use, age at menarche and menopause, total ovulatory years, and history of oophorectomy/hysterectomy. Hazard ratios (HRs) and 95 % confidence intervals (CIs) for mortality were determined using Cox proportional hazards regression models adjusted for menopausal status, body mass index, physical activity, education level, and smoking status/intensity and duration. RESULTS During a mean follow-up of 12.9 years, 14,383 deaths occurred. The HR (95 % CI) for risk of all-cause mortality was lower in parous versus nulliparous women (0.80; 0.76-0.84), in women who had ever versus never breastfed (0.92; 0.87-0.97), in ever versus never users of oral contraceptives (among non-smokers; 0.90; 0.86-0.95), and in women reporting a later age at menarche (≥15 years versus <12; 0.90; 0.85-0.96; P for trend = 0.038). CONCLUSIONS Childbirth, breastfeeding, oral contraceptive use, and a later age at menarche were associated with better health outcomes. These findings may contribute to the development of improved strategies to promote better long-term health in women.
Collapse
Affiliation(s)
- Melissa A Merritt
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - Neil Murphy
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - Mai Kadi
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100, Copenhagen, Denmark.
| | - Anja Olsen
- Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100, Copenhagen, Denmark.
| | - Kim Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Bartholins Allé 2 - Building 1260, DK-8000, Aarhus, Denmark.
| | - Laure Dossus
- Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, F-94805, Villejuif, France.
- Université Paris Sud, UMRS 1018, F-94805, Villejuif, France.
- Institut Gustave Roussy, F-94805, Villejuif, France.
| | - Laureen Dartois
- Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, F-94805, Villejuif, France.
- Université Paris Sud, UMRS 1018, F-94805, Villejuif, France.
- Institut Gustave Roussy, F-94805, Villejuif, France.
| | - Françoise Clavel-Chapelon
- Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, F-94805, Villejuif, France.
- Université Paris Sud, UMRS 1018, F-94805, Villejuif, France.
- Institut Gustave Roussy, F-94805, Villejuif, France.
| | - Renée T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
| | - Verena A Katzke
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany.
| | - Antonia Trichopoulou
- Hellenic Health Foundation, 13 Kaisareias Street, Athens, GR-115 27, Greece.
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 75 M Asias Street, Goudi GR-115 27, Athens, Greece.
- Bureau of Epidemiologic Research, Academy of Athens, 23 Alexandroupoleos Street, Athens, GR-115 27, Greece.
| | - Pagona Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 75 M Asias Street, Goudi GR-115 27, Athens, Greece.
- Bureau of Epidemiologic Research, Academy of Athens, 23 Alexandroupoleos Street, Athens, GR-115 27, Greece.
- Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Dimitrios Trichopoulos
- Hellenic Health Foundation, 13 Kaisareias Street, Athens, GR-115 27, Greece.
- Bureau of Epidemiologic Research, Academy of Athens, 23 Alexandroupoleos Street, Athens, GR-115 27, Greece.
- Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Domenico Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Ponte Nuovo Palazzina 28 A "Mario Fiori", Via delle Oblate 4, 50141, Florence, Italy.
| | - Sabina Sieri
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133, Milan, Italy.
| | - Rosario Tumino
- Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, ASP, Via Dante N° 109, 97100, Ragusa, Italy.
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Citta' della Salute e della Scienza Hospital- University of Turin and Center for Cancer Prevention (CPO), Via Santena 7, 10126, Turin, Italy.
| | - Salvatore Panico
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, via Pansini 5, 80131, Naples, Italy.
| | - H Bas Bueno-de-Mesquita
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
- Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720, BA, Bilthoven, The Netherlands.
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Heidelberglann 100, 3584, CX, Utrecht, The Netherlands.
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Petra H Peeters
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Huispost Str. 6.131, PO Box 85500, 3508, GA, Utrecht, The Netherlands.
| | - Eiliv Lund
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Breivika, N-9037, Tromsø, Norway.
| | - Aurelie Nakamura
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Breivika, N-9037, Tromsø, Norway.
| | - Elisabete Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Breivika, N-9037, Tromsø, Norway.
- Department of Research, Cancer Registry of Norway, 0310, Oslo, Norway.
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, 17177, Sweden.
- Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, FI-00290, Finland.
| | - J Ramón Quirós
- Public Health Directorate, Asturias, Ciriaco Miguel Vigil St, 9, 33006, Oviedo, Spain.
| | - Antonio Agudo
- Unit of Nutrition and Cancer, IDIBELL, Catalan Institute of Oncology-ICO, L'Hospitalet de Llobregat, Barcelona, 08908, Spain.
| | - Esther Molina-Montes
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs and Hospitales Universitarios de Granada/Universidad de Granada, Cuesta del Observatorio, 4, Campus Universitario de Cartuja, 18080, Granada, Spain.
- CIBER de Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain.
| | - Nerea Larrañaga
- CIBER de Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain.
- Public Health Division of Gipuzkoa, BIODonostia Research Institute, Basque Health Department, Avenida de Navarra, 4-20013, Donostia San Sebastian, Spain.
| | - Miren Dorronsoro
- CIBER de Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain.
- Public Health Direction and Biodonostia-Ciberesp, Basque Regional Health Department, 01010, Vitoria, Spain.
| | - Lluís Cirera
- CIBER de Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain.
- Department of Epidemiology, Murcia Regional Health Council, IMIB - Arrixaca, Ronda de Levante 11, 30008, Murcia, Spain.
| | - Aurelio Barricarte
- CIBER de Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain.
- Navarre Public Health Institute, Leyre 15, 31003, Pamplona, Spain.
| | - Åsa Olsson
- Institute of Clinical Sciences, Malmö and Department of Surgery, Lund University, Skane University Hospital, SE-205 02, Malmö, Sweden.
| | - Salma Butt
- Institute of Clinical Sciences, Malmö and Department of Surgery, Lund University, Skane University Hospital, SE-205 02, Malmö, Sweden.
| | - Annika Idahl
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, SE-901 87, Umeå, Sweden.
- Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, SE-901 87, Umeå, Sweden.
| | - Eva Lundin
- Department of Medical Biosciences, Pathology, Umeå University, SE-901 87, Umeå, Sweden.
| | - Nicholas J Wareham
- MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Addenbrooke's Hospital, Hills Road, PO Box 285, Cambridge, CB2 0QQ, UK.
| | - Timothy J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, Richard Doll Building, University of Oxford, Oxford, OX3 7LF, UK.
| | - Paul Brennan
- International Agency for Research on Cancer, 150 Cours Albert-Thomas, 69372, Lyon, Cedex 08, France.
| | - Pietro Ferrari
- International Agency for Research on Cancer, 150 Cours Albert-Thomas, 69372, Lyon, Cedex 08, France.
| | - Petra A Wark
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - Teresa Norat
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - Amanda J Cross
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - Marc J Gunter
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| |
Collapse
|