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Tschiderer L, Peters SAE, van der Schouw YT, van Westing AC, Tong TYN, Willeit P, Seekircher L, Moreno‐Iribas C, Huerta JM, Crous‐Bou M, Söderholm M, Schulze MB, Johansson C, Själander S, Heath AK, Macciotta A, Dahm CC, Ibsen DB, Pala V, Mellemkjær L, Burgess S, Wood A, Kaaks R, Katzke V, Amiano P, Rodriguez‐Barranco M, Engström G, Weiderpass E, Tjønneland A, Halkjær J, Panico S, Danesh J, Butterworth A, Onland‐Moret NC. Age at Menopause and the Risk of Stroke: Observational and Mendelian Randomization Analysis in 204 244 Postmenopausal Women. J Am Heart Assoc 2023; 12:e030280. [PMID: 37681566 PMCID: PMC10547274 DOI: 10.1161/jaha.123.030280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/08/2023] [Indexed: 09/09/2023]
Abstract
Background Observational studies have shown that women with an early menopause are at higher risk of stroke compared with women with a later menopause. However, associations with stroke subtypes are inconsistent, and the causality is unclear. Methods and Results We analyzed data of the UK Biobank and EPIC-CVD (European Prospective Investigation Into Cancer and Nutrition-Cardiovascular Diseases) study. A total of 204 244 postmenopausal women without a history of stroke at baseline were included (7883 from EPIC-CVD [5292 from the subcohort], 196 361 from the UK Biobank). Pooled mean baseline age was 58.9 years (SD, 5.8), and pooled mean age at menopause was 47.8 years (SD, 6.2). Over a median follow-up of 12.6 years (interquartile range, 11.8-13.3), 6770 women experienced a stroke (5155 ischemic strokes, 1615 hemorrhagic strokes, 976 intracerebral hemorrhages, and 639 subarachnoid hemorrhages). In multivariable adjusted observational Cox regression analyses, the pooled hazard ratios per 5 years younger age at menopause were 1.09 (95% CI, 1.07-1.12) for stroke, 1.09 (95% CI, 1.06-1.13) for ischemic stroke, 1.10 (95% CI, 1.04-1.16) for hemorrhagic stroke, 1.14 (95% CI, 1.08-1.20) for intracerebral hemorrhage, and 1.00 (95% CI, 0.84-1.20) for subarachnoid hemorrhage. When using 2-sample Mendelian randomization analysis, we found no statistically significant association between genetically proxied age at menopause and risk of any type of stroke. Conclusions In our study, earlier age at menopause was related to a higher risk of stroke. We found no statistically significant association between genetically proxied age at menopause and risk of stroke, suggesting no causal relationship.
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Affiliation(s)
- Lena Tschiderer
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtthe Netherlands
- Institute of Health EconomicsMedical University of InnsbruckInnsbruckAustria
| | - Sanne A. E. Peters
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtthe Netherlands
- The George Institute for Global Health, School of Public HealthImperial College LondonLondonUnited Kingdom
- The George Institute for Global HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Yvonne T. van der Schouw
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Anniek C. van Westing
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtthe Netherlands
- Division of Human Nutrition and HealthWageningen UniversityWageningenthe Netherlands
| | - Tammy Y. N. Tong
- Cancer Epidemiology Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
| | - Peter Willeit
- Institute of Health EconomicsMedical University of InnsbruckInnsbruckAustria
- Department of Public Health and Primary CareUniversity of CambridgeCambridgeUnited Kingdom
| | - Lisa Seekircher
- Institute of Health EconomicsMedical University of InnsbruckInnsbruckAustria
| | - Conchi Moreno‐Iribas
- Instituto de Salud Pública y Laboral de NavarraPamplonaSpain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)MadridSpain
- Navarra Institute for Health Research (IdiSNA)PamplonaSpain
| | - José María Huerta
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)MadridSpain
- Department of EpidemiologyMurcia Regional Health Council‐IMIBMurciaSpain
| | - Marta Crous‐Bou
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)–Bellvitge Biomedical Research Institute (IDIBELL)L’Hospitalet de LlobregatBarcelonaSpain
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMA
| | - Martin Söderholm
- Department of NeurologySkåne University Hospital, Lund and MalmöMalmöSweden
- Department of Clinical Sciences, MalmöLund UniversityMalmöSweden
| | - Matthias B. Schulze
- Department of Molecular EpidemiologyGerman Institute of Human Nutrition Potsdam‐RehbrueckeNuthetalGermany
- Institute of Nutritional ScienceUniversity of PotsdamNuthetalGermany
| | - Cecilia Johansson
- Skellefteå Research Unit, Department of Public Health and Clinical MedicineUmeå UniversityUmeåVästerbottenSweden
| | - Sara Själander
- Department of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
| | - Alicia K. Heath
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUnited Kingdom
| | - Alessandra Macciotta
- Centre for Biostatistics, Epidemiology, and Public Health (C‐BEPH), Department of Clinical and Biological SciencesUniversity of TurinTurinItaly
| | | | - Daniel B. Ibsen
- Department of Public HealthAarhus UniversityAarhusDenmark
- Steno Diabetes Center AarhusAarhusDenmark
- MRC Epidemiology UnitUniversity of Cambridge School of Clinical MedicineCambridgeUnited Kingdom
- Department of Nutrition, Exercise and SportsUniversity of CopenhagenFrederiksbergDenmark
| | - Valeria Pala
- Epidemiology and Prevention UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | | | - Stephen Burgess
- Department of Public Health and Primary CareUniversity of CambridgeCambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeCambridgeUnited Kingdom
- MRC Biostatistics Unit, School of Clinical MedicineUniversity of CambridgeCambridgeUnited Kingdom
| | - Angela Wood
- Department of Public Health and Primary CareUniversity of CambridgeCambridgeUnited Kingdom
| | - Rudolf Kaaks
- Division of Cancer EpidemiologyGerman Cancer Research Center, DKFZHeidelbergGermany
| | - Verena Katzke
- Division of Cancer EpidemiologyGerman Cancer Research Center, DKFZHeidelbergGermany
| | - Pilar Amiano
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)MadridSpain
- Ministry of Health of the Basque GovernmentSub Directorate for Public Health and Addictions of GipuzkoaSan SebastianSpain
- Biodonostia Health Research InstituteEpidemiology of Chronic and Communicable Diseases GroupSan SebastianSpain
| | - Miguel Rodriguez‐Barranco
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)MadridSpain
- Escuela Andaluza de Salud Pública (EASP)GranadaSpain
- Instituto de Investigación Biosanitaria ibs.GRANADAGranadaSpain
| | - Gunnar Engström
- Department of Clinical Sciences, MalmöLund UniversityMalmöSweden
| | | | - Anne Tjønneland
- Danish Cancer Society Research CenterCopenhagenDenmark
- Department of Public Health, Section of Environmental Health, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Jytte Halkjær
- Danish Cancer Society Research CenterCopenhagenDenmark
| | | | - John Danesh
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUnited Kingdom
- National Institute for Health and Care Research Cambridge Biomedical Research CentreCambridge University HospitalsCambridgeUnited Kingdom
- The National Institute for Health and Care Research Blood and Transplant Unit (NIHR BTRU) in Donor Health and GenomicsUniversity of CambridgeCambridgeUnited Kingdom
- Human GeneticsWellcome Sanger InstituteSaffron WaldenUnited Kingdom
- Health Data Research UK CambridgeWellcome Genome Campus and University of CambridgeCambridgeUnited Kingdom
- British Heart Foundation Centre of Research Excellence, Division of Cardiovascular MedicineAddenbrooke’s HospitalCambridgeUnited Kingdom
| | - Adam Butterworth
- Department of Public Health and Primary CareUniversity of CambridgeCambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeCambridgeUnited Kingdom
- Health Data Research UK CambridgeWellcome Genome Campus and University of CambridgeCambridgeUnited Kingdom
- NIHR Blood and Transplant Research Unit in Donor Health and BehaviourUniversity of CambridgeCambridgeUnited Kingdom
- BHF Centre of Research Excellence, School of Clinical MedicineAddenbrooke’s HospitalCambridgeUnited Kingdom
| | - N. Charlotte Onland‐Moret
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtthe Netherlands
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