Age at Menopause and Incident Heart Failure
Age at Menopause and Incident Heart Failure
Objective. This study aims to evaluate the associations of early menopause (menopause occurring before age 45 years) and age at menopause with incident heart failure (HF) in postmenopausal women. We also explored the associations of early menopause and age at menopause with left ventricular (LV) measures of structure and function in postmenopausal women.
Methods. We included 2,947 postmenopausal women, aged 45 to 84 years without known cardiovascular disease (2000-2002), from the Multi-Ethnic Study of Atherosclerosis. Cox proportional hazards models were used to examine the associations of early menopause and age at menopause with incident HF. In 2,123 postmenopausal women in whom cardiac magnetic resonance imaging was obtained at baseline, we explored the associations of early menopause and age at menopause with LV measures using multivariable linear regression.
Results. Across a median follow-up of 8.5 years, we observed 71 HF events. There were no significant interactions with ethnicity for incident HF (Pinteraction > 0.05). In adjusted analysis, early menopause was associated with an increased risk of incident HF (hazard ratio, 1.66; 95% CI, 1.01-2.73), whereas every 1-year increase in age at menopause was associated with a decreased risk of incident HF (hazard ratio, 0.96; 95% CI, 0.94-0.99). We observed significant interactions between early menopause and ethnicity for LV mass-to-volume ratio (LVMVR; Pinteraction = 0.02). In Chinese-American women, early menopause was associated with a higher LVMVR (+0.11; P = 0.0002), whereas every 1-year increase in age at menopause was associated with a lower LVMVR (−0.004; P = 0.04) at baseline.
Conclusions. Older age at menopause is independently associated with a decreased risk of incident HF. Concentric LV remodeling, indicated by a higher LVMVR, is present in Chinese-American women who experienced early menopause at baseline.
Prior studies have investigated the relationship between menopause and cardiovascular disease (CVD); however, the results have been inconsistent, and the direct causal relationship between menopause and increased cardiovascular risk is still being debated. Early menopause (menopause occurring before age 45 years) has been linked to increased cardiovascular risk, and age at menopause may be an indicator of biologic aging. The increase in cardiovascular risk at menopause may be a consequence of estrogen deprivation or may result from a higher prevalence of cardiovascular risk factors, such as hypertension, diabetes, visceral obesity, insulin resistance, dyslipidemia, and endothelial dysfunction, that occur with aging.
Amidst ongoing studies investigating the relationship between menopause and CVD, the association between age at menopause and heart failure (HF) is yet to be investigated. Sex-related differences in the anatomy and physiology of the myocardium have been found, and there could also be differences in HF between women and men. HF with preserved ejection fraction or diastolic dysfunction occurs more commonly in women than in men. Estrogen has multiple effects on the cardiovascular system, and its deficiency may contribute to sex differences in the pathogenesis and progression of CVD, including HF in the postmenopausal period.
Studies involving small sample sizes have indicated that menopause may be associated with impaired left ventricular (LV) systolic and diastolic cardiac functions. However, the relationship between age at menopause and LV measures of structure and function has not been studied in large population-based cohorts. We evaluated the associations of early menopause and age at menopause with incident HF in postmenopausal women enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA). We also explored the associations of early menopause and age at menopause with LV measures of structure and function obtained by magnetic resonance imaging (MRI) in MESA postmenopausal women at baseline.
Abstract and Introduction
Abstract
Objective. This study aims to evaluate the associations of early menopause (menopause occurring before age 45 years) and age at menopause with incident heart failure (HF) in postmenopausal women. We also explored the associations of early menopause and age at menopause with left ventricular (LV) measures of structure and function in postmenopausal women.
Methods. We included 2,947 postmenopausal women, aged 45 to 84 years without known cardiovascular disease (2000-2002), from the Multi-Ethnic Study of Atherosclerosis. Cox proportional hazards models were used to examine the associations of early menopause and age at menopause with incident HF. In 2,123 postmenopausal women in whom cardiac magnetic resonance imaging was obtained at baseline, we explored the associations of early menopause and age at menopause with LV measures using multivariable linear regression.
Results. Across a median follow-up of 8.5 years, we observed 71 HF events. There were no significant interactions with ethnicity for incident HF (Pinteraction > 0.05). In adjusted analysis, early menopause was associated with an increased risk of incident HF (hazard ratio, 1.66; 95% CI, 1.01-2.73), whereas every 1-year increase in age at menopause was associated with a decreased risk of incident HF (hazard ratio, 0.96; 95% CI, 0.94-0.99). We observed significant interactions between early menopause and ethnicity for LV mass-to-volume ratio (LVMVR; Pinteraction = 0.02). In Chinese-American women, early menopause was associated with a higher LVMVR (+0.11; P = 0.0002), whereas every 1-year increase in age at menopause was associated with a lower LVMVR (−0.004; P = 0.04) at baseline.
Conclusions. Older age at menopause is independently associated with a decreased risk of incident HF. Concentric LV remodeling, indicated by a higher LVMVR, is present in Chinese-American women who experienced early menopause at baseline.
Introduction
Prior studies have investigated the relationship between menopause and cardiovascular disease (CVD); however, the results have been inconsistent, and the direct causal relationship between menopause and increased cardiovascular risk is still being debated. Early menopause (menopause occurring before age 45 years) has been linked to increased cardiovascular risk, and age at menopause may be an indicator of biologic aging. The increase in cardiovascular risk at menopause may be a consequence of estrogen deprivation or may result from a higher prevalence of cardiovascular risk factors, such as hypertension, diabetes, visceral obesity, insulin resistance, dyslipidemia, and endothelial dysfunction, that occur with aging.
Amidst ongoing studies investigating the relationship between menopause and CVD, the association between age at menopause and heart failure (HF) is yet to be investigated. Sex-related differences in the anatomy and physiology of the myocardium have been found, and there could also be differences in HF between women and men. HF with preserved ejection fraction or diastolic dysfunction occurs more commonly in women than in men. Estrogen has multiple effects on the cardiovascular system, and its deficiency may contribute to sex differences in the pathogenesis and progression of CVD, including HF in the postmenopausal period.
Studies involving small sample sizes have indicated that menopause may be associated with impaired left ventricular (LV) systolic and diastolic cardiac functions. However, the relationship between age at menopause and LV measures of structure and function has not been studied in large population-based cohorts. We evaluated the associations of early menopause and age at menopause with incident HF in postmenopausal women enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA). We also explored the associations of early menopause and age at menopause with LV measures of structure and function obtained by magnetic resonance imaging (MRI) in MESA postmenopausal women at baseline.
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