Late menarche associated with MI, stroke in premenopausal women
Click Here to Manage Email Alerts
Late menarche was associated with a 15% to 33% greater risk for MI and stroke among premenopausal women compared with menarche at age 13 years, researchers reported.
Other reproductive factors associated with CVD risk in premenopausal women included oral contraceptive use and longer duration of breastfeeding, according to a study published in the European Journal of Preventive Cardiology.
“Age at menarche is an independent risk factor for MI and ischemic stroke among premenopausal women. Overall, later menarche was associated with an increased risk of CVD, compared to the mean age at menarche,” Su-Min Jeong, MD, of the department of family medicine/supportive care center at Samsung Medical Center, Sungkyunkwan University School of Medicine in Seoul, South Korea, and colleagues wrote. “Use of oral contraception and longer duration of oral contraception use was associated with an increased risk of CVD with significant P for trend. This study suggests that female reproductive factors could be considered unique risk factors for CVD in premenopausal women even when the absolute cardiovascular risk is low.”
To better understand how age at menarche and other reproductive factors affected risk for MI and stroke in premenopausal women, Jeong and colleagues evaluated the data of nearly 1.1 million women in South Korea who participated in health screenings in 2009 (mean age, 44 years).
Analyses were adjusted for traditional CVD risk factors and reproductive factors such as oral contraceptive use, breastfeeding duration and parity. Mean follow-up was 8.3 years.
Age at menarche and risk for CVD
Menarche at age 12 years or younger was not associated with any significant increase in CVD risk compared with menarche at age 13 years (adjusted HR = 1.04; 95% CI, 0.93-1.16).
Compared with menarche at age 13 years, later menarche was associated with greater risk for MI and stroke:
- 14 years (aHR = 1.06; 95% CI, 0.98-1.14);
- 15 years (aHR = 1.15; 95% CI, 1.07-1.24);
- 16 years (aHR = 1.23; 95% CI, 1.14-1.34); and
- 17 years or older (aHR = 1.33; 95% CI, 1.24-1.44; P for trend < .0001).
The association between menarche at age 17 years or older and CVD risk was even stronger among women who were not obese (P for interaction = .033) or hypertensive (P for interaction = .008), according to the study.
Among women younger than 40 years, menarche at age 12 years or younger was associated with a lower risk for CVD (aHR = 0.64; 95% CI, 0.46-0.88) or MI (aHR = 0.6; 95% CI, 0.39-0.92) compared with those who experienced menarche at age 13 years. However, in women aged 40 years or older, both early and late menarche were associated with increased CVD risk compared with menarche at age 13 years.
“The cause of this difference by age group is uncertain but suggests that menarcheal age could be associated with CVD risk by age group,” the researchers wrote. “It may be possible that in premenopausal women in their 30s, age at menarche may affect estrogen levels. Women with early menarche had higher serum estradiol and lower serum sex hormone-binding globulin concentration than women with later menarche, which may protect against CVD events.”
Reproductive factors and CVD risk
Oral contraceptive use was also associated with increased risk for CVD compared with nonuse (aHR for < 1 year of use = 1.06; 95% CI, 0.99-1.12; aHR for 1 year of use = 1.11; 95%, CI 1.01-1.22; P for trend = .007).
Researchers observed that longer duration of breastfeeding was associated with increased risk for MI (P for trend = .004) but not stroke (P for trend = .445).
Researchers reported no association between parity and CVD risk.
“This study suggests that female reproductive factors could be considered unique risk factors for CVD in premenopausal women even when the absolute cardiovascular risk is low,” the researchers wrote.
Collapse
Read more about
Click Here to Manage Email Alerts