In the Journals

Early menarche, other reproductive factors increase risk for CVD

Sanne A.E. Peters

Women who had a history of miscarriage, stillbirth or hysterectomy, early menarche, early menopause and early age at first birth had an increased risk for CVD later in life, according to a study published in Heart.

“This study shows that reproductive factors earlier in life can have a long-term impact on women’s future cardiovascular health,” Sanne A.E. Peters, PhD, research fellow in epidemiology at The George Institute for Global Health at University of Oxford in the United Kingdom, told Cardiology Today. “More frequent screening for cardiovascular disease would seem to be sensible among women who are early in their reproductive cycle or who have a history of adverse reproductive events or a hysterectomy, as this might help to delay or prevent their onset of cardiovascular disease. Key reproductive factors should be considered to help address the considerable CVD risk among affected women. Maintaining a healthy lifestyle, including nonsmoking, healthy weight, eating well and sufficient exercise, will also help to reduce the risk of cardiovascular diseases.”

UK Biobank data

Peters and Mark Woodward, PhD, senior professorial fellow of the professorial unit at The George Institute for Global Health, professor of statistics and epidemiology at the University of Oxford, professor of medical statistics at University of New South Wales Sydney and adjunct professor of epidemiology at Johns Hopkins University, analyzed data from 267,440 women (mean age, 56 years) and 215,088 men (mean age, 56 years) from the UK Biobank who did not have a history of CVD at baseline.

Participants completed questionnaires on their environment, lifestyle and medical history, in addition to measurements of physical and functional capacities and a collection of blood, saliva and urine samples. The questionnaires for women focused on factors such as age at menarche, age at first birth, number of live births and menopausal status. The men’s questionnaires asked about the number of children they have fathered.

Early menarche was the first menstrual period before age 12 years, and early menopause was the absence of menstrual periods before age 47 years.

The main endpoints of interest were the incidence of CVD or stroke. Participants were followed up for a median of 7.1 years, which started at inclusion into the UK Biobank and ended at March 2016 or the first incidence of fatal or nonfatal MI or stroke, whichever occurred first.

Increased CVD risk

Women who had early menarche had an adjusted HR for CVD of 1.1 (95% CI, 1.01-1.3). Each year increase in age at first birth was associated with an aHR of 0.97 (95% CI, 0.96-0.98) for CVD. Each miscarriage had an aHR of 1.04 (95% CI, 1-1.09) for CVD, and each additional stillbirth was linked to an aHR of 1.14 (95% CI, 1.02-1.28). An aHR of 1.13 (95% CI, 1.19-1.49) was associated with early menopause.

An increased risk for CVD was also seen in those who had a hysterectomy without oophorectomy (aHR = 1.16; 95% CI, 1.06-1.28) or had a previous oophorectomy (aHR = 2.3; 95% CI, 1.2-4.43).

The risk for incident CVD was similar in men (aHR = 1.03; 95% CI, 1.02-1.05) and women (aHR = 1.03; 95% CI, 1-1.06) with each additional child.

“Our findings show that the risk of developing cardiovascular disease increases for both women of healthy weight and women who are overweight or obese, which suggests we need more research to understand the association between an early first menstrual cycle and a greater risk of heart disease and stroke later in life,” Peters told Cardiology Today. – by Darlene Dobkowski

Disclosures: Peters and Woodward report no relevant financial disclosures.

Sanne A.E. Peters

Women who had a history of miscarriage, stillbirth or hysterectomy, early menarche, early menopause and early age at first birth had an increased risk for CVD later in life, according to a study published in Heart.

“This study shows that reproductive factors earlier in life can have a long-term impact on women’s future cardiovascular health,” Sanne A.E. Peters, PhD, research fellow in epidemiology at The George Institute for Global Health at University of Oxford in the United Kingdom, told Cardiology Today. “More frequent screening for cardiovascular disease would seem to be sensible among women who are early in their reproductive cycle or who have a history of adverse reproductive events or a hysterectomy, as this might help to delay or prevent their onset of cardiovascular disease. Key reproductive factors should be considered to help address the considerable CVD risk among affected women. Maintaining a healthy lifestyle, including nonsmoking, healthy weight, eating well and sufficient exercise, will also help to reduce the risk of cardiovascular diseases.”

UK Biobank data

Peters and Mark Woodward, PhD, senior professorial fellow of the professorial unit at The George Institute for Global Health, professor of statistics and epidemiology at the University of Oxford, professor of medical statistics at University of New South Wales Sydney and adjunct professor of epidemiology at Johns Hopkins University, analyzed data from 267,440 women (mean age, 56 years) and 215,088 men (mean age, 56 years) from the UK Biobank who did not have a history of CVD at baseline.

Participants completed questionnaires on their environment, lifestyle and medical history, in addition to measurements of physical and functional capacities and a collection of blood, saliva and urine samples. The questionnaires for women focused on factors such as age at menarche, age at first birth, number of live births and menopausal status. The men’s questionnaires asked about the number of children they have fathered.

Early menarche was the first menstrual period before age 12 years, and early menopause was the absence of menstrual periods before age 47 years.

The main endpoints of interest were the incidence of CVD or stroke. Participants were followed up for a median of 7.1 years, which started at inclusion into the UK Biobank and ended at March 2016 or the first incidence of fatal or nonfatal MI or stroke, whichever occurred first.

Increased CVD risk

Women who had early menarche had an adjusted HR for CVD of 1.1 (95% CI, 1.01-1.3). Each year increase in age at first birth was associated with an aHR of 0.97 (95% CI, 0.96-0.98) for CVD. Each miscarriage had an aHR of 1.04 (95% CI, 1-1.09) for CVD, and each additional stillbirth was linked to an aHR of 1.14 (95% CI, 1.02-1.28). An aHR of 1.13 (95% CI, 1.19-1.49) was associated with early menopause.

An increased risk for CVD was also seen in those who had a hysterectomy without oophorectomy (aHR = 1.16; 95% CI, 1.06-1.28) or had a previous oophorectomy (aHR = 2.3; 95% CI, 1.2-4.43).

The risk for incident CVD was similar in men (aHR = 1.03; 95% CI, 1.02-1.05) and women (aHR = 1.03; 95% CI, 1-1.06) with each additional child.

“Our findings show that the risk of developing cardiovascular disease increases for both women of healthy weight and women who are overweight or obese, which suggests we need more research to understand the association between an early first menstrual cycle and a greater risk of heart disease and stroke later in life,” Peters told Cardiology Today. – by Darlene Dobkowski

Disclosures: Peters and Woodward report no relevant financial disclosures.