Early, late menarche increases odds of CV events in women
Early or later presence of menarche was associated with elevated risk for adverse CVD outcomes in women, according to findings published in the Journal of the American Heart Association.
The association was not explained by previously known CVD risk factors or estrogen exposure or supra-physiologic states of estrogen exposure, the report stated.
Julie J. Lee, MD, MPH, and colleagues investigated the age at menarche and major adverse CV events among women who participated in the original cohort of the WISE study.
“Both early and late age at menarche is associated with increased risks of coronary heart disease,” Lee, an internal medicine resident at the University of California-Riverside Medical School, and colleagues wrote. “However, despite preliminary findings, the clinical significance of age at menarche as a sex-specific finding for major adverse cardiovascular events in women represents an important knowledge gap.”
The researchers examined data from 648 women in the study without surgical menopause who received coronary angiography for suspected ischemia. The women were evaluated at baseline and followed for a median of 6 years.
Participants were stratified by self-reported age at menarche. All age groups were compared with the reference age of 12 years.
Total estrogen time and supra-total estrogen time were also calculated, the researchers wrote. The researchers performed a Cox regression analysis adjusting for CVD risk factors.
Mean age at baseline was 58 years, mean BMI was 29.5 kg/m2, mean total estrogen time was 32.2 years and mean supra-total estrogen time was 41.4 years.
Major adverse CV events, defined as all-cause death, nonfatal MI, nonfatal stroke or HF hospitalization, occurred in 27% of patients, with a J-shaped adjusted regression model, the researchers wrote.
Lee and colleagues reported that women with menarche at age 10 years or younger had an increased risk for major adverse CV events compared with women with menarche at age 12 years (adjusted HR = 4.53; 95% CI, 2.13-9.63).
The risk for major adverse CV events in women with menarche at age 15 years or older was also greater (aHR = 2.58; 95% CI, 1.28-5.21) compared with women with menarche at age 12 years, the researchers wrote.
According to Lee and colleagues, one of the limitations in the study was that most of the women in the study were white, so the findings may not apply to minority ethnic groups, including Hispanic and black women who have menarche at an earlier age and are more likely to display traditional CVD risk factors.
“Future studies should focus on female-specific risk factors that include menarche and mechanisms by which inflammatory biomarkers increase risk of CVD events in women,” Lee and colleagues wrote. – by Earl Holland Jr.
Disclosures: Lee reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.