TY - JOUR

T1 - Association of menopausal characteristics and risk of coronary heart disease

T2 - A pan-European case-cohort analysis

AU - Dam, Veerle

AU - Van Der Schouw, Yvonne T.

AU - Onland-Moret, N. Charlotte

AU - Groenwold, Rolf H.H.

AU - Peters, Sanne A.E.

AU - Burgess, Stephen

AU - Wood, Angela M.

AU - Chirlaque, Maria Dolores

AU - Moons, Karel G.M.

AU - Oliver-Williams, Clare

AU - Schuit, Ewoud

AU - Tikk, Kaja

AU - Weiderpass, Elisabete

AU - Holm, Marianne

AU - Tjønneland, Anne

AU - Kühn, Tilman

AU - Fortner, Renée T.

AU - Trichopoulou, Antonia

AU - Karakatsani, Anna

AU - La Vecchia, Carlo

AU - Ferrari, Pietro

AU - Gunter, Marc

AU - Masala, Giovanna

AU - Sieri, Sabina

AU - Tumino, Rosario

AU - Panico, Salvatore

AU - Boer, Jolanda M.A.

AU - Monique Verschuren, W. M.

AU - Salamanca-Fernández, Elena

AU - Arriola, Larraitz

AU - Moreno-Iribas, Conchi

AU - Engström, Gunnar

AU - Melander, Olle

AU - Nordendahl, Maria

AU - Wennberg, Patrik

AU - Key, Timothy J.

AU - Colorado-Yohar, Sandra

AU - Matullo, Giuseppe

AU - Overvad, Kim

AU - Clavel-Chapelon, Francoise

AU - Boeing, Heiner

AU - Ramon Quiros, J.

AU - Di Angelantonio, Emanuele

AU - Langenberg, Claudia

AU - Sweeting, Michael J.

AU - Riboli, Elio

AU - Wareham, Nicholas J.

AU - Danesh, John

AU - Butterworth, Adam

N1 - Publisher Copyright: © 2019 The Author(s).

PY - 2019

Y1 - 2019

N2 - Background: Earlier age at menopause has been associated with increased risk of coronary heart disease (CHD), but the shape of association and role of established cardiovascular risk factors remain unclear. Therefore, we examined the associations between menopausal characteristics and CHD risk; the shape of the association between age at menopause and CHD risk; and the extent to which these associations are explained by established cardiovascular risk factors. Methods: We used data from EPIC-CVD, a case-cohort study, which includes data from 23 centres from 10 European countries. We included only women, of whom 10 880 comprise the randomly selected sub-cohort, supplemented with 4522 cases outside the sub-cohort. We conducted Prentice-weighted Cox proportional hazards regressions with age as the underlying time scale, stratified by country and adjusted for relevant confounders. Results: After confounder and intermediate adjustment, post-menopausal women were not at higher CHD risk compared with pre-menopausal women. Among post-menopausal women, earlier menopause was linearly associated with higher CHD risk [HRconfounder and intermediate adjusted per-year decrease = 1.02, 95% confidence interval (CI) = 1.01-1.03, p = 0.001]. Women with a surgical menopause were at higher risk of CHD compared with those with natural menopause (HRconfounder-adjusted = 1.25, 95% CI = 1.10-1.42, p < 0.001), but this attenuated after additional adjustment for age at menopause and intermediates (HR = 1.12, 95% CI = 0.96-1.29, p = 0.15). A proportion of the association was explained by cardiovascular risk factors. Conclusions: Earlier and surgical menopause were associated with higher CHD risk. These associations could partially be explained by differences in conventional cardiovascular risk factors. These women might benefit from close monitoring of cardiovascular risk factors and disease.

AB - Background: Earlier age at menopause has been associated with increased risk of coronary heart disease (CHD), but the shape of association and role of established cardiovascular risk factors remain unclear. Therefore, we examined the associations between menopausal characteristics and CHD risk; the shape of the association between age at menopause and CHD risk; and the extent to which these associations are explained by established cardiovascular risk factors. Methods: We used data from EPIC-CVD, a case-cohort study, which includes data from 23 centres from 10 European countries. We included only women, of whom 10 880 comprise the randomly selected sub-cohort, supplemented with 4522 cases outside the sub-cohort. We conducted Prentice-weighted Cox proportional hazards regressions with age as the underlying time scale, stratified by country and adjusted for relevant confounders. Results: After confounder and intermediate adjustment, post-menopausal women were not at higher CHD risk compared with pre-menopausal women. Among post-menopausal women, earlier menopause was linearly associated with higher CHD risk [HRconfounder and intermediate adjusted per-year decrease = 1.02, 95% confidence interval (CI) = 1.01-1.03, p = 0.001]. Women with a surgical menopause were at higher risk of CHD compared with those with natural menopause (HRconfounder-adjusted = 1.25, 95% CI = 1.10-1.42, p < 0.001), but this attenuated after additional adjustment for age at menopause and intermediates (HR = 1.12, 95% CI = 0.96-1.29, p = 0.15). A proportion of the association was explained by cardiovascular risk factors. Conclusions: Earlier and surgical menopause were associated with higher CHD risk. These associations could partially be explained by differences in conventional cardiovascular risk factors. These women might benefit from close monitoring of cardiovascular risk factors and disease.

KW - ageing

KW - coronary disease

KW - Epidemiology

KW - Menopause

KW - risk factors

KW - women

U2 - 10.1093/ije/dyz016

DO - 10.1093/ije/dyz016

M3 - Journal article

C2 - 30796459

AN - SCOPUS:85070837799

VL - 48

SP - 1275

EP - 1285

JO - International Journal of Epidemiology

JF - International Journal of Epidemiology

SN - 0300-5771

IS - 4

M1 - dyz016

ER -