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Association of menopausal characteristics and risk of coronary heart disease : A pan-European case-cohort analysis

Dam, Veerle; Van Der Schouw, Yvonne T.; Onland-Moret, N. Charlotte; Groenwold, Rolf H.H.; Peters, Sanne A.E.; Burgess, Stephen; Wood, Angela M.; Chirlaque, Maria Dolores; Moons, Karel G.M. and Oliver-Williams, Clare, et al. (2019) In International Journal of Epidemiology 48(4). p.1275-1285
Abstract

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... (More)

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.

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publication status
published
subject
keywords
ageing, coronary disease, Epidemiology, Menopause, risk factors, women
in
International Journal of Epidemiology
volume
48
issue
4
pages
11 pages
publisher
Oxford University Press
external identifiers
  • scopus:85070837799
ISSN
0300-5771
DOI
10.1093/ije/dyz016
language
English
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yes
id
f97f0591-41a9-44fa-b283-18c63c701987
date added to LUP
2019-09-06 15:18:35
date last changed
2019-09-26 04:41:38
@article{f97f0591-41a9-44fa-b283-18c63c701987,
  abstract     = {<p>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 [HR<sub>confounder and intermediate adjusted</sub> 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 (HR<sub>confounder-adjusted</sub> = 1.25, 95% CI = 1.10-1.42, p &lt; 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.</p>},
  articleno    = {dyz016},
  author       = {Dam, Veerle and Van Der Schouw, Yvonne T. and Onland-Moret, N. Charlotte and Groenwold, Rolf H.H. and Peters, Sanne A.E. and Burgess, Stephen and Wood, Angela M. and Chirlaque, Maria Dolores and Moons, Karel G.M. and Oliver-Williams, Clare and Schuit, Ewoud and Tikk, Kaja and Weiderpass, Elisabete and Holm, Marianne and Tjønneland, Anne and Kühn, Tilman and Fortner, Renée T. and Trichopoulou, Antonia and Karakatsani, Anna and La Vecchia, Carlo and Ferrari, Pietro and Gunter, Marc and Masala, Giovanna and Sieri, Sabina and Tumino, Rosario and Panico, Salvatore and Boer, Jolanda M.A. and Monique Verschuren, W. M. and Salamanca-Fernández, Elena and Arriola, Larraitz and Moreno-Iribas, Conchi and Engström, Gunnar and Melander, Olle and Nordendahl, Maria and Wennberg, Patrik and Key, Timothy J. and Colorado-Yohar, Sandra and Matullo, Giuseppe and Overvad, Kim and Clavel-Chapelon, Francoise and Boeing, Heiner and Ramon Quiros, J. and Di Angelantonio, Emanuele and Langenberg, Claudia and Sweeting, Michael J. and Riboli, Elio and Wareham, Nicholas J. and Danesh, John and Butterworth, Adam},
  issn         = {0300-5771},
  keyword      = {ageing,coronary disease,Epidemiology,Menopause,risk factors,women},
  language     = {eng},
  month        = {08},
  number       = {4},
  pages        = {1275--1285},
  publisher    = {Oxford University Press},
  series       = {International Journal of Epidemiology},
  title        = {Association of menopausal characteristics and risk of coronary heart disease : A pan-European case-cohort analysis},
  url          = {http://dx.doi.org/10.1093/ije/dyz016},
  volume       = {48},
  year         = {2019},
}