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 - Verschuren, W M Monique
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 - Quiros, J Ramon
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 - © The Author(s) 2019. Published by Oxford University Press on behalf of the International Epidemiological Association.
PY - 2019/8/1
Y1 - 2019/8/1
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 - Adult
KW - Age Factors
KW - Cohort Studies
KW - Coronary Disease/epidemiology
KW - Europe/epidemiology
KW - Female
KW - Humans
KW - Menopause
KW - Middle Aged
KW - Ovariectomy/adverse effects
KW - Proportional Hazards Models
KW - Risk Factors
U2 - 10.1093/ije/dyz016
DO - 10.1093/ije/dyz016
M3 - Article
C2 - 30796459
SN - 0300-5771
VL - 48
SP - 1275
EP - 1285
JO - International Journal of Epidemiology
JF - International Journal of Epidemiology
IS - 4
ER -