Age at Menarche and Risks of Coronary Heart and Other Vascular Diseases in a Large UK Cohort | Journal Scan

Study Questions:

Is age of menarche associated with risk for coronary heart disease (CHD) and other vascular diseases?

Methods:

Data from the Million Women Study were used for the present analysis. Women without prior heart disease, stroke, or cancer were included in this study. This UK population-based cohort study recruited 1.3 million women (ages 50-64 years) who had been invited for a routine breast cancer screening by National Health Service. All women resided in England and Scotland between 1996 and 2001. Women reported their age at menarche in single years, and were classified for this study as having an age at menarche of ≤10, 11, 12, 13, 14, 15, 16, or ≥17 years. Information was collected on additional factors including menopausal status (including age of onset) and type of menopause, parity, use of oral contraceptives or hormonal replacement, and cardiovascular disease risk factors such as hypertension, hypercholesterolemia, presence of diabetes, and smoking. Information on body mass index (BMI) and socioeconomic status (SES) was also collected. Cox regression models were used to examine relative risks for age, menarcheal age, and vascular outcomes.

Results:

A total of 1.2 million women (mean age 56 years) without prior vascular disease diagnoses at baseline were included. Self-reported menarcheal age was 13 years in 25% of the cohort, ≤10 years in 4% of the cohort, and ≥17 years in 1% of the cohort. Over the 11.6 years of follow-up, 73,378 women experienced a first hospitalization of death for CHD: 25,426 for cerebrovascular disease and 249,426 for hypertensive disease. The association between CHD and age of menarche was U-shape, such that women with early- or late-onset menarche experienced the greatest risk for CHD. The adjusted relative risk for CHD for menarche at age ≤10 years was 1.27 (95% confidence interval [CI], 1.22-1.31; p < 0.0001); and for menarche at age ≥17 years was 1.23 (95% CI, 1.16-1.30; p < 0.0001), using women with age at menarche of 13 years as the reference group. U-shaped relationships were also seen for cerebrovascular and hypertensive disease, although the magnitudes of these risks for early and late menarche were smaller than those for CHD. These associations did not differ significantly between BMI groups (i.e., lean, overweight, and obese), smoking status, or SES groups.

Conclusions:

The authors concluded that in this cohort, the relation of age at menarche to vascular disease risk was U-shaped, with both early and late menarche being associated with increased risk. Associations were weaker for cerebrovascular and hypertensive disease than for CHD.

Perspective:

This is the largest study to date to report an association between risk for CHD and age of menarche. These data suggest that clinicians gathering such information on patients may be able to monitor women more carefully for risk factors that can be modified (i.e., lipids and blood pressure). Research directed at understanding the mechanism(s) for this association is important.

Clinical Topics: Dyslipidemia, Prevention, Homozygous Familial Hypercholesterolemia, Lipid Metabolism, Hypertension

Keywords: Age of Onset, Blood Pressure, Body Mass Index, Contraceptives, Oral, Coronary Disease, Diabetes Mellitus, England, Hospitalization, Hypercholesterolemia, Hypertension, Lipids, Menarche, Menopause, National Health Programs, Parity, Risk, Risk Factors, Scotland, Social Class, Social Class


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