Premature menopause and cardiovascular disease: can we blame estrogen?
Premature menopause and cardiovascular disease: can we blame estrogen?
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过早绝经和心血管疾病：我们可以归咎于雌激素吗？
DOI：
10.1093/eurheartj/ehac321
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发表时间：
2022
影响因子：
39.3
通讯作者：
NoelBaireyMerz,C
中科院分区：
文献类型：
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作者：
Torbati,Tina;Shufelt,Chrisandra;Wei,Janet;NoelBaireyMerz,C
这篇社论引用了“绝经年龄与心力衰竭和房颤风险：一项全国性队列研究”，J. Shin等人，https：//doi. org/10.1093/eurheartj/ehac364。由于早期发生的心脏代谢变化而导致的疾病。[1]然而，欧洲心血管指南并不支持这一点，与绝经早期（45岁）的关系也不太清楚。3虽然1%的女性经历过早绝经，但高达10%的女性经历过早绝经，定义为45岁。先前的荟萃分析发现，与非早期绝经的女性相比，早期绝经与射血分数降低的心力衰竭（HF）风险高出33%相关。4相反，先前的研究没有发现绝经年龄与房颤（AF）风险之间的关联。5，6在本期《欧洲心脏杂志》中，Shin等研究了过早绝经（40岁）和绝经年龄较早与HF和AF发病率之间的关系。7 HF定义为一次或多次住院或一次或多次门诊就诊，诊断为ICD-10代码150，而AF定义为一次住院或两次以上门诊就诊，ICD-10代码148。使用韩国国民健康保险制度，140多万绝经后妇女被分为过早绝经史和没有过早绝经史的妇女。平均随访9.1年后，研究发现有过早绝经史的女性HF和AF的发生率更高（均为对数秩P，0.001）。在调整CVD风险因素（包括高血压、糖尿病和血脂异常、绝经激素治疗（HT）和初潮年龄）后，与未过早绝经的女性相比，过早绝经的女性有更高的HF风险（1.33，95% CI：1.26-1.40）和更高的AF风险（1.09，95% CI：1.02-1.16）。作者进一步将过早绝经分为自然绝经和手术绝经，发现过早自然绝经与HF风险增加相关（HR：1.33，95% CI：1.25-1.40）和AF（HR：1.09，95% CI：1.03-1.16），而过早手术绝经与HF风险无显著相关性（1.25，95% CI：0.72-2.15）或AF（0.87，95% CI：0.53-1.45）。此外，过早绝经与冠心病显著相关（1.16，95% CI：1.09-1.22）与所有其他类别的绝经年龄相比。除了分析过早绝经，Shin及其同事进一步评估了女性进入绝经年龄的HF和AF的相关性（即40岁、40-44岁、45-49岁、≥ 50岁）。随着绝经年龄的降低，HF和AF的发生率均增加（均为对数秩P，0.001）。具体而言，与所有其他绝经年龄类别相比，45岁阈值的早期绝经具有增加的HF风险（1.23，95%CI：1.19-1.28）和增加的AF风险（1.10，95%CI：1.06-1.14）。传统的心血管危险因素、绝经期激素治疗和初潮年龄之间没有显著的相互作用。
This editorial refers to ‘Age at menopause and risk of heart failure and atrial fibrillation: a nationwide cohort study’, J. Shin et al., https://doi. org/10.1093/eurheartj/ehac364. disease due to the cardiometabolic changes that occur earlier. 1 However, European cardiovascular guidelines have not endorsed this and the association with early menopause (, 45 years) is less clear. 3 While 1% of women undergo premature menopause, up to 10% of women experience early menopause, defined as, 45 years. Prior meta-analyses have found that early menopause is associated with a 33% higher risk of heart failure (HF) with reduced ejection fraction when compared to women with non-early menopause. 4 Conversely, prior studies have not found an association between earlier age of menopause and risk of atrial fibrillation (AF). 5, 6 In this issue of European Heart Journal, Shin et al. investigate the association between premature menopause (, 40 years) and early age of menopause with the incidence of HF and AF as individual disease entities. 7 HF was defined as one or more hospitalizations or one or more outpatient visits with a diagnosis of ICD-10 code 150, while AF was defined as one hospitalization or more than two outpatient visits with ICD-10 code 148. Using the Korean National Health Insurance System, over 1.4 million post-menopausal women were categorized into a history of premature menopause and those without a history of premature menopause. Following 9.1 years of mean follow-up, the study found a greater incidence of HF and AF in women with a history of premature menopause (both log rank P, 0.001). After adjusting for CVD risk factors including hypertension, diabetes, and dyslipidemia, menopause hormone therapy (HT) and age of menarche, women with premature menopause had a higher risk of HF (1.33, 95% CI: 1.26–1.40) and higher risk of AF (1.09, 95% CI: 1.02–1.16) compared to women without premature menopause. The authors further stratified premature menopause by natural vs. surgical, finding that premature natural menopause was associated with greater risk of HF (HR: 1.33, 95% CI: 1.25–1.40) and AF (HR: 1.09, 95% CI: 1.03–1.16), while premature surgical menopause was not significantly associated with a risk of HF (1.25, 95% CI: 0.72–2.15) or AF (0.87, 95% CI: 0.53–1.45). Furthermore, premature menopause was significantly associated with coronary heart disease (1.16, 95% CI: 1.09–1.22) compared to all other categories of age at menopause.In addition to analyzing by premature menopause, Shin and colleagues further evaluated the association of HF and AF by the age a woman entered menopause (ie, 40 years, 40–44 years, 45–49 years,≥ 50 years). As age of menopause decreased, the incidence of both HF and AF increased (both log rank P, 0.001). Specifically, early menopause at the threshold of, 45 years had an increased risk of HF (1.23, 95% CI: 1.19–1.28) and increased risk of AF (1.10, 95% CI: 1.06–1.14) compared to all other age-at-menopause categories. There were no significant interactions between traditional cardiovascular risk factors, menopausal hormone therapy, and age of menarche.