Duration of Reproductive Life Span, Age at Menarche, and Age at Menopause Are Associated With Risk of Cardiovascular Disease in Women.
Duration of Reproductive Life Span, Age at Menarche, and Age at Menopause Are Associated With Risk of Cardiovascular Disease in Women.
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DOI：
10.1161/jaha.117.006713
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发表时间：
2017-11-02
影响因子：
5.4
通讯作者：
Rexrode KM
中科院分区：
文献类型：
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作者：
Ley SH;Li Y;Tobias DK;Manson JE;Rosner B;Hu FB;Rexrode KM
虽然月经初潮和绝经的时间可能与心血管疾病（CVD）有关，但整个生殖寿命并没有被全面认为是CVD的风险。我们调查了自然方法或双侧卵巢切除术引起的生育寿命持续时间和初潮和绝经年龄与女性CVD事件的关系。前瞻性队列研究73814名护士健康研究参与者没有心血管疾病，定义为冠心病或中风，从1980年到2012年。生殖寿命的持续时间是由绝经年龄减去初潮年龄得出的。在多变量校正后，较短的生育寿命与较高的CVD发生风险相关（相对风险，1.32 [95%置信区间，1.16-1.49]，比较生育寿命<30年与≥42年; P趋势<0.0001）。绝经年龄早与多变量校正的CVD风险较高相关（1.32 [1.16-1.51]，年龄<40岁与50岁与<55岁比较; P趋势<0.0001），自然绝经和手术绝经的风险均过高。与初潮13岁的女性相比，初潮≤10岁的女性的多变量校正CVD风险为1.22（1.09-1.36）。在敏感性分析中，排除了初潮年龄极早或使用激素治疗的女性，生殖寿命与CVD之间的相关性仍然显著。较短的生殖寿命与较高的CVD风险相关，这可能是由自然或手术诱导的绝经时间引起的。初潮年龄极早也与CVD的风险较高有关。
Although the timing of menarche and menopause may be associated with cardiovascular disease (CVD), the entire reproductive life span has not been considered comprehensively as risk for CVD. We investigate the associations of reproductive life span duration and ages at menarche and menopause, induced by natural means or surgical bilateral oophorectomy, with incident CVD in women. Prospective cohort study of 73 814 Nurses' Health Study following participants without CVD, defined as incident coronary heart disease or stroke, from 1980 through 2012. Duration of reproductive life span was generated by subtracting age at menarche from age at menopause. A shorter reproductive life span was associated with a higher risk of incident CVD after multivariable adjustment (relative risk, 1.32 [95% confidence interval, 1.16–1.49] comparing duration <30 with ≥42 years; P trend<0.0001). Early age at menopause was associated with higher multivariable‐adjusted CVD risk (1.32 [1.16–1.51] comparing age <40 with 50 to <55 years; P trend<0.0001), with excess risk for both natural and surgical menopause. Compared with women with menarche at 13 years, the multivariable‐adjusted CVD risk for early menarche at ≤10 years was 1.22 (1.09–1.36). The association between reproductive life span and CVD remained significant in sensitivity analyses excluding women who experienced extreme early age at menarche or who used hormone therapy. A shorter duration of reproductive life span is associated with a higher risk of CVD, which is likely driven by the timing of menopause induced either naturally or surgically. Extremely early age at menarche is also associated with a higher risk of CVD.