Coronary artery calcium and atherosclerotic cardiovascular disease risk in women with early menopause: The Multi-Ethnic Study of Atherosclerosis (MESA).
Coronary artery calcium and atherosclerotic cardiovascular disease risk in women with early menopause: The Multi-Ethnic Study of Atherosclerosis (MESA).
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DOI：
10.1016/j.ajpc.2022.100362
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发表时间：
2022-09
影响因子：
4.1
通讯作者：
Whelton, Seamus P
中科院分区：
文献类型：
--
作者：
Chu, Jian H;Michos, Erin D;Ouyang, Pamela;Vaidya, Dhananjay;Blumenthal, Roger S;Budoff, Matthew J;Blaha, Michael J;Whelton, Seamus P
从长期来看，绝经早的妇女患心脏病的风险更大。超过一半的绝经早期的中年妇女没有CAC，类似于没有绝经早期的妇女。有和没有早期绝经的妇女冠状动脉钙评分相似。不补钙的妇女患心脏病的风险较低，无论绝经史如何。我们的目的是确定冠状动脉钙化（CAC）的效用动脉粥样硬化性心血管疾病（ASCVD）的危险分层的妇女和不提前绝经（EM）。为了研究CAC与ASCVD事件之间的关系，我们使用多种族动脉粥样硬化研究（梅萨）中2,456名绝经后妇女伴或不伴EM（定义为发生于<45岁）的数据进行Kaplan-Meier生存分析和多变量考克斯比例风险模型。该队列的年龄为64.1 ± 9.1岁，28.0%发生EM。在12.5 ± 3.6年的随访中，有291例ASCVD事件，EM患者的事件发生率高于无EM患者，分别为13.6例/1,000年和9.0例/1,000年（p < 0.01）。EM女性CAC = 0的患病率（55.1%）略低于无EM女性（59.7%）（p = 0.04），尽管平均年龄无差异。在CAC = 0的女性中，10年时ASCVD的累积发病率在EM女性（5.4%）和非EM女性（3.2%）中低至临界值（p = 0.06）。然而，EM女性的15年风险显著更高，校正后的HR为1.96（95% CI：1.26-3.04）。在多变量考克斯模型中，CAC ≥ 1的女性ASCVD风险逐渐增加，EM状态无显著差异。在梅萨中，>50%患有EM的中年绝经后妇女的CAC = 0，与未患有EM的妇女相似。在CAC = 0的女性中，EM患者发生ASCVD的10年风险较低，但EM患者的15年风险显著高于无EM患者。当CAC ≥ 1时，有EM和无EM的女性ASCVD的发生率相似。这些发现支持使用CAC来帮助改善EM女性的ASCVD风险分层。本研究调查了绝经后妇女（有或无绝经早期（EM））冠状动脉钙化（CAC）与动脉粥样硬化性心血管疾病（ASCVD）之间的关系。我们发现>50%的女性CAC = 0，并且相关的ASCVD 10年累积发病率低至临界值。然而，15年随访后，EM女性ASCVD的风险显著较高。需要进一步的研究来更好地了解CAC = 0的EM和非EM女性之间长期ASCVD风险的差异。
Women with early menopause are at greater risk for heart disease over the long-term. Over half of middle-aged women with early menopause were free of CAC, similar to women without early menopause. Coronary calcium scores were similar between women with and without early menopause. Women without calcium had low risk for heart disease regardless of menopause history. We aimed to determine the utility of coronary artery calcium (CAC) for atherosclerotic cardiovascular disease (ASCVD) risk stratification in women with and without early menopause (EM). To examine the association between CAC and incident ASCVD, we performed Kaplan-Meier survival analysis and multivariable Cox proportional hazards modeling using data from 2,456 postmenopausal women in the Multi-Ethnic Study of Atherosclerosis (MESA) with or without EM, defined as occurring at <45 years of age. The cohort was 64.1 ± 9.1 years old and 28.0% experienced EM. There were 291 ASCVD events over 12.5 ± 3.6 year follow-up with a higher event rate among those with EM compared to those without EM of 13.6 vs. 9.0 per 1,000 year follow-up (p < 0.01). Women with EM had a slightly lower prevalence of CAC = 0 (55.1%) than women without EM (59.7%) (p = 0.04) despite no difference in mean age. Among women with CAC = 0, the cumulative incidence of ASCVD at 10 years was low-to-borderline for women with (5.4%) and without EM (3.2%) (p = 0.06). However, women with EM had a significantly higher 15-year risk with an adjusted HR of 1.96 (95% CI: 1.26–3.04). In multivariable Cox models, women with CAC ≥ 1 had progressively increased ASCVD risk that did not significantly differ by EM status. In MESA, >50% of middle-aged postmenopausal women with EM had CAC = 0, similar to those without EM. Among women with CAC = 0, those with EM had a low to borderline 10-year risk of ASCVD, but the 15-year risk was significantly higher for women with EM versus those without EM. When CAC ≥ 1, the incidence of ASCVD was similar for women with and without EM. These findings support the use of CAC to help improve ASCVD risk stratification in women with EM. This study investigated the association between coronary artery calcium (CAC) and incident atherosclerotic cardiovascular disease (ASCVD) in postmenopausal women with and without early menopause (EM). We found that >50% of women had CAC = 0 and an associated low-to-borderline 10-year cumulative incidence of ASCVD. However, the risk for ASCVD was significantly higher for women with EM after 15-years follow-up. Additional research is needed to better understand the differences in long-term ASCVD risk between women with and without EM who have CAC = 0.