Association of Premature Natural and Surgical Menopause With Incident Cardiovascular Disease
Association of Premature Natural and Surgical Menopause With Incident Cardiovascular Disease
复制标题
DOI：
10.1001/jama.2019.19191
复制
发表时间：
2019-12-24
影响因子：
120.7
通讯作者：
Natarajan, Pradeep
中科院分区：
文献类型：
--
作者：
Honigberg, Michael C.;Zekavat, Seyedeh Maryam;Natarajan, Pradeep
最近的指南支持使用40岁以前的绝经史来完善中年妇女动脉粥样硬化性心血管疾病的风险评估。在这个population.Objective心血管疾病的危险因素的发展，研究心血管疾病和心血管疾病的危险因素在妇女与自然和手术绝经前40 years.DESIGN，SETTING，AND PARTICIPANTS队列研究（英国生物银行），与英国的成年居民之间招募2006年和2010年。在研究入组时年龄为40 - 69岁且绝经后的女性中，有144260例符合入选条件。随访至2016年8月。暴露自然过早绝经（40岁之前绝经，未进行卵巢切除术）和手术过早绝经（40岁之前双侧卵巢切除术）。绝经后妇女没有过早绝经作为参考group.Main结局和措施的主要结果是一个复合事件冠状动脉疾病，心力衰竭，主动脉瓣狭窄，二尖瓣关闭不全，心房颤动，缺血性中风，外周动脉疾病，静脉血栓栓塞。次要结果包括主要结果的各个组成部分，高血压、高脂血症和2型糖尿病。结果在纳入的144260名绝经后妇女中（平均[SD]年龄为59.9 [5.4]岁），4904名（3.4%）自然过早绝经，644名（0.4%）手术过早绝经。参与者的中位随访时间为7年（四分位距，6.3-7.7）。主要结局发生在5415名妇女中（3.9%）没有过早绝经（发病率，5.70/1000女性-年），292名女性（6.0%）自然过早绝经（发病率，8.78/1 000妇女-年）（与无过早绝经的差异，+3.08/1000妇女-年[95% CI，2.06-4.10]; 49名女性（7.6%）有手术过早绝经（发病率为11.27/1000女性-年）（与无过早绝经的女性相比，差异为+5.57/1000女性-年[95%CI，2.41-8.73]; P <0.001）。对于主要结局，自然绝经和手术过早绝经的风险比为1.36（95% CI，1.19-1.56; P < .001）和1.87（95% CI，1.36-2.58; P <0.001），在调整了传统的心血管疾病危险因素和使用绝经期激素治疗后。手术过早绝经（40岁之前）与绝经后妇女心血管疾病复合风险增加相关，但增加幅度较小，且具有统计学显著性。需要进一步的研究来了解这些关联的机制。
IMPORTANCE Recent guidelines endorse using history of menopause before age 40 years to refine atherosclerotic cardiovascular disease risk assessments among middle-aged women. Robust data on cardiovascular disease risk in this population are lacking.OBJECTIVE To examine the development of cardiovascular diseases and cardiovascular risk factors in women with natural and surgical menopause before age 40 years.DESIGN, SETTING, AND PARTICIPANTS Cohort study (UK Biobank), with adult residents of the United Kingdom recruited between 2006 and 2010. Of women who were 40 to 69 years old and postmenopausal at study enrollment, 144 260 were eligible for inclusion. Follow-up occurred through August 2016.EXPOSURES Natural premature menopause (menopause before age 40 without oophorectomy) and surgical premature menopause (bilateral oophorectomy before age 40). Postmenopausal women without premature menopause served as the reference group.MAIN OUTCOMES AND MEASURES The primary outcome was a composite of incident coronary artery disease, heart failure, aortic stenosis, mitral regurgitation, atrial fibrillation, ischemic stroke, peripheral artery disease, and venous thromboembolism. Secondary outcomes included individual components of the primary outcome, incident hypertension, hyperlipidemia, and type 2 diabetes.RESULTS Of 144 260 postmenopausal women included (mean [SD] age at enrollment, 59.9 [5.4] years), 4904 (3.4%) had natural premature menopause and 644 (0.4%) had surgical premature menopause. Participants were followed up for a median of 7 years (interquartile range, 6.3-7.7). The primary outcome occurred in 5415 women (3.9%) with no premature menopause (incidence, 5.70/1000 woman-years), 292 women (6.0%) with natural premature menopause (incidence, 8.78/1000 woman-years) (difference vs no premature menopause, +3.08/1000 woman-years [95% CI, 2.06-4.10]; P < .001), and 49 women (7.6%) with surgical premature menopause (incidence, 11.27/1000 woman-years) (difference vs no premature menopause, +5.57/1000 woman-years [95% CI, 2.41-8.73]; P < .001). For the primary outcome, natural and surgical premature menopause were associated with hazard ratios of 1.36 (95% CI, 1.19-1.56; P < .001) and 1.87 (95% CI, 1.36-2.58; P < .001), respectively, after adjustment for conventional cardiovascular disease risk factors and use of menopausal hormone therapy.CONCLUSIONS AND RELEVANCE Natural and surgical premature menopause (before age 40 years) were associated with a small but statistically significant increased risk for a composite of cardiovascular diseases among postmenopausal women. Further research is needed to understand the mechanisms underlying these associations.