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1. Genetically Determined Reproductive Aging and Coronary Heart Disease : A Bidirectional 2-sample Mendelian Randomization

Author

Dam, Veerle, Onland-Moret, N. Charlotte, Burgess, Stephen, Chirlaque, Maria-Dolores, Peters, Sanne A. E, Schuit, Ewoud, Tikk, Kaja, Weiderpass, Elisabete, Oliver-Williams, Clare, Wood, Angela M, Tjønneland, Anne, Dahm, Christina C, Overvad, Kim, Boutron-Ruault, Marie-Christine, Schulze, Matthias B, Trichopoulou, Antonia, Ferrari, Pietro, Masala, Giovanna, Krogh, Vittorio, Tumino, Rosario, Matullo, Giuseppe, Panico, Salvatore, Boer, Jolanda M. A, Verschuren, W. M. Monique, Waaseth, Marit, PCrossed D sign©rez, Maria JosCrossed D sign© Sánchez, Amiano, Pilar, Imaz, Liher, Moreno-Iribas, Conchi, Melander, Olle, Harlid, Sophia, Nordendahl, Maria, Wennberg, Patrik, Key, Timothy J, Riboli, Elio, Santiuste, Carmen, Kaaks, Rudolf, Katzke, Verena, Langenberg, Claudia, Wareham, Nicholas J, Schunkert, Heribert, Erdmann, Jeanette, Willenborg, Christina, Hengstenberg, Christian, Kleber, Marcus E, Delgado, Graciela, März, Winfried, Kanoni, Stavroula, Dedoussis, George, Deloukas, Panos, Nikpay, Majid, Mcpherson, Ruth, Scholz, Markus, Teren, Andrej, Butterworth, Adam S, Van Der Schouw, Yvonne T, Dam, Veerle, Onland-Moret, N. Charlotte, Burgess, Stephen, Chirlaque, Maria-Dolores, Peters, Sanne A. E, Schuit, Ewoud, Tikk, Kaja, Weiderpass, Elisabete, Oliver-Williams, Clare, Wood, Angela M, Tjønneland, Anne, Dahm, Christina C, Overvad, Kim, Boutron-Ruault, Marie-Christine, Schulze, Matthias B, Trichopoulou, Antonia, Ferrari, Pietro, Masala, Giovanna, Krogh, Vittorio, Tumino, Rosario, Matullo, Giuseppe, Panico, Salvatore, Boer, Jolanda M. A, Verschuren, W. M. Monique, Waaseth, Marit, PCrossed D sign©rez, Maria JosCrossed D sign© Sánchez, Amiano, Pilar, Imaz, Liher, Moreno-Iribas, Conchi, Melander, Olle, Harlid, Sophia, Nordendahl, Maria, Wennberg, Patrik, Key, Timothy J, Riboli, Elio, Santiuste, Carmen, Kaaks, Rudolf, Katzke, Verena, Langenberg, Claudia, Wareham, Nicholas J, Schunkert, Heribert, Erdmann, Jeanette, Willenborg, Christina, Hengstenberg, Christian, Kleber, Marcus E, Delgado, Graciela, März, Winfried, Kanoni, Stavroula, Dedoussis, George, Deloukas, Panos, Nikpay, Majid, Mcpherson, Ruth, Scholz, Markus, Teren, Andrej, Butterworth, Adam S, and Van Der Schouw, Yvonne T

Abstract

Background: Accelerated reproductive aging, in women indicated by early natural menopause, is associated with increased coronary heart disease (CHD) risk in observational studies. Conversely, an adverse CHD risk profile has been suggested to accelerate menopause. Objectives: To study the direction and evidence for causality of the relationship between reproductive aging and (non-)fatal CHD and CHD risk factors in a bidirectional Mendelian randomization (MR) approach, using age at natural menopause (ANM) genetic variants as a measure for genetically determined reproductive aging in women. We also studied the association of these variants with CHD risk (factors) in men. Design: Two-sample MR, using both cohort data as well as summary statistics, with 4 methods: simple and weighted median-based, standard inverse-variance weighted (IVW) regression, and MR-Egger regression. Participants: Data from EPIC-CVD and summary statistics from UK Biobank and publicly available genome-wide association studies were pooled for the different analyses. Main Outcome Measures: CHD, CHD risk factors, and ANM. Results: Across different methods of MR, no association was found between genetically determined reproductive aging and CHD risk in women (relative risk estimateIVW = 0.99; 95% confidence interval (CI), 0.97-1.01), or any of the CHD risk factors. Similarly, no associations were found in men. Neither did the reversed analyses show evidence for an association between CHD (risk factors) and reproductive aging. Conclusion: Genetically determined reproductive aging is not causally associated with CHD risk (factors) in women, nor were the genetic variants associated in men. We found no evidence for a reverse association in a combined sample of women and men.

Published
2022
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2. Association of menopausal characteristics and risk of coronary heart disease : A pan-European case-cohort analysis

Author

Dam, Veerle, Van Der Schouw, Yvonne T., Onland-Moret, N. Charlotte, Groenwold, Rolf H. H., Peters, Sanne A. E., Burgess, Stephen, Wood, Angela M., Chirlaque, Maria-Dolores, Moons, Karel G. M., Oliver-Williams, Clare, Schuit, Ewoud, Tikk, Kaja, Weiderpass, Elisabete, Holm, Marianne, Tjønneland, Anne, Kühn, Tilman, Fortner, Renée T., Trichopoulou, Antonia, Karakatsani, Anna, La Vecchia, Carlo, Ferrari, Pietro, Gunter, Marc, Masala, Giovanna, Sieri, Sabina, Tumino, Rosario, Panico, Salvatore, Boer, Jolanda M. A., Monique Verschuren, W.M., Salamanca-Fernández, Elena, Arriola, Larraitz, Moreno-Iribas, Conchi, Engström, Gunnar, Melander, Olle, Nordendahl, Maria, Wennberg, Patrik, Key, Timothy J., Colorado-Yohar, Sandra, Matullo, Giuseppe, Overvad, Kim, Clavel-Chapelon, Francoise, Boeing, Heiner, Ramon Quiros, J., Di Angelantonio, Emanuele, Langenberg, Claudia, Sweeting, Michael J., Riboli, Elio, Wareham, Nicholas J., Danesh, John, Butterworth, Adam, Dam, Veerle, Van Der Schouw, Yvonne T., Onland-Moret, N. Charlotte, Groenwold, Rolf H. H., Peters, Sanne A. E., Burgess, Stephen, Wood, Angela M., Chirlaque, Maria-Dolores, Moons, Karel G. M., Oliver-Williams, Clare, Schuit, Ewoud, Tikk, Kaja, Weiderpass, Elisabete, Holm, Marianne, Tjønneland, Anne, Kühn, Tilman, Fortner, Renée T., Trichopoulou, Antonia, Karakatsani, Anna, La Vecchia, Carlo, Ferrari, Pietro, Gunter, Marc, Masala, Giovanna, Sieri, Sabina, Tumino, Rosario, Panico, Salvatore, Boer, Jolanda M. A., Monique Verschuren, W.M., Salamanca-Fernández, Elena, Arriola, Larraitz, Moreno-Iribas, Conchi, Engström, Gunnar, Melander, Olle, Nordendahl, Maria, Wennberg, Patrik, Key, Timothy J., Colorado-Yohar, Sandra, Matullo, Giuseppe, Overvad, Kim, Clavel-Chapelon, Francoise, Boeing, Heiner, Ramon Quiros, J., Di Angelantonio, Emanuele, Langenberg, Claudia, Sweeting, Michael J., Riboli, Elio, Wareham, Nicholas J., Danesh, John, and Butterworth, Adam

Abstract

Background: Earlier age at menopause has been associated with increased risk of coronary heart disease (CHD), but the shape of association and role of established cardiovascular risk factors remain unclear. Therefore, we examined the associations between menopausal characteristics and CHD risk; the shape of the association between age at menopause and CHD risk; and the extent to which these associations are explained by established cardiovascular risk factors. Methods: We used data from EPIC-CVD, a case-cohort study, which includes data from 23 centres from 10 European countries. We included only women, of whom 10 880 comprise the randomly selected sub-cohort, supplemented with 4522 cases outside the sub-cohort. We conducted Prentice-weighted Cox proportional hazards regressions with age as the underlying time scale, stratified by country and adjusted for relevant confounders. Results: After confounder and intermediate adjustment, post-menopausal women were not at higher CHD risk compared with pre-menopausal women. Among post-menopausal women, earlier menopause was linearly associated with higher CHD risk [HRconfounder and intermediate adjusted per-year decrease = 1.02, 95% confidence interval (CI) = 1.01-1.03, p = 0.001]. Women with a surgical menopause were at higher risk of CHD compared with those with natural menopause (HRconfounder-adjusted = 1.25, 95% CI = 1.10-1.42, p < 0.001), but this attenuated after additional adjustment for age at menopause and intermediates (HR = 1.12, 95% CI = 0.96-1.29, p = 0.15). A proportion of the association was explained by cardiovascular risk factors. Conclusions: Earlier and surgical menopause were associated with higher CHD risk. These associations could partially be explained by differences in conventional cardiovascular risk factors. These women might benefit from close monitoring of cardiovascular risk factors and disease.

Published
2019
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3. Association of menopausal characteristics and risk of coronary heart disease : A pan-European case-cohort analysis

Author

Dam, Veerle, Van Der Schouw, Yvonne T., Onland-Moret, N. Charlotte, Groenwold, Rolf H. H., Peters, Sanne A. E., Burgess, Stephen, Wood, Angela M., Chirlaque, Maria-Dolores, Moons, Karel G. M., Oliver-Williams, Clare, Schuit, Ewoud, Tikk, Kaja, Weiderpass, Elisabete, Holm, Marianne, Tjønneland, Anne, Kühn, Tilman, Fortner, Renée T., Trichopoulou, Antonia, Karakatsani, Anna, La Vecchia, Carlo, Ferrari, Pietro, Gunter, Marc, Masala, Giovanna, Sieri, Sabina, Tumino, Rosario, Panico, Salvatore, Boer, Jolanda M. A., Monique Verschuren, W.M., Salamanca-Fernández, Elena, Arriola, Larraitz, Moreno-Iribas, Conchi, Engström, Gunnar, Melander, Olle, Nordendahl, Maria, Wennberg, Patrik, Key, Timothy J., Colorado-Yohar, Sandra, Matullo, Giuseppe, Overvad, Kim, Clavel-Chapelon, Francoise, Boeing, Heiner, Ramon Quiros, J., Di Angelantonio, Emanuele, Langenberg, Claudia, Sweeting, Michael J., Riboli, Elio, Wareham, Nicholas J., Danesh, John, Butterworth, Adam, Dam, Veerle, Van Der Schouw, Yvonne T., Onland-Moret, N. Charlotte, Groenwold, Rolf H. H., Peters, Sanne A. E., Burgess, Stephen, Wood, Angela M., Chirlaque, Maria-Dolores, Moons, Karel G. M., Oliver-Williams, Clare, Schuit, Ewoud, Tikk, Kaja, Weiderpass, Elisabete, Holm, Marianne, Tjønneland, Anne, Kühn, Tilman, Fortner, Renée T., Trichopoulou, Antonia, Karakatsani, Anna, La Vecchia, Carlo, Ferrari, Pietro, Gunter, Marc, Masala, Giovanna, Sieri, Sabina, Tumino, Rosario, Panico, Salvatore, Boer, Jolanda M. A., Monique Verschuren, W.M., Salamanca-Fernández, Elena, Arriola, Larraitz, Moreno-Iribas, Conchi, Engström, Gunnar, Melander, Olle, Nordendahl, Maria, Wennberg, Patrik, Key, Timothy J., Colorado-Yohar, Sandra, Matullo, Giuseppe, Overvad, Kim, Clavel-Chapelon, Francoise, Boeing, Heiner, Ramon Quiros, J., Di Angelantonio, Emanuele, Langenberg, Claudia, Sweeting, Michael J., Riboli, Elio, Wareham, Nicholas J., Danesh, John, and Butterworth, Adam

Abstract

Background: Earlier age at menopause has been associated with increased risk of coronary heart disease (CHD), but the shape of association and role of established cardiovascular risk factors remain unclear. Therefore, we examined the associations between menopausal characteristics and CHD risk; the shape of the association between age at menopause and CHD risk; and the extent to which these associations are explained by established cardiovascular risk factors. Methods: We used data from EPIC-CVD, a case-cohort study, which includes data from 23 centres from 10 European countries. We included only women, of whom 10 880 comprise the randomly selected sub-cohort, supplemented with 4522 cases outside the sub-cohort. We conducted Prentice-weighted Cox proportional hazards regressions with age as the underlying time scale, stratified by country and adjusted for relevant confounders. Results: After confounder and intermediate adjustment, post-menopausal women were not at higher CHD risk compared with pre-menopausal women. Among post-menopausal women, earlier menopause was linearly associated with higher CHD risk [HRconfounder and intermediate adjusted per-year decrease = 1.02, 95% confidence interval (CI) = 1.01-1.03, p = 0.001]. Women with a surgical menopause were at higher risk of CHD compared with those with natural menopause (HRconfounder-adjusted = 1.25, 95% CI = 1.10-1.42, p < 0.001), but this attenuated after additional adjustment for age at menopause and intermediates (HR = 1.12, 95% CI = 0.96-1.29, p = 0.15). A proportion of the association was explained by cardiovascular risk factors. Conclusions: Earlier and surgical menopause were associated with higher CHD risk. These associations could partially be explained by differences in conventional cardiovascular risk factors. These women might benefit from close monitoring of cardiovascular risk factors and disease.

Published
2019
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4. Association of menopausal characteristics and risk of coronary heart disease : A pan-European case-cohort analysis

Author

Dam, Veerle, Van Der Schouw, Yvonne T., Onland-Moret, N. Charlotte, Groenwold, Rolf H. H., Peters, Sanne A. E., Burgess, Stephen, Wood, Angela M., Chirlaque, Maria-Dolores, Moons, Karel G. M., Oliver-Williams, Clare, Schuit, Ewoud, Tikk, Kaja, Weiderpass, Elisabete, Holm, Marianne, Tjønneland, Anne, Kühn, Tilman, Fortner, Renée T., Trichopoulou, Antonia, Karakatsani, Anna, La Vecchia, Carlo, Ferrari, Pietro, Gunter, Marc, Masala, Giovanna, Sieri, Sabina, Tumino, Rosario, Panico, Salvatore, Boer, Jolanda M. A., Monique Verschuren, W.M., Salamanca-Fernández, Elena, Arriola, Larraitz, Moreno-Iribas, Conchi, Engström, Gunnar, Melander, Olle, Nordendahl, Maria, Wennberg, Patrik, Key, Timothy J., Colorado-Yohar, Sandra, Matullo, Giuseppe, Overvad, Kim, Clavel-Chapelon, Francoise, Boeing, Heiner, Ramon Quiros, J., Di Angelantonio, Emanuele, Langenberg, Claudia, Sweeting, Michael J., Riboli, Elio, Wareham, Nicholas J., Danesh, John, Butterworth, Adam, Dam, Veerle, Van Der Schouw, Yvonne T., Onland-Moret, N. Charlotte, Groenwold, Rolf H. H., Peters, Sanne A. E., Burgess, Stephen, Wood, Angela M., Chirlaque, Maria-Dolores, Moons, Karel G. M., Oliver-Williams, Clare, Schuit, Ewoud, Tikk, Kaja, Weiderpass, Elisabete, Holm, Marianne, Tjønneland, Anne, Kühn, Tilman, Fortner, Renée T., Trichopoulou, Antonia, Karakatsani, Anna, La Vecchia, Carlo, Ferrari, Pietro, Gunter, Marc, Masala, Giovanna, Sieri, Sabina, Tumino, Rosario, Panico, Salvatore, Boer, Jolanda M. A., Monique Verschuren, W.M., Salamanca-Fernández, Elena, Arriola, Larraitz, Moreno-Iribas, Conchi, Engström, Gunnar, Melander, Olle, Nordendahl, Maria, Wennberg, Patrik, Key, Timothy J., Colorado-Yohar, Sandra, Matullo, Giuseppe, Overvad, Kim, Clavel-Chapelon, Francoise, Boeing, Heiner, Ramon Quiros, J., Di Angelantonio, Emanuele, Langenberg, Claudia, Sweeting, Michael J., Riboli, Elio, Wareham, Nicholas J., Danesh, John, and Butterworth, Adam

Abstract

Background: Earlier age at menopause has been associated with increased risk of coronary heart disease (CHD), but the shape of association and role of established cardiovascular risk factors remain unclear. Therefore, we examined the associations between menopausal characteristics and CHD risk; the shape of the association between age at menopause and CHD risk; and the extent to which these associations are explained by established cardiovascular risk factors. Methods: We used data from EPIC-CVD, a case-cohort study, which includes data from 23 centres from 10 European countries. We included only women, of whom 10 880 comprise the randomly selected sub-cohort, supplemented with 4522 cases outside the sub-cohort. We conducted Prentice-weighted Cox proportional hazards regressions with age as the underlying time scale, stratified by country and adjusted for relevant confounders. Results: After confounder and intermediate adjustment, post-menopausal women were not at higher CHD risk compared with pre-menopausal women. Among post-menopausal women, earlier menopause was linearly associated with higher CHD risk [HRconfounder and intermediate adjusted per-year decrease = 1.02, 95% confidence interval (CI) = 1.01-1.03, p = 0.001]. Women with a surgical menopause were at higher risk of CHD compared with those with natural menopause (HRconfounder-adjusted = 1.25, 95% CI = 1.10-1.42, p < 0.001), but this attenuated after additional adjustment for age at menopause and intermediates (HR = 1.12, 95% CI = 0.96-1.29, p = 0.15). A proportion of the association was explained by cardiovascular risk factors. Conclusions: Earlier and surgical menopause were associated with higher CHD risk. These associations could partially be explained by differences in conventional cardiovascular risk factors. These women might benefit from close monitoring of cardiovascular risk factors and disease.

Published
2019
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5. Association of menopausal characteristics and risk of coronary heart disease : A pan-European case-cohort analysis

Author

Dam, Veerle, Van Der Schouw, Yvonne T., Onland-Moret, N. Charlotte, Groenwold, Rolf H. H., Peters, Sanne A. E., Burgess, Stephen, Wood, Angela M., Chirlaque, Maria-Dolores, Moons, Karel G. M., Oliver-Williams, Clare, Schuit, Ewoud, Tikk, Kaja, Weiderpass, Elisabete, Holm, Marianne, Tjønneland, Anne, Kühn, Tilman, Fortner, Renée T., Trichopoulou, Antonia, Karakatsani, Anna, La Vecchia, Carlo, Ferrari, Pietro, Gunter, Marc, Masala, Giovanna, Sieri, Sabina, Tumino, Rosario, Panico, Salvatore, Boer, Jolanda M. A., Monique Verschuren, W.M., Salamanca-Fernández, Elena, Arriola, Larraitz, Moreno-Iribas, Conchi, Engström, Gunnar, Melander, Olle, Nordendahl, Maria, Wennberg, Patrik, Key, Timothy J., Colorado-Yohar, Sandra, Matullo, Giuseppe, Overvad, Kim, Clavel-Chapelon, Francoise, Boeing, Heiner, Ramon Quiros, J., Di Angelantonio, Emanuele, Langenberg, Claudia, Sweeting, Michael J., Riboli, Elio, Wareham, Nicholas J., Danesh, John, Butterworth, Adam, Dam, Veerle, Van Der Schouw, Yvonne T., Onland-Moret, N. Charlotte, Groenwold, Rolf H. H., Peters, Sanne A. E., Burgess, Stephen, Wood, Angela M., Chirlaque, Maria-Dolores, Moons, Karel G. M., Oliver-Williams, Clare, Schuit, Ewoud, Tikk, Kaja, Weiderpass, Elisabete, Holm, Marianne, Tjønneland, Anne, Kühn, Tilman, Fortner, Renée T., Trichopoulou, Antonia, Karakatsani, Anna, La Vecchia, Carlo, Ferrari, Pietro, Gunter, Marc, Masala, Giovanna, Sieri, Sabina, Tumino, Rosario, Panico, Salvatore, Boer, Jolanda M. A., Monique Verschuren, W.M., Salamanca-Fernández, Elena, Arriola, Larraitz, Moreno-Iribas, Conchi, Engström, Gunnar, Melander, Olle, Nordendahl, Maria, Wennberg, Patrik, Key, Timothy J., Colorado-Yohar, Sandra, Matullo, Giuseppe, Overvad, Kim, Clavel-Chapelon, Francoise, Boeing, Heiner, Ramon Quiros, J., Di Angelantonio, Emanuele, Langenberg, Claudia, Sweeting, Michael J., Riboli, Elio, Wareham, Nicholas J., Danesh, John, and Butterworth, Adam

Abstract

Background: Earlier age at menopause has been associated with increased risk of coronary heart disease (CHD), but the shape of association and role of established cardiovascular risk factors remain unclear. Therefore, we examined the associations between menopausal characteristics and CHD risk; the shape of the association between age at menopause and CHD risk; and the extent to which these associations are explained by established cardiovascular risk factors. Methods: We used data from EPIC-CVD, a case-cohort study, which includes data from 23 centres from 10 European countries. We included only women, of whom 10 880 comprise the randomly selected sub-cohort, supplemented with 4522 cases outside the sub-cohort. We conducted Prentice-weighted Cox proportional hazards regressions with age as the underlying time scale, stratified by country and adjusted for relevant confounders. Results: After confounder and intermediate adjustment, post-menopausal women were not at higher CHD risk compared with pre-menopausal women. Among post-menopausal women, earlier menopause was linearly associated with higher CHD risk [HRconfounder and intermediate adjusted per-year decrease = 1.02, 95% confidence interval (CI) = 1.01-1.03, p = 0.001]. Women with a surgical menopause were at higher risk of CHD compared with those with natural menopause (HRconfounder-adjusted = 1.25, 95% CI = 1.10-1.42, p < 0.001), but this attenuated after additional adjustment for age at menopause and intermediates (HR = 1.12, 95% CI = 0.96-1.29, p = 0.15). A proportion of the association was explained by cardiovascular risk factors. Conclusions: Earlier and surgical menopause were associated with higher CHD risk. These associations could partially be explained by differences in conventional cardiovascular risk factors. These women might benefit from close monitoring of cardiovascular risk factors and disease.

Published
2019
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6. Association of menopausal characteristics and risk of coronary heart disease : A pan-European case-cohort analysis

Author

Dam, Veerle, Van Der Schouw, Yvonne T., Onland-Moret, N. Charlotte, Groenwold, Rolf H. H., Peters, Sanne A. E., Burgess, Stephen, Wood, Angela M., Chirlaque, Maria-Dolores, Moons, Karel G. M., Oliver-Williams, Clare, Schuit, Ewoud, Tikk, Kaja, Weiderpass, Elisabete, Holm, Marianne, Tjønneland, Anne, Kühn, Tilman, Fortner, Renée T., Trichopoulou, Antonia, Karakatsani, Anna, La Vecchia, Carlo, Ferrari, Pietro, Gunter, Marc, Masala, Giovanna, Sieri, Sabina, Tumino, Rosario, Panico, Salvatore, Boer, Jolanda M. A., Monique Verschuren, W.M., Salamanca-Fernández, Elena, Arriola, Larraitz, Moreno-Iribas, Conchi, Engström, Gunnar, Melander, Olle, Nordendahl, Maria, Wennberg, Patrik, Key, Timothy J., Colorado-Yohar, Sandra, Matullo, Giuseppe, Overvad, Kim, Clavel-Chapelon, Francoise, Boeing, Heiner, Ramon Quiros, J., Di Angelantonio, Emanuele, Langenberg, Claudia, Sweeting, Michael J., Riboli, Elio, Wareham, Nicholas J., Danesh, John, Butterworth, Adam, Dam, Veerle, Van Der Schouw, Yvonne T., Onland-Moret, N. Charlotte, Groenwold, Rolf H. H., Peters, Sanne A. E., Burgess, Stephen, Wood, Angela M., Chirlaque, Maria-Dolores, Moons, Karel G. M., Oliver-Williams, Clare, Schuit, Ewoud, Tikk, Kaja, Weiderpass, Elisabete, Holm, Marianne, Tjønneland, Anne, Kühn, Tilman, Fortner, Renée T., Trichopoulou, Antonia, Karakatsani, Anna, La Vecchia, Carlo, Ferrari, Pietro, Gunter, Marc, Masala, Giovanna, Sieri, Sabina, Tumino, Rosario, Panico, Salvatore, Boer, Jolanda M. A., Monique Verschuren, W.M., Salamanca-Fernández, Elena, Arriola, Larraitz, Moreno-Iribas, Conchi, Engström, Gunnar, Melander, Olle, Nordendahl, Maria, Wennberg, Patrik, Key, Timothy J., Colorado-Yohar, Sandra, Matullo, Giuseppe, Overvad, Kim, Clavel-Chapelon, Francoise, Boeing, Heiner, Ramon Quiros, J., Di Angelantonio, Emanuele, Langenberg, Claudia, Sweeting, Michael J., Riboli, Elio, Wareham, Nicholas J., Danesh, John, and Butterworth, Adam

Abstract

Background: Earlier age at menopause has been associated with increased risk of coronary heart disease (CHD), but the shape of association and role of established cardiovascular risk factors remain unclear. Therefore, we examined the associations between menopausal characteristics and CHD risk; the shape of the association between age at menopause and CHD risk; and the extent to which these associations are explained by established cardiovascular risk factors. Methods: We used data from EPIC-CVD, a case-cohort study, which includes data from 23 centres from 10 European countries. We included only women, of whom 10 880 comprise the randomly selected sub-cohort, supplemented with 4522 cases outside the sub-cohort. We conducted Prentice-weighted Cox proportional hazards regressions with age as the underlying time scale, stratified by country and adjusted for relevant confounders. Results: After confounder and intermediate adjustment, post-menopausal women were not at higher CHD risk compared with pre-menopausal women. Among post-menopausal women, earlier menopause was linearly associated with higher CHD risk [HRconfounder and intermediate adjusted per-year decrease = 1.02, 95% confidence interval (CI) = 1.01-1.03, p = 0.001]. Women with a surgical menopause were at higher risk of CHD compared with those with natural menopause (HRconfounder-adjusted = 1.25, 95% CI = 1.10-1.42, p < 0.001), but this attenuated after additional adjustment for age at menopause and intermediates (HR = 1.12, 95% CI = 0.96-1.29, p = 0.15). A proportion of the association was explained by cardiovascular risk factors. Conclusions: Earlier and surgical menopause were associated with higher CHD risk. These associations could partially be explained by differences in conventional cardiovascular risk factors. These women might benefit from close monitoring of cardiovascular risk factors and disease.

Published
2019
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