Association of menopausal characteristics and risk of coronary heart disease: A pan-European case-cohort analysis
AuthorDam, 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.; Verschuren, W.M. Monique; 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; Ramõn Quirõs, Jose; di Angelantonio, Emanuele; Langenberg, Claudia; Sweeting, Michael J.; Riboli, Elio; Wareham, Nicholas J.; Danesh, John; Butterworth, Adam
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.