Age of Natural Menopause and Atrial Fibrillation
Background Early menopausal age is associated with risk of cardiovascular events including myocardial infraction, stroke, and increased mortality. Relations between menopausal age and atrial fibrillation (AF) have not been investigated. We examined the association between menopausal age and AF.
Methods Framingham Heart Study women ≥60 years old without prevalent AF and natural menopause were followed up for 10 years or until incident AF. Menopausal age was modeled as a continuous variable and by categories (<45, 45–53, and >53 years). We used Cox proportional hazards regression to determine associations between menopausal age and AF risk.
Results In 1,809 Framingham women (2,662 person-examinations, mean baseline age 71.4 ± 7.6 years, menopausal age 49.8 ± 3.6 years), there were 273 unique participants with incident AF. We did not identify a significant association between the SD of menopausal age (3.6 years) and AF (hazard ratio [HR] per SD 0.94, 95% CI 0.83–1.06; P = .29). In a multivariable model with established risk factors for AF, menopausal age was not associated with incident AF (HR per SD 0.97, 95% CI 0.86–1.09; P = .60). Examining categorical menopausal age, earlier menopausal age (<45 years) was not significantly associated with increased AF risk compared with older menopausal age >53 years (HR 1.20, 95% CI 0.74–1.94; P = .52) or menopausal age 45 to 53 years (HR 1.38, 95% CI 0.93–2.04; P = .11).
Conclusion In our moderate-sized, community-based sample, we did not identify menopausal age as significantly increasing AF risk. However, future larger studies will need to examine whether there is a small effect of menopausal age on AF risk.
Younger age at menopause has been associated with increased risk of myocardial infarction, stroke, and mortality. In the Nurse's Health Study, menopausal age <40 years and early menopause (age 40–44 years) were associated with up to 1.5- and 1.4-fold increased risk of cardiovascular events compared with menopause ≥55 years. Conversely, older menopausal age (≥53 years) has been related to decreased mortality secondary to ischemic heart disease. Prospective cohort studies have further related earlier age of menopause to increased risk for all-cause mortality.
Given the association between menopausal age and cardiovascular events, we sought to examine the relation between age of menopause and atrial fibrillation (AF). Atrial fibrillation has profound social and medical burdens, increasing mortality and eliminating the survival advantage that women have over men. Identifying risk factors for AF in women therefore has significant public health importance. To our knowledge, the association between AF and age of menopause has had limited investigation. We considered that the myriad endocrinologic and vascular changes accompanying menopause would predispose women toward increased AF risk. We consequently hypothesized an increased risk of AF for women experiencing menopause at a younger age and, in particular, that cardiac events may mediate the increased risk for developing AF.
Abstract and Introduction
Abstract
Background Early menopausal age is associated with risk of cardiovascular events including myocardial infraction, stroke, and increased mortality. Relations between menopausal age and atrial fibrillation (AF) have not been investigated. We examined the association between menopausal age and AF.
Methods Framingham Heart Study women ≥60 years old without prevalent AF and natural menopause were followed up for 10 years or until incident AF. Menopausal age was modeled as a continuous variable and by categories (<45, 45–53, and >53 years). We used Cox proportional hazards regression to determine associations between menopausal age and AF risk.
Results In 1,809 Framingham women (2,662 person-examinations, mean baseline age 71.4 ± 7.6 years, menopausal age 49.8 ± 3.6 years), there were 273 unique participants with incident AF. We did not identify a significant association between the SD of menopausal age (3.6 years) and AF (hazard ratio [HR] per SD 0.94, 95% CI 0.83–1.06; P = .29). In a multivariable model with established risk factors for AF, menopausal age was not associated with incident AF (HR per SD 0.97, 95% CI 0.86–1.09; P = .60). Examining categorical menopausal age, earlier menopausal age (<45 years) was not significantly associated with increased AF risk compared with older menopausal age >53 years (HR 1.20, 95% CI 0.74–1.94; P = .52) or menopausal age 45 to 53 years (HR 1.38, 95% CI 0.93–2.04; P = .11).
Conclusion In our moderate-sized, community-based sample, we did not identify menopausal age as significantly increasing AF risk. However, future larger studies will need to examine whether there is a small effect of menopausal age on AF risk.
Introduction
Younger age at menopause has been associated with increased risk of myocardial infarction, stroke, and mortality. In the Nurse's Health Study, menopausal age <40 years and early menopause (age 40–44 years) were associated with up to 1.5- and 1.4-fold increased risk of cardiovascular events compared with menopause ≥55 years. Conversely, older menopausal age (≥53 years) has been related to decreased mortality secondary to ischemic heart disease. Prospective cohort studies have further related earlier age of menopause to increased risk for all-cause mortality.
Given the association between menopausal age and cardiovascular events, we sought to examine the relation between age of menopause and atrial fibrillation (AF). Atrial fibrillation has profound social and medical burdens, increasing mortality and eliminating the survival advantage that women have over men. Identifying risk factors for AF in women therefore has significant public health importance. To our knowledge, the association between AF and age of menopause has had limited investigation. We considered that the myriad endocrinologic and vascular changes accompanying menopause would predispose women toward increased AF risk. We consequently hypothesized an increased risk of AF for women experiencing menopause at a younger age and, in particular, that cardiac events may mediate the increased risk for developing AF.
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