Atsma Femke, van der Schouw Yvonne T, Grobbee Diederick E, Hoes Arno W, Bartelink Marie-Louise E L
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Int J Cardiol. 2008 Nov 12;130(2):190-5. doi: 10.1016/j.ijcard.2007.08.040. Epub 2007 Dec 11.
The aim of the present study was to investigate the added value of age at menopause and the lifetime cumulative number of menstrual cycles in cardiovascular risk prediction in postmenopausal women.
This study included 971 women. The ankle-arm index was used as a proxy for cardiovascular morbidity and mortality. The ankle-arm index was calculated for each leg by dividing the highest ankle systolic blood pressure by the highest brachial systolic blood pressure. A cut-off value of 0.95 was used to differentiate between low and high risk women. Three cardiovascular risk models were constructed. In the initial model all classical predictors for cardiovascular disease were investigated. This model was then extended by age at menopause or the lifetime cumulative number of menstrual cycles to test their added value for cardiovascular risk prediction. Differences in discriminative power between the models were investigated by comparing the area under the receiver operating characteristic (ROC) curves.
The mean age was 66.0 (+/-5.6) years. The 6 independent predictors for cardiovascular disease were age, systolic blood pressure, total to HDL cholesterol ratio, current smoking, glucose level, and body mass index > or =30 kg/m(2). The ROC area was 0.69 (0.64-0.73) and did not change when age at menopause or the lifetime cumulative number of menstrual cycles was added.
The findings in this study among postmenopausal women did not support the view that age at menopause or a refined estimation of lifetime endogenous estrogen exposure would improve cardiovascular risk prediction as approximated by the ankle-arm index.
本研究旨在探讨绝经年龄和一生月经周期累积数在绝经后女性心血管疾病风险预测中的附加价值。
本研究纳入971名女性。踝臂指数用作心血管疾病发病率和死亡率的替代指标。通过将最高踝部收缩压除以最高肱部收缩压来计算每条腿的踝臂指数。采用0.95的临界值区分低风险和高风险女性。构建了三种心血管疾病风险模型。在初始模型中，研究了所有经典的心血管疾病预测因素。然后通过绝经年龄或一生月经周期累积数对该模型进行扩展，以测试它们在心血管疾病风险预测中的附加价值。通过比较受试者工作特征（ROC）曲线下面积来研究模型之间判别能力的差异。
平均年龄为66.0（±5.6）岁。心血管疾病的6个独立预测因素为年龄、收缩压、总胆固醇与高密度脂蛋白胆固醇比值、当前吸烟状况、血糖水平以及体重指数≥30kg/m²。ROC曲线下面积为0.69（0.64 - 0.73），在加入绝经年龄或一生月经周期累积数后未发生变化。
本研究中绝经后女性的研究结果不支持以下观点，即绝经年龄或对一生内源性雌激素暴露的精确估计会改善以踝臂指数近似评估的心血管疾病风险预测。
