Ebong Imo A, Watson Karol E, Goff David C, Bluemke David A, Srikanthan Preethi, Horwich Tamara, Bertoni Alain G
From the 1Department of Medicine, University of Southern California, Los Angeles, CA; 2Division of Cardiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; 3Colorado School of Public Health, Aurora, CO; 4National Institutes of Health/Clinical Center, Bethesda, MD; 5Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; and 6Departments of Medicine and Epidemiology, Wake Forest University School of Medicine, Winston Salem, NC.
Menopause. 2014 Jun;21(6):585-91. doi: 10.1097/GME.0000000000000138.
This study aims to evaluate the associations of early menopause (menopause occurring before age 45 years) and age at menopause with incident heart failure (HF) in postmenopausal women. We also explored the associations of early menopause and age at menopause with left ventricular (LV) measures of structure and function in postmenopausal women.
We included 2,947 postmenopausal women, aged 45 to 84 years without known cardiovascular disease (2000-2002), from the Multi-Ethnic Study of Atherosclerosis. Cox proportional hazards models were used to examine the associations of early menopause and age at menopause with incident HF. In 2,123 postmenopausal women in whom cardiac magnetic resonance imaging was obtained at baseline, we explored the associations of early menopause and age at menopause with LV measures using multivariable linear regression.
Across a median follow-up of 8.5 years, we observed 71 HF events. There were no significant interactions with ethnicity for incident HF (Pinteraction > 0.05). In adjusted analysis, early menopause was associated with an increased risk of incident HF (hazard ratio, 1.66; 95% CI, 1.01-2.73), whereas every 1-year increase in age at menopause was associated with a decreased risk of incident HF (hazard ratio, 0.96; 95% CI, 0.94-0.99). We observed significant interactions between early menopause and ethnicity for LV mass-to-volume ratio (LVMVR; Pinteraction = 0.02). In Chinese-American women, early menopause was associated with a higher LVMVR (+0.11; P = 0.0002), whereas every 1-year increase in age at menopause was associated with a lower LVMVR (-0.004; P = 0.04) at baseline.
Older age at menopause is independently associated with a decreased risk of incident HF. Concentric LV remodeling, indicated by a higher LVMVR, is present in Chinese-American women who experienced early menopause at baseline.
本研究旨在评估绝经后女性中早期绝经（45岁之前绝经）及绝经年龄与心力衰竭（HF）发病的相关性。我们还探讨了早期绝经和绝经年龄与绝经后女性左心室（LV）结构和功能指标的相关性。
我们纳入了来自动脉粥样硬化多族裔研究的2947名45至84岁无已知心血管疾病的绝经后女性（2000 - 2002年）。采用Cox比例风险模型来检验早期绝经和绝经年龄与HF发病的相关性。在2123名基线时接受心脏磁共振成像检查的绝经后女性中，我们使用多变量线性回归探讨了早期绝经和绝经年龄与LV指标的相关性。
在中位随访8.5年期间，我们观察到71例HF事件。HF发病与种族之间无显著交互作用（P交互>0.05）。在调整分析中，早期绝经与HF发病风险增加相关（风险比，1.66；95%CI，1.01 - 2.73），而绝经年龄每增加1岁与HF发病风险降低相关（风险比，0.96；95%CI，0.94 - 0.99）。我们观察到早期绝经和种族之间在左心室质量与容积比（LVMVR）方面存在显著交互作用（P交互 = 0.02）。在华裔美国女性中，早期绝经与更高的LVMVR相关（+0.11；P = 0.0002），而绝经年龄每增加1岁与基线时更低的LVMVR相关（-0.004；P = 0.04）。
绝经年龄较大与HF发病风险降低独立相关。基线时经历早期绝经的华裔美国女性存在以更高的LVMVR为特征的向心性左心室重构。
