Savonitto Stefano, Colombo Delia, Franco Nicoletta, Misuraca Leonardo, Lenatti Laura, Romano Ilaria J, Morici Nuccia, Lo Jacono Emilia, Leuzzi Chiara, Corrada Elena, Aranzulla Tiziana C, Petronio A Sonia, Bellia Gilberto, Romagnoli Enrico, Cagnacci Angelo, Zoccai Giuseppe Biondi, Prati Francesco
Division of Cardiology, Ospedale Manzoni, Lecco, Italy.
Clinical Pharmacology, Milan, Italy.
Am J Med. 2016 Nov;129(11):1205-1212. doi: 10.1016/j.amjmed.2016.05.031. Epub 2016 Jun 16.
Epidemiological studies have shown a higher risk of cardiovascular mortality associated with early menopause, but the relation between menopausal age and extent of coronary artery disease after menopause is unknown. We assessed the relation between menopausal age and extent of coronary disease in postmenopausal women with an acute coronary syndrome.
A prospective study was conducted in patients ≥55 years old undergoing coronary angiography for an acute coronary syndrome. Enrollment was stratified by sex (women/men ratio 2:1) and age (55-64, 65-74, 75-85, and >85 years). Women were administered menopause questionnaires during admission. An independent core lab quantified coronary artery disease extent using the Gensini Score, which classifies both significant (>50%) and nonsignificant lesions. Linear correlation was used to appraise the association between the Gensini score and menopausal age.
We enrolled 675 patients, 249 men and 426 women (mean age 74 years). The mean Gensini score was 60 ± 36 in men vs 50 ± 32 in women (P <.001), being higher among men at any age. The median menopausal age of women was 50 years. Risk factors and age at first acute coronary syndrome were identical among women below and above the median menopausal age. The Gensini score in women showed a weak association with age (R = 0.127; P = .0129), but not with menopausal age (R = 0.063; P = .228). At multivariable analysis, ejection fraction, female sex, and ST elevation myocardial infarction were independent predictors of the Gensini score in the overall population.
Menopausal age was not associated with the extent of coronary artery disease. Age at first acute coronary syndrome presentation, risk factors, and prior cardiovascular events were not affected by menopausal age. (The LADIES ACS study: NCT01997307).
流行病学研究表明，早期绝经与心血管疾病死亡风险较高相关，但绝经年龄与绝经后冠状动脉疾病范围之间的关系尚不清楚。我们评估了急性冠状动脉综合征绝经后女性的绝经年龄与冠状动脉疾病范围之间的关系。
对年龄≥55岁因急性冠状动脉综合征接受冠状动脉造影的患者进行了一项前瞻性研究。入组按性别（女性/男性比例2:1）和年龄（55 - 64岁、65 - 74岁、75 - 85岁和>85岁）分层。女性在入院期间接受绝经问卷调查。一个独立的核心实验室使用Gensini评分对冠状动脉疾病范围进行量化，该评分对显著（>50%）和非显著病变均进行分类。采用线性相关分析评估Gensini评分与绝经年龄之间的关联。
我们纳入了675例患者，其中249例男性和426例女性（平均年龄74岁）。男性的平均Gensini评分为60±36，女性为50±32（P<.001），在任何年龄组中男性的评分均更高。女性的绝经年龄中位数为50岁。绝经年龄中位数以下和以上的女性在首次急性冠状动脉综合征的危险因素和年龄方面相同。女性的Gensini评分与年龄呈弱关联（R = 0.127；P = 0.0129），但与绝经年龄无关联（R = 0.063；P = 0.228）。在多变量分析中，射血分数、女性性别和ST段抬高型心肌梗死是总体人群中Gensini评分的独立预测因素。
绝经年龄与冠状动脉疾病范围无关。首次急性冠状动脉综合征发作时的年龄、危险因素和既往心血管事件不受绝经年龄影响。（LADIES ACS研究：NCT01997307）
