Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
J Am Heart Assoc. 2017 Nov 2;6(11):e006713. doi: 10.1161/JAHA.117.006713.
Although the timing of menarche and menopause may be associated with cardiovascular disease (CVD), the entire reproductive life span has not been considered comprehensively as risk for CVD. We investigate the associations of reproductive life span duration and ages at menarche and menopause, induced by natural means or surgical bilateral oophorectomy, with incident CVD in women.
Prospective cohort study of 73 814 Nurses' Health Study following participants without CVD, defined as incident coronary heart disease or stroke, from 1980 through 2012. Duration of reproductive life span was generated by subtracting age at menarche from age at menopause. A shorter reproductive life span was associated with a higher risk of incident CVD after multivariable adjustment (relative risk, 1.32 [95% confidence interval, 1.16-1.49] comparing duration <30 with ≥42 years; trend<0.0001). Early age at menopause was associated with higher multivariable-adjusted CVD risk (1.32 [1.16-1.51] comparing age <40 with 50 to <55 years; trend<0.0001), with excess risk for both natural and surgical menopause. Compared with women with menarche at 13 years, the multivariable-adjusted CVD risk for early menarche at ≤10 years was 1.22 (1.09-1.36). The association between reproductive life span and CVD remained significant in sensitivity analyses excluding women who experienced extreme early age at menarche or who used hormone therapy.
A shorter duration of reproductive life span is associated with a higher risk of CVD, which is likely driven by the timing of menopause induced either naturally or surgically. Extremely early age at menarche is also associated with a higher risk of CVD.
尽管初潮和绝经时间可能与心血管疾病（CVD）有关，但整个生殖寿命期尚未被全面视为 CVD 的风险因素。我们研究了自然或手术双侧卵巢切除引起的初潮和绝经年龄以及生殖寿命期持续时间与女性 CVD 发病风险之间的关系。
这是一项前瞻性队列研究，纳入了 73814 名参加护士健康研究的女性，这些女性在 1980 年至 2012 年期间无 CVD（定义为新发冠心病或中风）。生殖寿命期持续时间通过从绝经年龄中减去初潮年龄计算得出。多变量调整后，生殖寿命期较短与 CVD 发病风险增加相关（相对风险，比较持续时间<30 年与≥42 年的 1.32[95%置信区间，1.16-1.49]；趋势<0.0001）。绝经年龄较早与 CVD 风险增加相关（多变量调整后，比较年龄<40 岁与 50-<55 岁的 1.32[1.16-1.51]；趋势<0.0001），且与自然和手术绝经均相关。与初潮年龄为 13 岁的女性相比，初潮年龄≤10 岁的女性多变量调整 CVD 风险为 1.22（1.09-1.36）。生殖寿命期与 CVD 之间的关联在排除了初潮年龄过早或使用激素治疗的女性的敏感性分析中仍然显著。
生殖寿命期较短与 CVD 风险增加相关，这可能是由自然或手术引起的绝经时间所驱动。初潮年龄过早也与 CVD 风险增加相关。
