Malek Angela M, Vladutiu Catherine J, Meyer Michelle L, Cushman Mary, Newman Roger, Lisabeth Lynda D, Kleindorfer Dawn, Lakkur Sindhu, Howard Virginia J
Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.
Department of Obstetrics & Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Prev Med Rep. 2019 Jul 14;15:100955. doi: 10.1016/j.pmedr.2019.100955. eCollection 2019 Sep.
While a mean age at menopause of 51 years has been reported in the United States (U.S.), some U.S. women experience menopause before age 45, possibly increasing risk of cardiovascular mortality; however, the role in all-cause and cerebrovascular-related mortality is unclear. The purpose of this study was to investigate the association between age at menopause and all-cause and cause-specific mortality by race, hormone replacement therapy (HRT) use, and smoking status. REasons for Geographic and Racial Differences in Stroke (REGARDS) is a population-based study of 30,239 participants aged ≥45 years enrolled between 2003 and 2007 of whom 14,361 were postmenopausal women. Age at menopause was defined as <45 (early) or ≥45. All-cause and cause-specific mortality were ascertained through 2013. Cox proportional hazards models estimated hazard ratios (HR) and 95% confidence intervals (CI) for the association between age at menopause and mortality, adjusting for baseline measures. Of 11,287 eligible women (6403 white; 4884 black), mean menopause age was 45.2 (SD 7.9) with 1524 deaths over 7.1 years. Significant interactions were detected between early age at menopause (39%) and HRT use in association with all-cause mortality ( < 0.01), mortality from coronary heart disease ( = 0.06), and mortality from all other causes ( = 0.04). An association between early age at menopause and all-cause mortality was observed among ever-HRT users (HR = 1.31, 95% CI: 1.10-1.56), but not never-HRT users (HR = 1.01, 95% CI: 0.85-1.20). There were no differences in associations examined by race or smoking status. Increased all-cause mortality risk was observed for ever-HRT users with menopause before age 45.
在美国，据报道更年期的平均年龄为51岁，但一些美国女性在45岁之前就经历了更年期，这可能会增加心血管疾病死亡的风险；然而，其在全因死亡率和脑血管相关死亡率中的作用尚不清楚。本研究的目的是按种族、激素替代疗法（HRT）使用情况和吸烟状况，调查更年期年龄与全因死亡率及特定病因死亡率之间的关联。“中风地理和种族差异原因（REGARDS）”研究是一项基于人群的研究，纳入了2003年至2007年间登记的30239名年龄≥45岁的参与者，其中14361名是绝经后女性。更年期年龄定义为<45岁（早发）或≥45岁。通过2013年确定全因死亡率和特定病因死亡率。Cox比例风险模型估计了更年期年龄与死亡率之间关联的风险比（HR）和95%置信区间（CI），并对基线测量值进行了调整。在11287名符合条件的女性（6403名白人；4884名黑人）中，平均绝经年龄为45.2岁（标准差7.9），在7.1年中有1524人死亡。在早发更年期（39%）与HRT使用和全因死亡率（<0.01）、冠心病死亡率（=0.06）以及所有其他原因导致的死亡率（=0.04）之间检测到显著的相互作用。在曾经使用HRT的女性中观察到早发更年期与全因死亡率之间存在关联（HR=1.31，95%CI：1.10-1.56），但在从未使用HRT的女性中未观察到（HR=1.01，95%CI：0.85-1.20）。按种族或吸烟状况检查的关联没有差异。对于45岁之前绝经的曾经使用HRT的女性，观察到全因死亡风险增加。
