Fan Hsien-Yu, Huang Yen-Tsung, Chen Yun-Yu, Hsu Justin BoKai, Li Hung-Yuan, Su Ta-Chen, Lin Hung-Ju, Chien Kuo-Liong, Chen Yang-Ching
Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
Department of Family Medicine, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan.
Front Cardiovasc Med. 2023 Jan 9;9:1023355. doi: 10.3389/fcvm.2022.1023355. eCollection 2022.
Menarche timing may not be directly associated with the risk of coronary artery disease (CAD). Therefore, we investigated the roles of metabolic factors in explaining the effect of age at menarche on CAD risk.
We identified women with age at menarche and CAD by using three analytical methods: Mendelian randomization (MR), logistic regression analysis, and Cox proportional hazard regression. The first two analyses were performed in the Taiwan Biobank ( = 71,923) study, and the last analysis was performed in the Chin-Shan Community Cardiovascular Cohort study ( = 1,598). We further investigated the role of metabolic factors in mediating the effect of age at menarche on CAD risk by using three complementary methods with mediation analyses.
One standard deviation of earlier age at menarche was associated with a 2% higher CAD risk [odds ratio = 1.02, 95% confidence interval (CI) = 1.001-1.03] in the MR analysis, an 11% higher risk (odds ratio = 1.11, 95% CI = 1.02-1.21) in the logistic regression analysis, and a 57% higher risk (hazard ratio = 1.57, 95% CI = 1.12-2.19) in the Cox proportional hazard regression. All the analyses consistently supported the role of systolic blood pressure in mediating this effect. The MR results indicated that 29% (95% CI = 26%-32%) of the effect of genetically predicted earlier age at menarche on CAD risk was mediated by genetically predicted systolic blood pressure.
The results obtained using different analytical methods suggest that interventions aimed at lowering systolic blood pressure can reduce the cases of CAD attributable to earlier age at menarche.
初潮时间可能与冠状动脉疾病（CAD）风险无直接关联。因此，我们研究了代谢因素在解释初潮年龄对CAD风险影响方面的作用。
我们使用三种分析方法确定了有初潮年龄和CAD的女性：孟德尔随机化（MR）、逻辑回归分析和Cox比例风险回归。前两种分析在台湾生物银行（n = 71,923）研究中进行，最后一种分析在金山社区心血管队列研究（n = 1,598）中进行。我们通过使用三种带有中介分析的互补方法，进一步研究了代谢因素在介导初潮年龄对CAD风险影响方面的作用。
在MR分析中，初潮年龄提前一个标准差与CAD风险高2%相关[比值比 = 1.02，95%置信区间（CI）= 1.001 - 1.03]，在逻辑回归分析中风险高11%（比值比 = 1.11，95% CI = 1.02 - 1.21），在Cox比例风险回归中风险高57%（风险比 = 1.57，95% CI = 1.12 - 2.19）。所有分析一致支持收缩压在介导这种影响中的作用。MR结果表明，遗传预测的初潮年龄提前对CAD风险的影响中有29%（95% CI = 26% - 32%）由遗传预测的收缩压介导。
使用不同分析方法获得的结果表明，旨在降低收缩压的干预措施可减少因初潮年龄提前导致的CAD病例。
