Department of Cardiology, Faculty of Medicine, Tarumanagara University, Jakarta, Indonesia.
Sebelas Maret University, Surakarta, Indonesia.
Anatol J Cardiol. 2024 Jul;28(7):329-338. doi: 10.14744/AnatolJCardiol.2024.3996.
Women are often neglected in cardiovascular health prevention. Age at menarche (AAM) has been linked to cardiovascular (CVD) disease in women and is potentially identified as one of the significant CVD risk factor. However, there is still limited comprehensive evidence addressing this issue. This systematic review and meta-analysis aimed to investigate how early menarche affects the outcome of all-cause mortality, CVD mortality, total cardiovascular disease event, stroke (ischemic, hemorrhagic, and total stroke), and coronary heart disease (CHD).
The Cochrane Library, MEDLINE, Embase, ScienceDirect, and Google Scholar databases were searched from March 2013 to March 2023 for cohorts investigating the effect of early onset of menarche on CVD events with a minimum follow-up period of 5 years. Studies that observed specific population and/or included women with a history of CVD at baseline were excluded. The Newcastle-Ottawa scale was used for risk of bias assessment for each cohort included. The data were presented as dichotomous measure using risk ratios. I2 statistics were utilized to evaluate the heterogeneity of presented data.
Thirteen cohorts included 18 626 799 female patients with ages ranging from 43 to 62.6 years. These reported 6 estimates each for CHD (5 483 298 patients) and all-cause mortality (1 595 878 patients), 5 estimates each for total stroke (2 941 321 patients) and CVD mortality (1 706 742 patients), 4 estimates each for total CVD events (3 988 311 patients) and ischemic stroke (2 434 580 patients), and 1 estimate for hemorrhagic stroke (66 104 patients). Our study found that events of CHD were significantly lower in early menarche (RR 0.57; 95% CI 0.41-0.78; P <.00001), as well as total stroke (RR 0.51; 95% CI 0.35-0.73; P =.0003), CVD mortality (RR 0.47; 95% CI 0.22-0.98; P =.04), total CVD events (RR 0.44; 95% CI 0.25-0.76; P =.003), ischemic stroke (RR 0.31; 95% CI 0.15-0.61; P <.0008), and hemorrhagic stroke (RR 0.12; 95% CI 0.07-0.20; P <.00001); and insignificantly higher in all-cause mortality (RR 0.90, 95% CI 0.76-1.06, P =.20).
In our study, cardiovascular events are lower in women with early menarche; hence, the later age of menarche is a potential risk factor to be considered when assessing CVD risk in a patient. However, our sample characteristics were heterogenous, and we did not consider other female hormonal factors that might potentially contribute to the CVD outcomes observed; thus, further studies are needed to clarify.
女性在心血管健康预防方面经常被忽视。初潮年龄（AAM）与女性心血管疾病（CVD）有关，并且可能被认为是一个重要的 CVD 风险因素。然而，目前仍缺乏全面的综合证据来解决这个问题。本系统评价和荟萃分析旨在研究初潮早如何影响全因死亡率、CVD 死亡率、总心血管疾病事件、中风（缺血性、出血性和总中风）和冠心病（CHD）的结局。
从 2013 年 3 月到 2023 年 3 月，我们在 Cochrane 图书馆、MEDLINE、Embase、ScienceDirect 和 Google Scholar 数据库中搜索了队列研究，这些研究调查了初潮早对 CVD 事件的影响，随访时间至少为 5 年。排除了观察特定人群和/或包含基线时有 CVD 病史的女性的研究。使用纽卡斯尔-渥太华量表对纳入的每个队列进行偏倚风险评估。数据以风险比表示为二分类测量。我们使用 I2 统计量评估呈现数据的异质性。
纳入了 13 个队列，共纳入了 18626799 名年龄在 43 至 62.6 岁之间的女性患者。这些队列报告了 CHD（5483298 名患者）和全因死亡率（1595878 名患者）各 6 项估计值，总中风（2941321 名患者）和 CVD 死亡率（1706742 名患者）各 5 项估计值，总心血管疾病事件（3988311 名患者）和缺血性中风（2434580 名患者）各 4 项估计值，以及出血性中风（66104 名患者）各 1 项估计值。我们的研究发现，初潮早的女性发生 CHD（RR 0.57；95%CI 0.41-0.78；P <.00001）、总中风（RR 0.51；95%CI 0.35-0.73；P =.0003）、CVD 死亡率（RR 0.47；95%CI 0.22-0.98；P =.04）、总心血管疾病事件（RR 0.44；95%CI 0.25-0.76；P =.003）、缺血性中风（RR 0.31；95%CI 0.15-0.61；P <.0008）和出血性中风（RR 0.12；95%CI 0.07-0.20；P <.00001）的风险显著降低；而全因死亡率（RR 0.90；95%CI 0.76-1.06；P =.20）则显著升高。
在我们的研究中，初潮早的女性发生心血管事件的风险较低；因此，在评估患者的 CVD 风险时，初潮年龄晚可能是一个需要考虑的潜在风险因素。然而，我们的样本特征存在异质性，我们没有考虑其他可能对观察到的 CVD 结局有潜在贡献的女性激素因素；因此，需要进一步的研究来阐明。
