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Age at menopause and incident heart failure: the Multi-Ethnic Study of Atherosclerosis

Ebong, Imo A. MD, MS1; Watson, Karol E. MD, PhD2; Goff, David C. Jr MD, PhD3; Bluemke, David A. MD, PhD4; Srikanthan, Preethi MD, MS5; Horwich, Tamara MD, MS2; Bertoni, Alain G. MD, MPH6

doi: 10.1097/GME.0000000000000138
Original Articles
Editorial

Objective: This study aims to evaluate the associations of early menopause (menopause occurring before age 45 years) and age at menopause with incident heart failure (HF) in postmenopausal women. We also explored the associations of early menopause and age at menopause with left ventricular (LV) measures of structure and function in postmenopausal women.

Methods: We included 2,947 postmenopausal women, aged 45 to 84 years without known cardiovascular disease (2000-2002), from the Multi-Ethnic Study of Atherosclerosis. Cox proportional hazards models were used to examine the associations of early menopause and age at menopause with incident HF. In 2,123 postmenopausal women in whom cardiac magnetic resonance imaging was obtained at baseline, we explored the associations of early menopause and age at menopause with LV measures using multivariable linear regression.

Results: Across a median follow-up of 8.5 years, we observed 71 HF events. There were no significant interactions with ethnicity for incident HF (Pinteraction > 0.05). In adjusted analysis, early menopause was associated with an increased risk of incident HF (hazard ratio, 1.66; 95% CI, 1.01-2.73), whereas every 1-year increase in age at menopause was associated with a decreased risk of incident HF (hazard ratio, 0.96; 95% CI, 0.94-0.99). We observed significant interactions between early menopause and ethnicity for LV mass-to-volume ratio (LVMVR; Pinteraction = 0.02). In Chinese-American women, early menopause was associated with a higher LVMVR (+0.11; P = 0.0002), whereas every 1-year increase in age at menopause was associated with a lower LVMVR (−0.004; P = 0.04) at baseline.

Conclusions: Older age at menopause is independently associated with a decreased risk of incident HF. Concentric LV remodeling, indicated by a higher LVMVR, is present in Chinese-American women who experienced early menopause at baseline.

From the 1Department of Medicine, University of Southern California, Los Angeles, CA; 2Division of Cardiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; 3Colorado School of Public Health, Aurora, CO; 4National Institutes of Health/Clinical Center, Bethesda, MD; 5Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; and 6Departments of Medicine and Epidemiology, Wake Forest University School of Medicine, Winston Salem, NC.

Received July 31, 2013; revised and accepted September 24, 2013.

A full list of participating Multi-Ethnic Study of Atherosclerosis investigators and institutions can be found at http://www.mesa-nhlbi.org.

This paper was presented in poster format at the American Heart Association 2013 Scientific Sessions in Dallas, TX.

Funding/support: The Multi-Ethnic Study of Atherosclerosis was supported by contracts N01-HC-95159 through N01-HC-95169 from the National Heart, Lung, and Blood Institute.

Financial disclosure/conflicts of interest: None reported.

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Address correspondence to: Imo A. Ebong, MD, MS, Department of Medicine, University of Southern California, 2020 Zonal Avenue, Los Angeles, CA 90033. E-mail: ebong@usc.edu

© 2014 by The North American Menopause Society.