title: Age of natural menopause and atrial fibrillation: the Framingham Heart Study.
abstract: BACKGROUND
  Early menopausal age is associated with risk of cardiovascular events including myocardial infraction, stroke, and increased mortality. Relations between menopausal age and atrial fibrillation (AF) have not been investigated. We examined the association between menopausal age and AF.
  
  
  METHODS
  Framingham Heart Study women ≥ 60 years old without prevalent AF and natural menopause were followed up for 10 years or until incident AF. Menopausal age was modeled as a continuous variable and by categories (<45, 45-53, and >53 years). We used Cox proportional hazards regression to determine associations between menopausal age and AF risk.
  
  
  RESULTS
  In 1,809 Framingham women (2,662 person-examinations, mean baseline age 71.4 ± 7.6 years, menopausal age 49.8 ± 3.6 years), there were 273 unique participants with incident AF. We did not identify a significant association between the SD of menopausal age (3.6 years) and AF (hazard ratio [HR] per SD 0.94, 95% CI 0.83-1.06; P = .29). In a multivariable model with established risk factors for AF, menopausal age was not associated with incident AF (HR per SD 0.97, 95% CI 0.86-1.09; P = .60). Examining categorical menopausal age, earlier menopausal age (<45 years) was not significantly associated with increased AF risk compared with older menopausal age >53 years (HR 1.20, 95% CI 0.74-1.94; P = .52) or menopausal age 45 to 53 years (HR 1.38, 95% CI 0.93-2.04; P = .11).
  
  
  CONCLUSIONS
  In our moderate-sized, community-based sample, we did not identify menopausal age as significantly increasing AF risk. However, future larger studies will need to examine whether there is a small effect of menopausal age on AF risk.
authors.affiliation: National Heart, Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA, USA. jmagnani@bu.edu
authors.forename: Jared W
authors.initials: JW
authors.lastname: Magnani
authors.forename: Carlee B
authors.initials: CB
authors.lastname: Moser
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Murabito
authors.forename: Kerrie P
authors.initials: KP
authors.lastname: Nelson
authors.forename: Joao D
authors.initials: JD
authors.lastname: Fontes
authors.forename: Steven A
authors.initials: SA
authors.lastname: Lubitz
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Sullivan
authors.forename: Patrick T
authors.initials: PT
authors.lastname: Ellinor
authors.forename: Emelia J
authors.initials: EJ
authors.lastname: Benjamin
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000503:physiopathology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008593:Menopause / Q000502:physiology*; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors