Early menopause predicts future coronary heart disease and stroke:  the Multi-Ethnic Study of Atherosclerosis.
OBJECTIVE
Cardiovascular disease is the number one killer of women. Identifying women at risk of cardiovascular disease has tremendous public health importance. Early menopause is associated with increased cardiovascular disease events in some predominantly white populations, but not consistently. Our objective was to determine if self-reported early menopause (menopause at an age <46 y) identifies women as at risk for future coronary heart disease or stroke.


METHODS
The study population came from the Multi-Ethnic Study of Atherosclerosis, a longitudinal, ethnically diverse cohort study of US men and women aged 45 to 84 years enrolled in 2000-2002 and followed up until 2008. The association between a personal history of early menopause (either natural menopause or surgical removal of ovaries at an age <46 y) and future coronary heart disease and stroke was assessed in 2,509 women (ages 45-84 y; 987 white, 331 Chinese, 641 black, and 550 Hispanic) from the Multi-ethnic Study Atherosclerosis who were free of cardiovascular disease at baseline.


RESULTS
Of 2,509 women, 693 (28%) reported either surgical or natural early menopause. In survival curves, women with early menopause had worse coronary heart disease and stroke-free survival (log rank P = 0.008 and P = 0.0158). In models adjusted for age, race/ethnicity, Multi-ethnic Study Atherosclerosis site, and traditional cardiovascular disease risk factors, this risk for coronary heart disease and stroke remained (hazard ratio, 2.08; 95% CI, 1.17-3.70; and hazard ratio, 2.19; 95% CI, 1.11-4.32, respectively).


CONCLUSIONS
Early menopause is positively associated with coronary heart disease and stroke in a multiethnic cohort, independent of traditional cardiovascular disease risk factors.
Department of Medicine & Obstetrics, University of Alabama, Birmingham, AL 35249-7333, USA. mwellons@uab.edu
Melissa
M
Wellons
Pamela
P
Ouyang
Pamela J
PJ
Schreiner
David M
DM
Herrington
Dhananjay
D
Vaidya
D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D044383:Black People; D015331:Cohort Studies; D003327:Coronary Disease / Q000208:ethnology*; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006630:Hispanic or Latino; D006801:Humans; D008137:Longitudinal Studies; D008593:Menopause; D008594:Menopause, Premature; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000208:ethnology*; D013997:Time Factors; D014481:United States; D044465:White People; D001741:Black or African American