title: Age at menopause and incident heart failure: the Multi-Ethnic Study of Atherosclerosis.
abstract: 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.
authors.affiliation: 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.
authors.forename: Imo A
authors.initials: IA
authors.lastname: Ebong
authors.forename: Karol E
authors.initials: KE
authors.lastname: Watson
authors.forename: David C
authors.initials: DC
authors.lastname: Goff
authors.forename: David A
authors.initials: DA
authors.lastname: Bluemke
authors.forename: Preethi
authors.initials: P
authors.lastname: Srikanthan
authors.forename: Tamara
authors.initials: T
authors.lastname: Horwich
authors.forename: Alain G
authors.initials: AG
authors.lastname: Bertoni
mesh_terms: D001741:Black or African American; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001213:Asian; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology* / Q000208:ethnology; D006630:Hispanic or Latino; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008593:Menopause; D008875:Middle Aged; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology* / Q000208:ethnology; D020257:Ventricular Remodeling; D044465:White People