Age at Menopause and Extent of Coronary Artery Disease Among Postmenopausal Women with Acute Coronary Syndromes.
BACKGROUND
Epidemiological studies have shown a higher risk of cardiovascular mortality associated with early menopause, but the relation between menopausal age and extent of coronary artery disease after menopause is unknown. We assessed the relation between menopausal age and extent of coronary disease in postmenopausal women with an acute coronary syndrome.


METHODS
A prospective study was conducted in patients ≥55 years old undergoing coronary angiography for an acute coronary syndrome. Enrollment was stratified by sex (women/men ratio 2:1) and age (55-64, 65-74, 75-85, and >85 years). Women were administered menopause questionnaires during admission. An independent core lab quantified coronary artery disease extent using the Gensini Score, which classifies both significant (>50%) and nonsignificant lesions. Linear correlation was used to appraise the association between the Gensini score and menopausal age.


RESULTS
We enrolled 675 patients, 249 men and 426 women (mean age 74 years). The mean Gensini score was 60 ± 36 in men vs 50 ± 32 in women (P <.001), being higher among men at any age. The median menopausal age of women was 50 years. Risk factors and age at first acute coronary syndrome were identical among women below and above the median menopausal age. The Gensini score in women showed a weak association with age (R = 0.127; P = .0129), but not with menopausal age (R = 0.063; P = .228). At multivariable analysis, ejection fraction, female sex, and ST elevation myocardial infarction were independent predictors of the Gensini score in the overall population.


CONCLUSIONS
Menopausal age was not associated with the extent of coronary artery disease. Age at first acute coronary syndrome presentation, risk factors, and prior cardiovascular events were not affected by menopausal age. (The LADIES ACS study: NCT01997307).
Division of Cardiology, Ospedale Manzoni, Lecco, Italy. Electronic address: s.savonitto@asst-lecco.it.
Stefano
S
Savonitto
Clinical Pharmacology, Milan, Italy.
Delia
D
Colombo
Division of Cardiology, Ospedale Infermi, Rimini, Italy.
Nicoletta
N
Franco
Division of Cardiology, Ospedale della Misericordia, Grosseto, Italy.
Leonardo
L
Misuraca
Division of Cardiology, Ospedale Manzoni, Lecco, Italy.
Laura
L
Lenatti
Division of Cardiology, Ospedale Manzoni, Lecco, Italy.
Ilaria J
IJ
Romano
Cardiologia Prima, Emodinamica, Ospedale Niguarda, Milano, Italy.
Nuccia
N
Morici
Division of Cardiology, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy.
Emilia
E
Lo Jacono
Division of Cardiology, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy.
Chiara
C
Leuzzi
Cardiovascular Department, Humanitas Clinical and Research Center, Rozzano, Italy.
Elena
E
Corrada
Division of Cardiology, Ospedale Mauriziano, Torino, Italy.
Tiziana C
TC
Aranzulla
Cardiovascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
A Sonia
AS
Petronio
Clinical Pharmacology, Milan, Italy.
Gilberto
G
Bellia
Division of Cardiology, Ospedale Belcolle, Viterbo, and Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy.
Enrico
E
Romagnoli
Department of Obstetrics, Gynecology and Pediatricss, Obstetrics and Gynecology Unit, Azienda Ospedaliero-Universitaria of Modena, Italy.
Angelo
A
Cagnacci
Department of Medico Surgical Sciences and Biotechnology, Sapienza University of Rome, Latina, Italy.
Giuseppe Biondi
GB
Zoccai
Division of Cardiology, Ospedale San Giovanni Addolorata, and Centro per la Lotta contro l' Infarto - CLI Foundation, Roma, Italy.
Francesco
F
Prati
D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D016014:Linear Models; D008593:Menopause; D008875:Middle Aged; D017698:Postmenopause; D011446:Prospective Studies; D012720:Severity of Illness Index
Atherosclerosis; Coronary angiography; Coronary artery disease; Menopause