Method:In this longitudinal population-based cohort study all patients aged 18-84 years with a first hospitalization for heart failure (HF) in Sweden 1992Sweden -2008 were identified using the National Inpatient Register (IPR). Longitudinal integration database for health insurance and labour market studies (LISA) is an integration database of several different national registers provided by the Statistics Sweden. Using the Swedish personal identity number (PIN) the IPR was linked to LISA and the Swedish National Register on Cause of Death to obtain information on marital status and education level, and mortality of all causes. Results: A total of 364,675 patients were included in the study. The relative risk of death among HF patients with the lowest educational level was 1.19 (95% CI 1.17-1.21) compared to those with the highest education level. Corresponding result for being unmarried versus married was 1.25 (95% CI 1.23-1.27). The 4-year cumulative survival for patients with low education and unmarried patients was 46.3% and 48.3% respectively.
Early age at menarche has been reported to be associated with increased risks of developing type 2 diabetes (T2D) and coronary heart disease (CHD) in adulthood, but a late menarche has also been found to be associated with an increased risk of CHD. Both T2D and CHD are important risk factors for developing heart failure (HF). We examined the relationship between age at menarche (AAM) and HF incidence in women from the European Prospective Investigation into Cancer and Nutrition-Netherlands (EPIC-NL) cohort study. Methods and results: The EPIC-NL cohort comprised 28,504 women aged 20-70 years at baseline (1993-1997). Mean age at menarche was 13.3 (standard deviation 1.6) years. During a median follow-up of 15.2 years HF occurred in 631 women. Cox proportional hazard regression models, stratified by cohort and adjusted for potential confounders, were used to investigate the associations between AAM and HF incidence. After confounder adjustment, each year of older age at menarche was associated with a 5% lower risk of HF (hazard ratio 0.95 (95% CI, 0.91-1.00), p-value 0.048). Further adjusting for body mass index (BMI), prevalent CHD, hypertension, or prevalent T2D as potential mediators between early menarche and risk of HF attenuated the associations between AAM and risk of HF to non-significance. Conclusion: Older AAM reduced the risk of HF in this study. BMI, prevalent CHD, hypertension and prevalent T2D seemed to mediate this association. Future research with a longer follow-up should establish whether there is an independent effect of AAM on HF risk. Also, further phenotyping of HF cases is necessary to enable whether the associations differ for the various subtypes of HF.
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