The association of age at natural menopause with pre- to postmenopausal changes in left ventricular structure and function: the Coronary Artery Risk Development in Young Adults (CARDIA) study

Abstract

Objective: The association between menopause and incident cardiovascular disease (CVD) is controversial. We evaluated the relationships of estrogen deficiency (ovarian reproductive aging) assessed by age at natural menopause (ANM), chronological aging, and antecedent CVD risk factors (biological aging) with left ventricular (LV) structure and function among women transitioning from pre-to postmenopause.Methods: We studied 771 premenopausal women (37% Black) from the Coronary Artery Risk Development in Young Adults Study with echocardiographic data in 1990 to 1991 (mean age: 32 y) who later reached natural menopause by 2015 to 2016 and had repeated echocardiographic measurements. Linear regression models were used to evaluate the association of ANM with parameters of LV structure and function.Results: Mean ANM was 50 (AE 3.8) years and the average time from ANM to the last echocardiograph was 7 years. In cross-sectional analyses, a 1-year increase in ANM was significantly associated with lower postmenopausal LV mass (LVM), LVM indexed to body surface area, LV mass-to-volume ratio, and relative wall thickness. In age-adjusted longitudinal analyses, higher ANM was inversely associated with pre-to postmenopausal changes in LVM (b ¼ -0.97; 95% CI: -1.81 to -0.13, P ¼ 0.024) and LVM indexed (b ¼ -0.48; 95% CI: -0.89 to -0.07, P ¼ 0.021). Controlling for baseline LV structure parameters and traditional CVD risk factors attenuated these associations. Further adjustment for hormone therapy uses did not alter these results.Conclusion: In this study, premenopausal CVD risk factors attenuated the association of ANM with changes in LV structure parameters. These data suggest that premenopausal CVD risk factors may predispose women to elevated future CVD risk more than ovarian aging.

The correlation of pericoronary adipose tissue with coronary artery disease and left ventricular function

“…Since the parameters of LV function are affected by individual differences [ 46 , 47 ], we analyzed the PCAT and LV function parameters by partial correlation analysis to exclude the effects of interference factors. There was no correlation between PCAT and LV function parameters, but a significant correlation between FAI and LV function parameters existed.…”

The Correlation of Pericoronary Adipose Tissue with Coronary artery disease and left ventricular function

“…Since the parameters of left ventricular function are affected by individual differences [32,33] , we analyzed the PCAT and left ventricular function parameters by using partial correlation analysis to exclude the effects of interference factors. There was no correlation between PCAT and left ventricular function parameters, but a signi cant correlation between FAI and left ventricular function parameters.…”

Women's Reproductive Milestones and Cardiovascular Disease Risk: A Review of Reports and Opportunities From the CARDIA Study

“… 161 , 162 , 163 , 164 One of the most interesting findings from the CARDIA study is that surgical menopause and age at natural menopause after 45 years were not strong predictors of CVD risk factors, subclinical atherosclerosis, or left ventricular indexes once presurgical or premenopausal risk factors were considered. 165 , 166 , 167 , 168 The CARDIA study's reproductive aging reports complement those from studies that enrolled perimenopausal women, such as the SWAN (Study of Women Across the Nation), or perimenopausal and postmenopausal women enrolled in cardiovascular cohorts, such as the ARIC (Atherosclerosis Risk in Communities Study) and MESA (Multi‐Ethnic Study of Atherosclerosis). 169 , 170 The CARDIA study and SWAN have both reported that risk factors are generally less favorable in the postmenopausal period than in the premenopausal period.…”