The association of surgical versus natural menopause with future left ventricular structure and function: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Abstract

OBJECTIVE Evaluate the association between surgical (SM) versus natural menopause (NM) in relation to later left ventricular (LV) structure and function, while taking into account the LV parameters and other cardiovascular disease risk factor (CVDRF) levels that predates the menopausal transition. METHODS We studied 825 premenopausal women from the CARDIA study in 1990–1991 (baseline, mean age: 32 years) who later reached menopause by 2010–2011 and had echocardiograms at these two time points. RESULTS During 20 years of follow up, 508 women reached NM while 317 underwent SM (34% had bilateral oophorectomy (BSO)). At baseline, women who later underwent SM were more likely to be black, younger, have greater parity and higher mean values of systolic blood pressure, body mass index as well as lower mean HDL cholesterol and physical activity than women who reached NM. No significant differences in LV structure/function were found between groups. In 2010–2011, SM women had significantly higher LV mass, LV mass/volume ratio, E/e′ ratio, and impaired longitudinal and circumferential strain than NM women. SM women with BSO had adverse LV measures than women with hysterectomy with ovarian conservation. Controlling for baseline echocardiographic parameters and CVDRF in linear regression models eliminated these differences between groups. Further adjustment for age at menopause/surgery and hormone therapy use did not change these results. CONCLUSION In this study, the adverse LV structure and function observed among women with SM compared to NM were explained by their unfavorable presurgical CVDRF profiles, suggesting that premenopausal CVDRF rather than gynecologic surgery predispose SM women to elevated future cardiovascular disease risk.

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

“…Additionally, the study by Ying et al 15 included women who had natural or surgical menopause. As shown in a previous CARDIA study, 35 women who have surgical menopause tend to have adverse parameters of LV structure and function compared with women who reached natural menopause.…”

The effects of estrogen deficiency and aging on myocardial deformation and motion in normotensive female rats

“…In this study, the CVD risk factors were shown to be more important determinants of adverse cardiac geometry than the loss of estrogen. 35 Conventional measures of systolic function, including ejection fraction and fractional shortening, were preserved following ovariectomy in the present study. Previous models of estrogen loss by ovariectomy have also reported preserved systolic function.…”

NT-pro B-type natriuretic peptide, early menopause, and incident heart failure in postmenopausal women of the ARIC study

“…Consequently, we surmised that nonhormonal factors concurrently impact NT-proBNP elevation and HF development in postmenopausal women and the relative contributions of hormonal and nonhormonal factors may vary for women who have experienced natural or surgical menopause. In the Coronary Artery Risk Development in Young Adults Study, an unfavorable CVD risk profile before surgical menopause was contributory to future changes in LV structure and function 38 . In the Tehran glucose and lipid study, the cardiometabolic abnormalities seen in the postmenopausal period were influenced by the type of menopause and were more prevalent in women with surgical menopause 39 .…”

“…In the Coronary Artery Risk Development in Young Adults Study, an unfavorable CVD risk profile before surgical menopause was contributory to future changes in LV structure and function. 38 In the Tehran glucose and lipid study, the cardiometabolic abnormalities seen in the postmenopausal period were influenced by the type of menopause and were more prevalent in women with surgical menopause. 39 This evidence was countered by Matthews et al in the Study of Women's Health across the Nation where the type of menopause was not a determinant of CVD risk status either before or after the onset of menopause.…”