SAN DIEGO (EGMN) – Women who go through menopause before the age of 46 are twice as likely to have a heart attack, stroke, or other cardiovascular event later in life as are women who do not go through early menopause, results from a large, multiethnic study showed.

“Our study is observational, so we cannot conclude that early menopause somehow causes these cardiovascular disease events, but our findings support using early menopause as a marker of increased cardiovascular disease risk,” Dr. Melissa F. Wellons said during a press briefing at the annual meeting of the Endocrine Society. “Therefore, getting clinicians to ask women about menopause and about when they went through menopause is an important part of potentially determining what their risk of CVD is in the future. Doing that can give them information on placing these women with early menopause into a higher risk group and counseling them appropriately, such as encouraging them to stop smoking, exercise, and lose weight.”

Dr. Wellons, a fellow in the department of medicine at the University of Alabama, Birmingham, and her associates evaluated data from 2,509 women enrolled in the observational Multi-Ethnic Study of Atherosclerosis (MESA), funded by the National Institutes of Health. It included more than 6,000 women, from six communities in the United States, who were recruited in 2000 and followed for an average of 7 years. Most (40%) were white, 25% were black, 22% were Hispanic, and 13% were Chinese-American.

“Our work is important because previous studies that have found a relationship between early menopause and cardiovascular disease events have taken place in primarily European and white cohorts,” Dr. Wellons noted.

The researchers defined early menopause as occurring before age 46, either naturally or surgically through removal of both ovaries, and they tracked the incidence of CVD among all study participants. This included heart attack, nonfatal cardiac arrest, a definite angina, probable angina (if followed by revascularization), a stroke, or death due to stroke, heart attack, or other cardiovascular disease.

At baseline, the women ranged in age from 45 to 84 years. Of the 2,509 women, 693 (28%) reported early menopause. Of these, 446 (64%) had natural menopause and 247 (36%) had surgical menopause.

In the early menopause group, 41 women (5.9%) had CVD events during the study period. Among those who did not have early menopause, 47 women (2.6%), had CVD events. The difference was statistically significant.

No woman in either group had a CVD event before the age of 55.

After adjusting for race/ethnicity, level of education, smoking history, hypertension, total cholesterol, HDL cholesterol, diabetes, and whether the menopause was natural or surgical, Dr. Wellons and her associates found that women in the early menopause group were 2.1 times more likely to experience a CVD event, compared with women who did not have early menopause. Further adjustment for current or previous use of hormone replacement therapy and body mass index produced identical results.

“The risk of having a heart attack, stroke, or other cardiovascular disease event later in life doubles in women with early menopause,” Dr. Wellons concluded. “We found [this] in a large, U.S., multiethnic cohort, so our findings are generalizable to the U.S. population.”

The study was funded by the U.S. National Heart, Lung, and Blood Institute.

Dr. Wellons was the recipient of an NHLBI Career Development Award.

Copyright (c) 2009 Elsevier Global Medical News. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

圣地亚哥(EGMN)—— 一项大规模、多种族研究的结果表明，在46岁前绝经的女性绝经后出现心脏病发作、卒中或其他心血管事件的几率是那些没有提前绝经的女性的2倍。

 

Melissa F. Wellons博士在美国内分泌学会2010年年会的新闻发布会上说：“由于这是一项观察性研究，所以我们无法得出定论，认定提前绝经通过某种途径导致了这些心血管疾病(CVD)事件，但我们的研究结果支持将提前绝经作为CVD风险增加的标志之一。” Wellons博士说：“因此，临床医生询问女性患者是否绝经以及绝经的时间对于确定其未来CVD潜在风险是很重要的一个组成部分。这样做可以获取到相关信息以便将提前绝经的女性归为高危人群，并向其提供恰当的咨询服务，比如鼓励其戒烟、多锻炼并减轻体重。”

 

美国阿拉巴马大学伯明翰分校医学系的研究员Wellons博士及其同事对观察性动脉粥样硬化多种族研究(MESA)纳入的2,509例女性的数据进行了评估。MESA研究是由美国国立卫生研究院资助的。该研究于2000年从美国的6个社区募集了6,000余例女性，并对其进行了平均为期7年的随访。白种人占多数(40%)，黑种人占25%，西班牙裔人占22%，华裔美国人占13%。

 

Wellons博士指出：“鉴于先前发现提前绝经与CVD事件之间存在关联的研究主要是在欧洲和白种人队列中开展的，因此我们的这项工作显得尤为重要。”

 

研究者将提前绝经定义为46岁前绝经，无论是自然绝经还是因双侧卵巢摘除而手术绝经。研究者对所有受试者的CVD发生率进行了追踪。CVD事件包括心脏病发作、非致命性心跳骤停、已确诊的心绞痛、高度疑似的心绞痛(如果随后接受了血运重建术)、卒中或因卒中、心脏病发作或其他心血管疾病而死亡。

 

这些女性受试者的基线年龄介于45~84岁。在这2,509例女性中，有693例(28%)属于提前绝经。其中446例(64%)为自然绝经，247例(36%)为手术绝经。

 

在提前绝经组中，有41例女性(5.9%)在研究期间出现了CVD事件。而在没有提前绝经的女性受试者中，则有47例(2.6%)出现了CVD事件，差异有统计学意义。

 

两组中无1例女性在55岁之前出现CVD事件。

 

对种族/民族、受教育程度、吸烟史、高血压、总胆固醇、高密度脂蛋白(HDL)胆固醇、糖尿病以及是否为自然绝经或手术绝经等因素进行校正后，Wellons博士及其同事发现，提前绝经组的女性出现CVD事件的几率是没有提前绝经的女性的2.1倍。研究者继而又对目前或曾经使用过激素替代疗法以及体重指数进行校正后，仍然得出了相同的结果。

 

Wellons博士总结道：“提前绝经的女性绝经后出现心脏病发作、卒中或其他心血管疾病事件的风险翻倍。由于我们是在一个大型、美国、多种族队列中得出的这一结果，所以我们的发现普遍适用于美国人群。”

 

该研究由美国国家心肺血液研究所(NHLBI)资助。

 

Wellons博士是NHLBI杰出青年教授奖的获得者。

 

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