TY - JOUR
T1 - Association between Reproductive Life Span and Incident Nonfatal Cardiovascular Disease
T2 - A Pooled Analysis of Individual Patient Data from 12 Studies
AU - Mishra, Shiva R.
AU - Chung, Hsin Fang
AU - Waller, Michael
AU - Dobson, Annette J.
AU - Greenwood, Darren C.
AU - Cade, Janet E.
AU - Giles, Graham G.
AU - Bruinsma, Fiona
AU - Simonsen, Mette Kildevæld
AU - Hardy, Rebecca
AU - Kuh, Diana
AU - Gold, Ellen B.
AU - Crawford, Sybil L.
AU - Derby, Carol A.
AU - Matthews, Karen A.
AU - Demakakos, Panayotes
AU - Lee, Jung Su
AU - Mizunuma, Hideki
AU - Hayashi, Kunihiko
AU - Sievert, Lynnette L.
AU - Brown, Daniel E.
AU - Sandin, Sven
AU - Weiderpass, Elisabete
AU - Mishra, Gita D.
N1 - Funding Information:
being director of Spin-Out Company Dietary Assessment Ltd. Dr Giles reports grants from National Health and Medical Research Council during the conduct of the study. Dr Hardy reports grants from UK Medical Research Council and UK Economic and Social Research Council during the conduct of the study. Dr Kuh reports grants from UK Medical Research Council during the conduct of the study. Dr Gold reports grants from National Institute on Aging during the conduct of the study. Dr Crawford reports grants from National Institutes of Health during the conduct of the study. Dr Derby reports grants from National Institutes of Health during the conduct of the study. Dr Hayashi reports grants from Japan Society for the Promotion of Science and Japan Agency for Medical Research and Development outside the submitted work. Dr Sievert reports grants from National Institutes of Health during the conduct of the study. Dr Brown reports grants from National Institutes of Health during the conduct of the study. No other disclosures were reported.
Funding Information:
Funding/Support: The InterLACE project is funded
Funding Information:
by the Australian National Health and Medical Research Council Project Grant (APP1027196). Dr Mishra is supported by the Australian National Health and Medical Research Council Principal Research Fellowship (APP1121844). A full acknowledgement list is available in the eAppendix in the Supplement.
Funding Information:
eAppendix. Acknowledgments The data on which this research is based were drawn from 12 observational studies. The research included data from the ALSWH, the University of Newcastle, Australia, and the University of Queensland, Australia. We are grateful to the Australian Government Department of Health for funding and to the women who provided the survey data. The Melbourne Collaborative Cohort Study (MCCS) cohort recruitment was funded by VicHealth and Cancer Council Victoria. The MCCS was further augmented by Australian National Health and Medical Research Council grants 209057, 396414 and 1074383 and by infrastructure provided by Cancer Council Victoria. Cases and their vital status were ascertained through the Victorian Cancer Registry and the Australian Institute of Health and Welfare, including the National Death Index and the Australian Cancer Database. DNCS was supported by the National Institute of Public Health, Copenhagen, Denmark. NSHD has core funding from the UK Medical Research Council (MC UU 12019/1). NCDS is funded by the UK Economic and Social Research Council. ELSA is funded by the National Institute on Aging (Grants 2RO1AG7644 and 2RO1AG017644-01A1) and a consortium of UK government departments coordinated by the Office for National Statistics. UKWCS was originally funded by the World Cancer Research Fund. HILO was supported by NIH grant 5 S06 GM08073-26. Baseline survey of the JNHS was supported in part by a Grant-in-Aid for Scientific Research (B: 14370133, 18390195) from the Japan Society for the Promotion of Science, and by the grants from the Japan Menopause Society. This research has been conducted using the UK Biobank resource under application 26629.
Publisher Copyright:
© 2020 American Medical Association. All rights reserved.
PY - 2020/12
Y1 - 2020/12
N2 - Importance: Early menarche and early menopause are associated with increased risk of cardiovascular disease (CVD) in midlife, but little is known about the association between reproductive life span and the risk of CVD. Objective: To investigate the association between the length of reproductive life span and risk of incident CVD events, while also considering the timing of menarche and menopause. Design, Setting, and Participants: Individual-level data were pooled from 12 studies participating in the International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease Events consortium. Women provided complete information on the timing of menarche and menopause, nonfatal CVD events, and covariates. Cox proportional hazards models were used to estimate hazard ratios and 95% CIs, adjusted for covariates. The association between reproductive life span and CVD was adjusted for age at menarche and age at menopause separately. Analysis began March 2018 and ended December 2019. Exposures: Reproductive life span was calculated by subtracting age at menarche from age at menopause and categorized as younger than 30, 30 to 32, 33 to 35, 36 to 38 (reference group), 39 to 41, 42 to 44, and 45 years or older. Main Outcomes and Measures: First nonfatal CVD event, including coronary heart disease and stroke events. Results: A total of 307855 women were included. Overall, the mean (SD) ages at menarche, menopause, and reproductive life span were 13.0 (1.5) years, 50.2 (4.4) years, and 37.2 (4.6) years, respectively. Pooled analyses showed that women with a very short reproductive life span (<30 years) were at 1.71 (95% CI, 1.58-1.84) times higher risk of incident CVD events than women with a reproductive life span of 36 to 38 years after adjustment for covariates. This association remained unchanged when adjusted for age at menarche but was attenuated to 1.26 (95% CI, 1.09-1.46) when adjusted for age at menopause. There was a significant interaction between reproductive life span and age at menarche associated with CVD risk (P <.001). Women who had both short reproductive life span (<33 years) and early menarche (age ≤11 years) had the highest risk of CVD (hazard ratio, 2.06; 95% CI, 1.76-2.41) compared with those with a reproductive life span of 36 to 38 years and menarche at age 13 years. Conclusions and Relevance: Short reproductive life span was associated with an increased risk of nonfatal CVD events in midlife, and the risk was significantly higher for women with early age at menarche.
AB - Importance: Early menarche and early menopause are associated with increased risk of cardiovascular disease (CVD) in midlife, but little is known about the association between reproductive life span and the risk of CVD. Objective: To investigate the association between the length of reproductive life span and risk of incident CVD events, while also considering the timing of menarche and menopause. Design, Setting, and Participants: Individual-level data were pooled from 12 studies participating in the International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease Events consortium. Women provided complete information on the timing of menarche and menopause, nonfatal CVD events, and covariates. Cox proportional hazards models were used to estimate hazard ratios and 95% CIs, adjusted for covariates. The association between reproductive life span and CVD was adjusted for age at menarche and age at menopause separately. Analysis began March 2018 and ended December 2019. Exposures: Reproductive life span was calculated by subtracting age at menarche from age at menopause and categorized as younger than 30, 30 to 32, 33 to 35, 36 to 38 (reference group), 39 to 41, 42 to 44, and 45 years or older. Main Outcomes and Measures: First nonfatal CVD event, including coronary heart disease and stroke events. Results: A total of 307855 women were included. Overall, the mean (SD) ages at menarche, menopause, and reproductive life span were 13.0 (1.5) years, 50.2 (4.4) years, and 37.2 (4.6) years, respectively. Pooled analyses showed that women with a very short reproductive life span (<30 years) were at 1.71 (95% CI, 1.58-1.84) times higher risk of incident CVD events than women with a reproductive life span of 36 to 38 years after adjustment for covariates. This association remained unchanged when adjusted for age at menarche but was attenuated to 1.26 (95% CI, 1.09-1.46) when adjusted for age at menopause. There was a significant interaction between reproductive life span and age at menarche associated with CVD risk (P <.001). Women who had both short reproductive life span (<33 years) and early menarche (age ≤11 years) had the highest risk of CVD (hazard ratio, 2.06; 95% CI, 1.76-2.41) compared with those with a reproductive life span of 36 to 38 years and menarche at age 13 years. Conclusions and Relevance: Short reproductive life span was associated with an increased risk of nonfatal CVD events in midlife, and the risk was significantly higher for women with early age at menarche.
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U2 - 10.1001/jamacardio.2020.4105
DO - 10.1001/jamacardio.2020.4105
M3 - Article
C2 - 32936210
AN - SCOPUS:85091918063
VL - 5
SP - 1410
EP - 1418
JO - JAMA Cardiology
JF - JAMA Cardiology
SN - 2380-6583
IS - 12
ER -
