Does Adding Premature Menopause Status Improve Prediction of Atherosclerotic Cardiovascular Disease?
BACKGROUND AND PURPOSE:
In 2019 the American College of Cardiology and American Heart Association recognized premature menopause as a risk factor for atherosclerotic cardiovascular disease (ASCVD)
However, most ASCVD risk calculations do not currently include premature menopause
Freaney et al. (JAMA Cardiology, 2021) assessed whether adding premature menopause status improves risk prediction of ASCVD among women
Black and White postmenopausal women
40 to 79 years
Premature menopause occurring at age <40 years
Cox proportional hazards regression models were used to define the association between premature menopause and ASCVD
Adjusted for traditional risk factors (e.g. diabetes, obesity)
Performance of pooled cohort equations used to predict risk of ASCVD
ASCVD: Defined as fatal or nonfatal coronary heart disease or stroke
Black women: 5466 | White women: 10,584
The cohort of black women was older, had a higher prevalence of hypertension, obesity, and diabetes
Premature menopause was more common among Black women
Black women: 17.4%
White women: 9.8%
Premature menopause was significantly associated with ASCVD independent of traditional risk factors, for both Black and White women
Black women: Hazard ratio (HR) 1.24 (95% CI, 1.03 to 1.49)
White women: HR 1.28 (95% CI, 1.13 to 1.45)
There was no incremental benefit in ASCVD risk predictions when premature menopause was added to the pooled cohort equations
In further analyses, similar findings in model performance were observed for women with
Only natural menopause
Only surgical menopause
Age 40 to 54 years
There is an association between premature menopause and ASCVD, consistent with previous studies that have found a similar trend
However, adding premature menopause to ASCVD risk prediction methods did not meaningfully change the ability of the model to predict ASCVD
The authors state
Although the menopausal transition is well established as one of the dynamic hormonal changes that may contribute to accelerated ASCVD risk, this risk appears to be mediated largely by the interim development of traditional risk factors (eg, diabetes and hypertension) in the causal pathway of ASCVD
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