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Early onset of menopause is associated with increased peripheral atherosclerotic plaque volume and progression

Michael Schreinlechnera,∗,’Correspondence information about the author Michael SchreinlechnerEmail the author Michael Schreinlechner, Maria Noflatschera, Sebastian Johannes Reinstadlera, Philip Sommera, Daniela Lenera, Elisabeth Reiserb, Markus Theurla, Rudolf Kirchmaira, Axel Bauera, Peter Marschanga,1

DOI: https://doi.org/10.1016/j.atherosclerosis.2020.01.023

Highlights

•In our study, an earlier onset of menopause (MP) was associated not only with a higher atherosclerotic plaque volume but also accelerated atherosclerotic progression.

•Based on our results, risk stratification for postmenopausal women may be improved by simple, additional anamnestic questions evaluating the onset of MP.

•In females with an earlier onset of MP an adapted strategy to control risk factors more aggressively may be considered.

•Therefore, we suggest the onset of MP as a risk factor unique to women.

Abstract

Background and aims

Cardiovascular disease (CVD) is the leading cause of death in western countries. One risk factor unique to women is the menopausal status. The aim of this study was to analyse the influence of the onset of menopause (MP) on the extent and progression of atherosclerotic plaque volume (PV).

Methods

Postmenopausal women with at least one cardiovascular risk factor (CVRF) but without established CVD were included. Quantification of PV was performed in peripheral arteries using a three – dimensional (3D) ultrasound (US) technique. Follow-up examination to assess PV progression was performed after 19 (±8) months.

Results

110 consecutive postmenopausal women (mean age 65.5) were included. Females with an earlier onset of MP (<45 years) had a significantly higher PV than those with an intermediate (45–52 years) or later onset of menopause (>52 years), irrespective of other CVRF (244 mm³ vs. 193 mm³ vs. 73 mm³, respectively, p = 0.023). In addition, women with an earlier onset of MP had a higher PV progression compared to women with an intermediate or late onset (40 mm³ vs. 35 mm³ vs. 8.5 mm³; p = 0.002, respectively). Moreover, these results were confirmed in multivariate regression, where only onset of MP (OR 0.88; 95%CI 0.81–0.96; p = 0.004) and age (OR 1.06; 95%CI 1.08–1.13; p = 0.025) were significant predictors for a higher atherosclerotic progression.

Conclusions

An earlier onset of MP was associated with an increase in atherosclerotic PV and accelerated progression, independent of other CVRF.