Elsevier

American Heart Journal

Volume 229, November 2020, Pages 138-143
American Heart Journal

Research Letter
Menopausal age and left ventricular remodeling by cardiac magnetic resonance imaging among 14,550 women

https://doi.org/10.1016/j.ahj.2020.08.005Get rights and content

The present study included 14,550 postmenopausal female participants in the UK Biobank who completed cardiac magnetic resonance imaging. Earlier age at menopause was significantly and independently associated with smaller left ventricular end-diastolic volume and smaller stroke volume, a pattern suggesting acceleration of previously described age-related left ventricular remodeling. These findings may have implications for understanding mechanisms of heart failure, specifically heart failure with preserved ejection fraction, among women with early menopause.

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Methods

We included women in the observational UK Biobank who completed cardiac magnetic resonance (CMR) imaging5 and who were 50-75 years old and postmenopausal at the time of CMR. Age at menopause, age at menarche, parity, and menopausal hormone therapy (MHT) use were ascertained by participant self-report. Women with both natural (ie, spontaneous) menopause and surgical menopause were included. Women who were premenopausal, had missing or unknown age at menopause, or had congenital heart disease

Results

Among 14,550 women included, mean (SD) age at CMR was 63.9 (6.1) years. Mean (SD) time from study enrollment to CMR was 8.8 (1.7) years. Most women (97.3%) were white. Mean age at menopause was 50.4 (4.5) years. A total of 1,304 women (9.0% of the overall cohort) experienced menopause before age 45 years (378 [2.6%] with surgical menopause and 926 [6.4%] with natural menopause). As expected, women with menopause before age 45 were more likely to have ever used MHT (Table I).

Overall, the mean

Discussion

In the largest study to date of LV volumes versus age at menopause to our knowledge, we find evidence of accelerated LV remodeling in women with earlier menopause as evidenced by small but significant and independent reductions in LVEDV and SV, analogous to previously described age-related alterations.4 In a substudy of the Multi-Ethnic Study of Atherosclerosis, 2,123 postmenopausal women underwent CMR; among Chinese American women, women with menopause before age 45 years had significantly

Acknowledgements

The authors thank Seyedeh M. Zakavat, BS, and Derek Klarin, MD, for critical review of this manuscript. This research was conducted using the UK Biobank Resource under Application Number 7089.

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Funding and disclosures: Dr Honigberg is supported by the National Institutes of Health (T32HL094301-07). Dr Pirruccello is supported by a Harvard Medical School John S. LaDue Memorial Fellowship in Cardiovascular Research. Dr Natarajan is supported by grants from the National Heart, Lung, and Blood Institute (R01HL142711, R01HL148565, R01HL148050); Fondation Leducq (TNE-18CVD04); and a Hassenfeld award from the Massachusetts General Hospital. Dr Natarajan reports grant support from Amgen, Apple, and Boston Scientific; consulting income from Apple; and spousal employment and equity in Vertex, all unrelated to this work.

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