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Age at Menarche and Risks of Coronary Heart and Other Vascular Diseases in a Large UK Cohort.

Canoy D, Beral V, Balkwill A, Wright FL, Kroll ME, Reeves GK, Green J, Cairns BJ; Million Women Study Collaborators.

Circulation 2015:131:237-44.

BACKGROUND:

-Early menarche has been associated with increased risk of coronary heart disease (CHD) but most studies were relatively small and could not assess risk across a wide range of menarcheal ages; few have examined associations with other vascular diseases. We examined coronary, cerebrovascular and hypertensive disease risks by age at menarche in a large prospective study of UK women.

METHODS AND RESULTS:

-In 1.2 million women (mean age=56 [SD5] years) without prior heart disease, stroke, or cancer, menarcheal age was reported to be 13 years by 25%; ≤10 years by 4%; and ≥17 years by 1%. After 11.6 years of follow-up, 73,378 women had first hospitalization or death for CHD; 25,426 for cerebrovascular disease; and 249,426 for hypertensive disease. Using Cox regression, we calculated relative risks for each vascular outcome by single year of menarcheal age. The relationship was U-shaped for CHD: compared to women with menarche at 13 years, the adjusted relative risk for CHD for menarche at ≤10 years was 1.27 (95% CI 1.22 to 1.31; P<0.0001); and for menarche at ≥17 years was 1.23 (95% CI 1.16 to 1.30; P<0.0001). U-shaped relationships were also seen for cerebrovascular and hypertensive disease, although the magnitudes of these risks for early and late menarche were smaller than those for CHD.

CONCLUSIONS:

-In this cohort, the relation of age at menarche to vascular disease risk was U-shaped, with both early and late menarche being associated with increased risk. Associations were weaker for cerebrovascular and hypertensive disease than for CHD.

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