Age at period cessation and trajectories of cardiovascular risk factors across mid and later life

Abstract

Objective: To examine the association between age at period cessation and trajectories of anthropometry, blood pressure, lipids and glycated haemoglobin (HbA1c) from midlife to age 69 years.

Methods: We used data from the UK Medical Research Council National Survey of Health and Development to examine the association between age at period cessation and trajectories of systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI) and waist circumference (WC) from 36 to 69 years and trajectories of triglyceride, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and HbA1c from 53 to 69 years.

Results: We found no evidence that age at period cessation was associated with trajectories of log triglyceride, LDL-C and HDL-C from 53 to 69 years and trajectories of SBP or DBP from 36 to 69 years, regardless of whether period cessation occurred naturally or due to hysterectomy. While we found some evidence of associations of age at period cessation with log BMI, log WC and log HbA1c, patterns were not consistent and differences were small at age 69 years, with confidence intervals that spanned the null value.

Conclusion: How and when women experience period cessation is unlikely to adversely affect conventional cardiovascular risk factors across mid and later life. Women and clinicians concerned about the impact of type and timing of period cessation on conventional cardiovascular intermediates from midlife should be reassured that the impact over the long term is small.

Keywords: cardiac risk factors and prevention; epidemiology.

Figure 1

Mean predicted confounder adjusted trajectories of SBP, DBP, log BMI and log WC from 36 to 69 years, by age at natural menopause. BMI and WC are natural log transformed. Trajectories adjusted for socioeconomic position, parity, time-varying hormone replacement therapy use, age at menarche, BMI at age 36 (SBP and DBP only), smoking at age 36, and physical activity at age 36. Trajectories for the 75th (age 52, green line), median (age 50, red line) and 25th percentile (age 49, blue line) of age at period cessation among women with a natural menopause. BMI, body mass index; CI, 95% confidence interval; DBP, diastolic blood pressure; SBP, systolic blood pressure; WC, waist circumference.

Figure 2

Mean predicted confounder adjusted trajectories of SBP, DBP, log BMI and log WC from 36 to 69 years, by age at hysterectomy. Trajectories adjusted for socioeconomic position, parity, time-varying hormone replacement therapy use, age at menarche, BMI at age 36 (SBP and DBP only), smoking at age 36, and physical activity at age 36. Trajectories for the 75th (age 49, green line), median (age 45, red line) and 25th percentile (age 40, blue line) of age at period cessation among women with hysterectomy. BMI, body mass index; CI, 95% confidence interval; DBP, diastolic blood pressure; SBP, systolic blood pressure; WC, waist circumference.

Figure 3

Mean predicted confounder adjusted trajectories of lipids and HbA1c from 53 to 69 years, by age at natural menopause. HbA1c and triglyceride are natural log transformed. Trajectories adjusted for socioeconomic position, parity, time-varying hormone replacement therapy use, age at menarche, BMI at age 36, smoking at age 36, and physical activity at age 36. Trajectories for the 75th (age 52, green line), median (age 50, red line) and 25th percentile (age 49, blue line) of age at period cessation among women with a natural menopause. BMI, body mass index; CI, 95% confidence interval; HbA1c, glycated haemoglobin; HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol.

Figure 4

Mean predicted confounder adjusted trajectories of lipids and HbA1c from 53 to 69 years, by age at hysterectomy. HbA1c and triglyceride are natural log transformed. Trajectories adjusted for socioeconomic position, parity, time-varying hormone replacement therapy use, age at menarche, BMI at age 36, smoking at age 36, and physical activity at age 36. Trajectories for the 75th (age 49, green line), median (age 45, red line) and 25th percentile (age 40, blue line) of age at period cessation among women with hysterectomy. BMI, body mass index; CI, 95% confidence interval; HbA1c, glycated haemoglobin; HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol.

Figure 5

Mean predicted confounder adjusted trajectories of SBP, DBP, log BMI and log WC from 36 to 69 years, by type of period cessation. Trajectories adjusted for socioeconomic position, age at period cessation, parity, time-varying hormone replacement therapy use, age at menarche, BMI at age 36 (SBP and DBP only), smoking at age 36, and physical activity at age 36. BMI, body mass index; CI, 95% confidence interval; DBP, diastolic blood pressure; SBP, systolic blood pressure; WC, waist circumference.

Figure 6

Mean predicted confounder adjusted trajectories of lipids and HbA1c from 53 to 69 years, by type of period cessation. HbA1c and triglyceride are natural log transformed. Trajectories adjusted for socioeconomic position, age at period cessation, parity, time-varying hormone replacement therapy use, age at menarche, BMI at age 36, smoking at age 36, and physical activity at age 36. BMI, body mass index; CI, 95% confidence interval; HbA1c, glycated haemoglobin; HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol.