Early menopause predicts angina after myocardial infarction

Abstract

Objective: Population studies have shown that age at menopause (AAM) predicts coronary heart disease. It is unknown, however, whether early menopause predicts post-myocardial infarction (MI) angina. We examined whether younger AAM increases risk of post-MI angina.

Methods: In a prospective multicenter MI registry, 493 postmenopausal women were enrolled (mean +/- SD age, 65.4 +/- 11.3 y, and mean +/- SD AAM, 45.2 ± 7.8 y). We categorized AAM into 40 years or younger, 41 to 49 years, and 50 years or older. In the multivariable analysis, we examined whether AAM predicted 1-year post-MI angina and severity of angina after adjusting for angina before MI, demographics, comorbidities, MI severity, and quality of care (QOC).

Results: Women with early AAM (> or =40 y; n = 132, 26.8%) were younger and more often smokers but were as likely to have comorbidities as were women with an AAM of 50 years or older. Although there were no differences in pre-MI angina, MI severity, obstructive coronary disease, and QOC based on AAM, the rate of 1-year angina was higher in women with an AAM of 40 years or younger (32.4%) than in women with an AAM of 50 years or older (12.2%). In the multivariable analysis, women with an AAM of 40 years or younger had more than twice the risk of angina (relative risk, 2.09; 95% CI, 1.38-3.17) and a higher severity of angina (odds ratio, 2.65; 95% CI, 1.34-5.22 for a higher severity level) compared with women with an AAM of 50 years or older.

Conclusions: Women with early menopause are at higher risk of angina after MI, independent of comorbidities, severity of MI, and QOC. The use of a simple question regarding AAM may help in the identification of women who need closer follow-up, careful evaluation, and intervention to improve their symptoms and quality of life after MI.

FIG. 1

Risk of angina according to age at menopause. RR, relative risk.

FIG. 2

Predictors of 1-year angina after myocardial infarction in postmenopausal women in the multivariable analysis. SAQ, Seattle Angina Questionnaire; BMI, body mass index; CHD, coronary heart disease; Hx, history; CHF, congestive heart failure; STEMI, ST-elevation myocardial infarction; EF, ejection fraction; JCAHO, Joint Commission on Accreditation of Healthcare Organizations; QOC, quality of care, RR, relative risk.

FIG. 3

Angina severity according to age at menopause. RR, relative risk.