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Observational Study
. 2017 Dec;103(24):1954-1961.
doi: 10.1136/heartjnl-2016-311002. Epub 2017 Oct 7.

Menopausal age, postmenopausal hormone therapy and incident atrial fibrillation

Jorge A Wong  1   2   3 , Kathryn M Rexrode  1 , Roopinder K Sandhu  4 , M Vinayaga Moorthy  1 , David Conen  3   5 , Christine M Albert  1   2
Affiliations
Observational Study

Menopausal age, postmenopausal hormone therapy and incident atrial fibrillation

Jorge A Wong et al. Heart. 2017 Dec.

Abstract

Objective: Limited data exist on the association between menopause and atrial fibrillation (AF). We sought to examine the relationship between menopausal age, postmenopausal hormone therapy (PHT) use and incident AF.

Methods: The Women's Health Study (WHS) enrolled 39 876 female health professionals between 1992 and 1995. We prospectively examined 30 034 women in WHS using Cox proportional-hazard models. Participants were free of cardiovascular disease and AF at baseline and had not undergone hysterectomy without bilateral oophorectomy prior to menopause. Incident AF was confirmed by medical record review.

Results: At baseline, median age was 53 years (IQR 49-60), median menopausal age was 50 years (IQR 46-52) and 14 415 (48.0%) had prior PHT use. Over a median follow-up of 20.5 years, 1350 AF events occurred. In multivariable analysis, relative hazards for AF were lower among women with younger age at menopause but did not differ significantly from women with the oldest menopausal age (<45: HR 0.82, 95% CI 0.67 to 1.02; 45-49: HR 0.90, 95% CI 0.74 to 1.08; 50-54: HR 0.89, 95% CI 0.75 to 1.06; >54 years: referent). Use of oestrogen-alone PHT, but not oestrogen and progesterone, was independently associated with AF risk (HR 1.22; 95% CI 1.02 to 1.45 vs HR 1.04; 95% CI 0.86 to 1.26). This relationship was not attenuated by intermediary cardiovascular events.

Conclusions: In this large prospective study, menopausal age was not significantly related to incident AF, while use of oestrogen monotherapy was associated with increased AF risk. Our findings suggest a pathophysiological link between unopposed oestrogen exposure and AF in women.

Clinical trial registration: NCT000000479; Post-results.

Trial registration: ClinicalTrials.gov NCT00000479.

Keywords: Atrial fibrillation; Epidemiology; Menopausal Age; Menopause; Post-menopausal Hormone Therapy; Women.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Schematic depicting the study population within the Women’s Health Study.
See this image and copyright information in PMC

Comment in

References

    1. Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001;285:2370–5. - PubMed
    1. Benjamin EJ, Levy D, Vaziri SM, et al. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA. 1994;271:840–4. - PubMed
    1. Fang MC, Singer DE, Chang Y, et al. Gender differences in the risk of ischemic stroke and peripheral embolism in atrial fibrillation: the AnTicoagulation and Risk factors In Atrial fibrillation (ATRIA) study. Circulation. 2005;112:1687–91. - PMC - PubMed
    1. Feinberg WM, Blackshear JL, Laupacis A, et al. Prevalence, age distribution, and gender of patients with atrial fibrillation. Analysis and implications. Arch Intern Med. 1995;155:469–73. - PubMed
    1. Olesen JB, Lip GY, Hansen ML, et al. Validation of risk stratification schemes for predicting stroke and thromboembolism in patients with atrial fibrillation: nationwide cohort study. BMJ. 2011;342:d124. - PMC - PubMed

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