背景:女性在心血管健康预防中经常被忽视。初潮年龄(AAM)与女性心血管(CVD)疾病有关,并可能被确定为重要的CVD风险因素之一。然而,解决这个问题的全面证据仍然有限。本系统综述和荟萃分析旨在调查初潮早期如何影响全因死亡率的结果。CVD死亡率,总心血管疾病事件,中风(缺血性,出血性,和总行程),冠心病(CHD)。
方法:Cochrane图书馆,MEDLINE,Embase,ScienceDirect,我们在2013年3月至2023年3月期间搜索了GoogleScholar数据库,以调查月经初潮早期发作对CVD事件的影响,最短随访期为5年.观察到特定人群和/或包括基线有CVD病史的女性的研究被排除。纽卡斯尔-渥太华量表用于评估每个队列的偏倚风险。使用风险比将数据呈现为二分测量。I2统计量用于评价所提供数据的异质性。
结果:13个队列包括18626799名女性患者,年龄在43至62.6岁之间。这些报告分别对冠心病(5483298例患者)和全因死亡率(1595878例患者)进行了6次估计,5估计每个总中风(2941321名患者)和心血管疾病死亡率(1706742名患者),4估计每个总CVD事件(3988311名患者)和缺血性卒中(2434580名患者),1估计出血性中风(66104例)。我们的研究发现,在初潮早期,CHD事件显著降低(RR0.57;95%CI0.41-0.78;P<.00001)。以及总卒中(RR0.51;95%CI0.35-0.73;P=.0003),CVD死亡率(RR0.47;95%CI0.22-0.98;P=0.04),总CVD事件(RR0.44;95%CI0.25-0.76;P=.003),缺血性卒中(RR0.31;95%CI0.15-0.61;P<.0008),出血性卒中(RR0.12;95%CI0.07-0.20;P<.00001);全因死亡率无明显升高(RR0.90,95%CI0.76-1.06,P=.20)。
结论:在我们的研究中,早期初潮女性的心血管事件较低;因此,初潮年龄越晚是评估患者CVD风险时需要考虑的潜在危险因素.然而,我们的样本特征是异质的,我们没有考虑其他女性荷尔蒙因素可能导致观察到的CVD结果;因此,需要进一步的研究来澄清。
BACKGROUND: Women are often neglected in cardiovascular health prevention. Age at menarche (AAM) has been linked to cardiovascular (CVD) disease in women and is potentially identified as one of the significant CVD risk factor. However, there is still limited comprehensive evidence addressing this issue. This systematic review and meta-analysis aimed to investigate how early menarche affects the outcome of all-cause mortality, CVD mortality, total cardiovascular disease event, stroke (ischemic, hemorrhagic, and total stroke), and coronary heart disease (CHD).
METHODS: The Cochrane Library, MEDLINE, Embase, ScienceDirect, and Google Scholar databases were searched from March 2013 to March 2023 for cohorts investigating the effect of early onset of menarche on CVD events with a minimum follow-up period of 5 years. Studies that observed specific population and/or included women with a history of CVD at baseline were excluded. The Newcastle-Ottawa scale was used for risk of bias assessment for each cohort included. The data were presented as dichotomous measure using risk ratios. I2 statistics were utilized to evaluate the heterogeneity of presented data.
RESULTS: Thirteen cohorts included 18 626 799 female patients with ages ranging from 43 to 62.6 years. These reported 6 estimates each for CHD (5 483 298 patients) and all-cause mortality (1 595 878 patients), 5 estimates each for total stroke (2 941 321 patients) and CVD mortality (1 706 742 patients), 4 estimates each for total CVD events (3 988 311 patients) and ischemic stroke (2 434 580 patients), and 1 estimate for hemorrhagic stroke (66 104 patients). Our study found that events of CHD were significantly lower in early menarche (RR 0.57; 95% CI 0.41-0.78; P <.00001), as well as total stroke (RR 0.51; 95% CI 0.35-0.73; P =.0003), CVD mortality (RR 0.47; 95% CI 0.22-0.98; P =.04), total CVD events (RR 0.44; 95% CI 0.25-0.76; P =.003), ischemic stroke (RR 0.31; 95% CI 0.15-0.61; P <.0008), and hemorrhagic stroke (RR 0.12; 95% CI 0.07-0.20; P <.00001); and insignificantly higher in all-cause mortality (RR 0.90, 95% CI 0.76-1.06, P =.20).
CONCLUSIONS: In our study, cardiovascular events are lower in women with early menarche; hence, the later age of menarche is a potential risk factor to be considered when assessing CVD risk in a patient. However, our sample characteristics were heterogenous, and we did not consider other female hormonal factors that might potentially contribute to the CVD outcomes observed; thus, further studies are needed to clarify.