Abstract P224: The Association of Surgical versus Natural Menopause with Future Left Ventricular Structure and Function: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Abstract

Introduction: The association of surgical and natural menopause (SM and NM, respectively) with CVD outcomes is controversial. We assessed the hypothesis that CVD risk factor levels antecedent to menopause explain differences in future left ventricular (LV) structure and function parameters rather than type of menopause. Methods: We studied 825 premenopausal women (49% black) from the CARDIA study in 1990-1991 (baseline, mean age: 32 years) who later reached menopause by 2010-2011 and had echocardiographs at these two time points. Results: During 20 years of follow up, 508 women reached NM while 317 underwent SM (34% with bilateral oophorectomy). At baseline, women who later underwent SM were more likely to be black, younger, have higher mean values of systolic blood pressure, body mass index as well as lower mean HDL cholesterol, physical activity, parity and years of education. With the exception of race, no statistically significant differences were found by ovarian status among women with SM. In 1990-1991, no differences in LV structure and function were found between women who later reach NM or SM. In 2010-2011, women with SM had significantly higher LV mass, LV mass/volume ratio, E/e’ ratio, and impaired longitudinal and circumferential strain than women with NM (Table 1). No significant differences in these measures were found among SM by ovarian status. Controlling for baseline echocardiographic parameters, demographics, BMI, physical activity, parity, smoking, systolic blood pressure and age at menarche in linear regression models attenuated these differences between groups (Table 1). Further adjustment for age at menopause and hormone therapy use did not change these results. Conclusion: In this study, presurgical CVD risk factors among women with SM attenuated the adverse postsurgical measures of LV structure and function found among such women. These data suggest that premenopausal CVD risk factors rather than gynecologic surgery predispose women with SM to elevated future CVD risk.