Abstract
BackgroundEarly and late age at menarche are associated with risk of hypertension, but little is known whether modifiable lifestyle can reduce this risk.MethodsOur study leverages 60,135 healthy young Chinese women from the Environmental and LifEstyle FActors iN metabolic health throughout life-course Trajectories (ELEFANT) study. Menarche age and lifestyle factors were assessed by self-reported questionnaires and hypertension was diagnosed by physicians. We estimated the odds ratios (ORs) of hypertension associated with menarche age using multivariable logistic regression. We further investigated whether modifiable lifestyles (body mass index, BMI; psychological stress; passive smoking; and imbalanced diet) increased risk in joint analyses.ResultsThe association between age at menarche and hypertension was U-shaped, with age ≤ 12 at menarche giving the highest OR (1.46, 95% confidence interval [CI], 1.27–1.69) and ≥ 16 the second highest (OR = 1.36, 95% CI = 1.15–1.62). Simultaneous analysis of lifestyle risk factors and age of menarche showed that having one or more modifiable risk factors increased the menarche age-hypertension association. The risk of hypertension among participants with menarche age ≤ 12 decreased from OR 13.21 (95% CI = 5.17–29.36) with four high-risk lifestyle factors to 12.36 (95% CI = 9.51–16.05) with three high-risk factors, 5.24 (95% CI = 4.11–6.69) with two, and 2.76 (95% CI = 2.09–3.60) with one, in comparison to individuals with no high-risk lifestyle factors and menarche age 14.ConclusionsOur results suggest that modification of lifestyle, including maintenance of normal weight and a balanced diet, are associated with substantially reduce the risk of hypertension in high-risk individuals.Plain English summaryEarly and late age at menarche are risk factors for the development of hypertension in Western populations, and there is limited evidence that this is also true of Chinese populations. Targeted prevention of hypertension in vulnerable populations would be highly beneficial in efforts to reduce the incidence of cardiovascular disease, but it is not currently known whether lifestyle intervention could reduce hypertension risk.In this study, we analysed the risk of hypertension by age at menarche and four modifiable lifestyle factors (BMI, diet, psychological stress, and smoking tobacco) in a cohort of 60,135 young adult Chinese women (mean age 29).We identified that early and late age at menarche are associated with increased risk of hypertension in young Chinese women. There was joint effects between age at menarche and lifestyles on hypertension only participants with age at menarche ≤12 and being overweight or obese. Modification of lifestyle, including maintenance of normal weight and a balanced diet, can substantially reduce the risk of hypertension in high-risk individuals.In conclusion, our study has revealed that early and late menarche age are associated with the development of hypertension in young Chinese women, and that this risk is modified by healthy lifestyle traits.
Highlights
And late age at menarche are associated with risk of hypertension, but little is known whether modifiable lifestyle can reduce this risk
We analysed the risk of hypertension by age at menarche and four modifiable lifestyle factors (BMI, diet, psychological stress, and smoking tobacco) in a cohort of 60,135 young adult Chinese women
We identified that early and late age at menarche are associated with increased risk of hypertension in young Chinese (Continued on page)
Summary
And late age at menarche are associated with risk of hypertension, but little is known whether modifiable lifestyle can reduce this risk. And late menarche age are known to be risk factors associated with adult onset diseases, including ischaemic heart disease, and hypertension, and may in part explain sex differences in the risk of cardiovascular disease (CVD) [5,6,7,8]. Healthy lifestyle has been suggested as a long-term approach for the prevention of diseases including hypertension [11], and may ameliorate the increased risk associated with early or late age at menarche. We assessed the risk of hypertension by menarche age and by level of four modifiable lifestyle factors in young adult Chinese women. By estimating the synergistic association of lifestyle factors and age of menarche on hypertension risk, we demonstrate the high-impact potential for intervention to reduce incidence in high-risk individuals
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