Abstract
We conducted a systematic review and meta-analysis to investigate the associations between menarcheal age and all-cause and cardiovascular death. Medline, Embase, Scopus, and Web of Knowledge were searched for articles published prior to March 2013 reporting on the associations between menarcheal age and death from all causes or from cardiovascular disease (total cardiovascular disease, ischemic heart disease (IHD), and stroke) in adult women. Nine articles were eligible for inclusion; these reported 5 estimates each for death from all causes and total cardiovascular death, 6 estimates for IHD, and 7 estimates for death from stroke. Our meta-analysis showed that each 1-year increase in age at menarche was associated with a 3% lower relative risk of death from all causes (pooled hazard ratio = 0.97, 95% confidence interval: 0.96, 0.98) with low heterogeneity (I2 = 32.2%). Meta-analysis of 2 cohorts showed a higher risk of death from all causes for women who experienced early menarche (at <12 years of age) versus “not early” menarche (at ≥12 years of age) (pooled hazard ratio = 1.23, 95% confidence interval: 1.10, 1.38; I2 = 0%). An inverse association between age at menarche and death from IHD was observed only among nonsmoking populations or populations with low prevalence of smoking. We found no evidence of association between age at menarche and death from all cardiovascular diseases or stroke. Early menarche was consistently associated with higher risk of death from all causes. Further studies are needed to clarify the role of menarcheal age on cardiovascular outcomes and to investigate the potential modifying role of smoking.
Highlights
Our meta-analysis showed that each 1-year increase in age at menarche was associated with a 3% lower relative risk of death from all causes with low heterogeneity (I2 = 32.2%)
We identified 821 unique articles, all of which were published in English
We found that the association between menarcheal age and death from all causes was still apparent in studies that adjusted for adult body mass index (BMI), which indicates that mechanisms other than obesity may be involved
Summary
There is a growing body of epidemiologic studies suggesting an association between early menarche and risk factors for cardiovascular disease and metabolic syndrome in both adolescent girls and adult women (2–5). There is evidence for a connection between menarche and morbidity from cardiovascular disease (CVD), with results from meta-analysis suggesting an association between early menarche and higher risk of CVD-related events (risk ratio = 1.15, 95% confidence interval (CI): 1.02, 1.28) (6). A link between the timing of menarche and cardiovascular morbidity has been shown (6), there was insufficient evidence in that earlier review to draw conclusions on the relevance of menarcheal age on other important health outcomes, including death from all causes and from cardiovascular diseases. The aim of the current study was to systematically review and synthesize existing evidence on the association between menarcheal age and the risks of death from all causes and from cardiovascular diseases in women
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