Abstract
BackgroundIt is unclear whether age at menarche is an independent determinant of future cardiovascular risk. ObjectiveWe aimed to determine whether menarcheal age is an independent predictor of body mass index (BMI) and a wide range of cardiovascular risk factors in adolescence and adulthood. DesignWe examined the associations of menarcheal age with BMI (in kg/m2) and other cardiovascular risk factors in adolescence and adulthood in a population-based sample of 794 female adolescents aged 9–18 y at baseline. Their age at first menstruation was requested at baseline and again 3 and 6 y later. Cardiovascular risk factors were assessed at baseline and at age 30–39 y. ResultsA 1-y decrease in menarcheal age was associated with 0.81 (95% CI: 0.53, 1.08) higher adult BMI as well as greater waist circumference and waist-to-hip ratio, elevated systolic blood pressure, higher insulin resistance, and greater risk of metabolic syndrome (P < 0.05 for all). In multivariable analysis in which these adult risk factors were mutually adjusted for, only the inverse association between age at menarche and adult BMI remained. However, this inverse association was lost after adjustment for premenarcheal BMI (β: −0.16; 95% CI −0.55, 0.23; P = 0.42). Higher premenarcheal BMI predicted earlier menarche, and the strong association between premenarcheal BMI and adult BMI was robust to adjustment for age at menarche. ConclusionsThese findings suggest that early menarche is only a risk marker. Greater childhood BMI seems to contribute to earlier age at menarche and, because of tracking, greater adult BMI and associated cardiovascular risk. An independent effect of early menarche on adult adiposity cannot be excluded, but it is likely to be small at best.
Highlights
Many studies show that girls with earlier age at menarche tend to have worse cardiovascular risk factor levels in adulthood than those who underwent menarche at a later age [1,2,3,4,5,6,7,8,9,10,11]
The most consistent evidence relates to higher adult body mass index (BMI; in kg/m2) in women who had on average earlier menarche (1, 2, 6 – 8, 10, 12), but an inverse association of menarcheal age has been reported with blood pressure [6], glucose intolerance [6], and risk of ischemic heart disease and stroke [4, 5, 13, 14]
A multivariable model including all premenarcheal cardiovascular factors as predictors of adult BMI provided little evidence for additional confounding by premenarcheal blood pressure, lipid concentrations, or parental socioeconomic position ( for age at menarche: Ҁ0.16; P ҃ 0.42 in a model adjusted for age and premenarcheal BMI and Ҁ0.15; P ҃ 0.47 in a model adjusted for other premenarcheal cardiovascular risk factors among the 334 women with no missing data on premenarcheal risk factors). This population-based study suggests that age at menarche is associated with adult BMI and associated risk factors, but we obtained no support for the interpretation that these associations would reflect an independent effect of early menarche on worse cardiovascular risk factor levels in adulthood
Summary
Many studies show that girls with earlier age at menarche tend to have worse cardiovascular risk factor levels in adulthood than those who underwent menarche at a later age [1,2,3,4,5,6,7,8,9,10,11]. If the associations are largely driven by prepubertal risk factors, such targeting would not result in public health benefit The latter is plausible because it is known that greater adiposity in childhood and factors that promote the accumulation of body fat are associated with an earlier age at menarche (8, 16 –19) and that greater adiposity tracks from childhood to adulthood [11]. Other exposures occurring before puberty that are associated both with younger age at menarche and greater adult adiposity (eg, familiar socioeconomic adversity and intrauterine influences) may result in such spurious associations (20 –23) It is unclear whether age at menarche is an independent determinant of future cardiovascular risk.
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