Menopause Status and Percutaneous Coronary Intervention.

Abstract

The age at natural menopause (ANM) is considered as an independent risk factor for morbidity and mortality and indicates the transition from a low to a higher risk of coronary heart disease (CHD) in women. The World Health Organization has defined natural menopause as minimum 12 consecutive months of amenorrhea occurring without any surgical intervention or other pathological causes. In the West industrialized populations, the mean ANM is 51 years, and in poor and nonindustrialized populations it is 48 years. However, Zhang et al reported the age of <46 years as early menopause in Chinese women with CHD admitted to the hospital for percutaneous coronary intervention (PCI). Furthermore, Zhang et al observed that the prevalence of early menopause in these women was 25%. The menopause results in reduced production of estrogens as well as increased levels of follicle-stimulating hormone. Besides the genetic effect on the timing of ANM and mother’s age at menopause, environmental factors such as cigarette smoking, nulliparity, and adult socioeconomic position play a role in determining the ANM Cigarette smoking and socioeconomics are also associated, independent of the menopause, with risk factors for cardiovascular (CV) disease. Zhang et al investigated the frequency of major adverse CV events (MACEs) in women who underwent PCI according to the ANM. The authors found that early menopause women compared with normal menopause women were younger, had additional comorbidities, and more severe lesions. Furthermore, early ANM was independently associated with the risk of MACEs mainly driven by the risk of target lesion revascularization. Studies that compared the outcomes of women after stenting angioplasty and ANM are limited; thus, the results cannot be compared with other similar studies. Nevertheless, there are studies that evaluated the influence of early menopause on premature CHD. For example, Lubiszewska et al have shown that smoking and early postmenopausal stage ( 3 years) are the most important determinants of premature CHD in women. However, most studies compared (with conflicting results) PCI CV outcomes between men and women. Funakoshi et al evaluated Japanese patients (2845 women and 6843 men undergoing first coronary revascularization; PCI or coronary artery bypass grafting) and found that the coronary risk factor burden appeared greater in women than in men, despite the fact that women had a lower incidence of repeated revascularization compared with men. Otten et al studied 4991 men and 1755 women admitted to the hospital for PCI. Patients were stratified into 2 groups, <65 years (young group) and 65 years (elderly). They found that the differences in mortality between men and women were age dependent. Although young women had less obstructive CHD, survival was worse compared with similarly aged men. Lin et al carried out a retrospective cohort study of patients who underwent PCI (8884 women and 23 937 men) and found that male sex was associated with a higher risk of rehospitalization for revascularization than female sex. Some studies evaluated PCI procedure success in women compared with men. Prior studies have suggested that PCIs in women were less successful than in men. The National Heart Lung and Blood Institute (NHLBI) investigators analyzed the results of PCI from 2136 patients (546 women) and found that women were older than men and had more coronary risk factors for CV disease. The angiographic success rate per lesion was similar for women and men. At 4 years, women had slightly fewer events (myocardial infarction, repeat PCI, and/or coronary artery bypass grafting). However, in-hospital mortality was greater in women than in men (2.6% vs 0.3%, respectively). Additionally, the mortality rate was 10 times higher in women 65 years than in men. Later, another report of the NHLBI showed better clinical outcomes including survival in women submitted to PCI. As the frequency of coronary stenting is steeply increasing, more studies evaluated the success and outcomes of PCI procedure in women compared with men. Moriel et al evaluated 560 consecutive patients (119 women) who had undergone stenting and found that coronary stenting is performed with similar success rates among women and men, with similar restenosis rates as well as early and late MACEs. Anderson et al reported the results from 426 996 patients 65 years old (42.3% women) from the National Cardiovascular