Abstract
Earlier age at menarche has been associated with higher risk of coronary heart disease, but the mechanisms underlying the association remain unclear. We assessed the relationship of pubertal timing, in both men (n = 672) and women (n = 713), with vascular (carotid intima-media thickness (cIMT), pulse wave velocity (PWV)) and cardiac (left ventricular (LV) structure and function) measures recorded at age 60–64 yrs in a British birth cohort study. Regression models found that earlier menarche was associated with higher (more adverse) LV mass, LV end diastolic volume and left atrial volume, but not with other cardiac measures, cIMT or PWV. Associations were attenuated after adjustment for either adult or childhood BMI (e.g. mean difference in LV mass per year later menarche: −4.2 g (95% CI:−7.0,−1.4) reducing to −2.2 g (95% CI:−4.7,0.4) after adjustment for adult BMI). There were no associations among men, despite those fully mature at 15 yrs having higher blood pressure than the least mature group by 10.21 mmHg (95% CI:19.45,0.98). Any effect of pubertal timing on vascular and cardiac structure and function is likely to be small and primarily confounded by pre-pubertal BMI and/or mediated through adult adiposity.
Highlights
Understanding of the relationship between pubertal timing and development of cardiovascular risk factors may lead to improved management of disease risk
Left ventricular (LV) hypertrophy and LV mass have been found to be risk factors for cardiovascular disease (CVD), independent of classic CV risk factors[24] and moderate and severe diastolic dysfunction are related to increased subsequent mortality[25]
The sample included in analyses was similar in terms of their outcomes to those excluded, but had slightly higher pulse wave velocity (PWV), as well as higher blood pressure (BP) and body mass index (BMI) (Supplementary Table 1)
Summary
Understanding of the relationship between pubertal timing and development of cardiovascular risk factors may lead to improved management of disease risk. Earlier age at menarche has been associated with higher risk of cardiovascular disease (CVD) and coronary heart disease (CHD) in women in some, but not all, observational studies[1,2,3,4,5,6,7,8]. There is little evidence of an association between age at menarche and cIMT in women in the few studies that do exist[11,12,13]. While most research on pubertal timing has focussed on CHD, a recent study using the Women’s Health Initiative (WHI) investigated associations of reproductive characteristics including age at menarche, with incident heart failure[22], an increasingly common and important manifestation of CVD in older people[23]. As most studies lack a measure of childhood BMI and are unable to adjust for childhood BMI7, the relative contribution of childhood and adult BMI to any relationship remains unclear
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