过早的自然和手术绝经与心血管疾病的关系，这一成果由美国马萨诸塞州综合医院Pradeep Natarajan研究组经过不懈努力而取得。相关论文2019年11月18日发表在国际顶尖学术期刊《美国医学会杂志》上。

最新指南支持在对中年妇女动脉粥样硬化性心血管疾病风险进行评估时，应考虑其40岁以前的绝经史，但仍缺乏该类人群心血管疾病风险的可靠数据。

2006-2010年间，研究组在英国招募了144260名40-69岁绝经后的女性，并随访至2016年8月。自然过早绝经指40岁前未经手术自然绝经，手术过早绝经指40岁前行双侧卵巢切除术。正常绝经的女性为对照组。

在144260名绝经后女性中，4904名（3.4%）自然过早绝经，644名（0.4%）手术过早绝经。对照组中有5415名（3.9%）女性发生心血管事件，发生率为每1000女性-年5.70例，包括冠状动脉疾病、心力衰竭、主动脉狭窄、二尖瓣反流、房颤、缺血性卒中、外周动脉疾病和静脉血栓栓塞。自然过早绝经组中有292名（6.0%），发生率为每1000女性-年8.78例；手术过早绝经组中有49名（7.6%），发生率为每1000女性-年11.27例。

与正常绝经的女性相比，自然过早绝经与手术过早绝经组中发生心血管单项事件、高血压、高脂血症和2型糖尿病的风险比分别为1.36和1.87，这两项指标均经过了传统心血管疾病危险因素和更年期激素治疗的校正。

总之，40岁前自然绝经或手术绝经增加了绝经后女性复合心血管疾病的风险。仍需进一步研究来了解这些关联背后的机制。

附：英文原文

Title: Association of Premature Natural and Surgical Menopause With Incident Cardiovascular Disease

Author: Michael C. Honigberg, Seyedeh Maryam Zekavat, Krishna Aragam, Phoebe Finneran, Derek Klarin, Deepak L. Bhatt, James L. Januzzi, Nandita S. Scott, Pradeep Natarajan

Issue&Volume: November 18, 2019

Abstract:

Importance  Recent guidelines endorse using history of menopause before age 40 years to refine atherosclerotic cardiovascular disease risk assessments among middle-aged women. Robust data on cardiovascular disease risk in this population are lacking.

Objective  To examine the development of cardiovascular diseases and cardiovascular risk factors in women with natural and surgical menopause before age 40 years.

Design, Setting, and Participants  Cohort study (UK Biobank), with adult residents of the United Kingdom recruited between 2006 and 2010. Of women who were 40 to 69 years old and postmenopausal at study enrollment, 144?260 were eligible for inclusion. Follow-up occurred through August 2016.

Exposures  Natural premature menopause (menopause before age 40 without oophorectomy) and surgical premature menopause (bilateral oophorectomy before age 40). Postmenopausal women without premature menopause served as the reference group.

Main Outcomes and Measures  The primary outcome was a composite of incident coronary artery disease, heart failure, aortic stenosis, mitral regurgitation, atrial fibrillation, ischemic stroke, peripheral artery disease, and venous thromboembolism. Secondary outcomes included individual components of the primary outcome, incident hypertension, hyperlipidemia, and type 2 diabetes.

Results  Of 144?260 postmenopausal women included (mean [SD] age at enrollment, 59.9 [5.4] years), 4904 (3.4%) had natural premature menopause and 644 (0.4%) had surgical premature menopause. Participants were followed up for a median of 7 years (interquartile range, 6.3-7.7). The primary outcome occurred in 5415 women (3.9%) with no premature menopause (incidence, 5.70/1000 woman-years), 292 women (6.0%) with natural premature menopause (incidence, 8.78/1000 woman-years) (difference vs no premature menopause, +3.08/1000 woman-years [95% CI, 2.06-4.10]; P < .001), and 49 women (7.6%) with surgical premature menopause (incidence, 11.27/1000 woman-years) (difference vs no premature menopause, +5.57/1000 woman-years [95% CI, 2.41-8.73]; P < .001). For the primary outcome, natural and surgical premature menopause were associated with hazard ratios of 1.36 (95% CI, 1.19-1.56; P < .001) and 1.87 (95% CI, 1.36-2.58; P < .001), respectively, after adjustment for conventional cardiovascular disease risk factors and use of menopausal hormone therapy.

Conclusions and Relevance  Natural and surgical premature menopause (before age 40 years) were associated with a small but statistically significant increased risk for a composite of cardiovascular diseases among postmenopausal women. Further research is needed to understand the mechanisms underlying these associations.

DOI: 10.1001/jama.2019.19191

Source: https://jamanetwork.com/journals/jama/fullarticle/2755841