Each additional decade of menstruation reduced heart failure risk by 34% (OR 0.66) and delayed onset by 2.51 years; HRT showed mild protection, OCP no effect.
Does duration of menses, OCP use, HRT use, or cumulative hormone exposure reduce incident heart failure in women?
Longer duration of endogenous estrogen exposure, as reflected by menstrual duration, is associated with a lower risk of incident heart failure and a later age of onset in women.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Women experience various hormonal exposures across the lifespan, including endogenous estrogen exposure from menstruation and exogenous hormone exposure from oral contraceptive pills (OCP) and hormone replacement therapy (HRT). Estrogen has been suggested to have cardioprotective effects, yet the relationships between lifetime hormone exposure and heart failure (HF) risk remain unclear. Purpose To use large cohort study data to examine whether duration of menses, OCP use, HRT use, or cumulative hormone exposure is associated with the incidence and age at onset of HF among women in the Atherosclerosis Risk in Communities (ARIC) study. Methods Data from ARIC, comprising 8,066 women were obtained from the NHLBI’s BioLINCC resource. Data elements were aggregated and analyzed using Google BigQuery and R. The primary outcome was age at HF onset. Hormone exposure variables included duration of menses, OCP use, HRT use, and cumulative measures of endogenous and exogenous estrogen exposure. Cox proportional hazards models were used to assess associations with incident HF, and linear regression models evaluated relationships with age at HF onset. Results Average age of menarche was not different between women without and with HF (12±9 vs. 12±9, p=0.37). However, women without HF had a significantly higher age at menopause (46±7 vs. 44±7, p0.001) and longer years of menstruation (33±7 vs. 31±7, p0.001) compared to women with HF. History of OCP use was significantly more prevalent among women without HF (48% vs. 36%, p0.001), although years of use of OCP was nominally different between (4.8±4.6 without HF vs. 4.6±4.9 with HF, p=0.02). History of HRT use was significantly more prevalent among women without HF (41% vs. 31%, p0.001), and women without HF use had significantly more years of use than women with HF (12±15 vs. 10±15, p0.001). Women without HF had longer cumulative hormone exposures (years of menses, OCP and HRT combined) compared to women with HF (56±16 vs. 53±18, p0.001). However, there was no difference in cumulative years of OCP and HRT combined between groups (23±16 vs. 12±17, p=0.003). Longer duration of menses was associated with a lower risk of incident HF and an older age at HF onset. Each additional decade of menses was associated with a 34% lower odds of incident HF (OR 0.66 0.56-0.79, p0.001) and a 2.51 year later onset of HF (β = 2.51±0.87, p=0.004). While HRT showed a potential protective association with incident HF (OR 0.95 0.92 - 0.99, p=0.010), OCP use did not demonstrate a relationship (OR 0.87 0.67 - 1.14, p=0.31). Conclusions These findings suggest that endogenous estrogen exposure, as reflected by menstrual duration, may play a stronger role in HF risk and timing than exogenous hormone use. Further investigation into how cumulative hormone exposure, timing, and formulation influence HF risk may provide insights into the role of hormonal factors in HF prevention.
Shalowitz et al. (Sat,) reported a other. Each additional decade of menstruation reduced heart failure risk by 34% (OR 0.66) and delayed onset by 2.51 years; HRT showed mild protection, OCP no effect.