Key result
Age at FMP lacks direct CAD link but modifies risk factor effects in type 1 diabetes.
Why the study?
Women with T1D have greater CAD risk and earlier age at FMP, but whether age at FMP modifies associations between clinical risk factors and CAD incidence was unknown.
Does age at final menstrual period modify the association between clinical risk factors and CAD incidence in women with Type 1 Diabetes?
Cohort (n=121)
Does age at final menstrual period modify the association between clinical risk factors and CAD incidence in women with Type 1 Diabetes?
Hazard Ratio: 0.95 (95% CI 0.89–1.01)
In women with Type 1 diabetes, earlier age at menopause weakens the association between traditional clinical risk factors and CAD incidence, suggesting early menopause may reflect advanced biological aging.
May alter CAD risk factor interpretation by menopause age in T1D women; leaves open prospective validation.
Introduction and Objective: Women with T1D have greater CAD risk and earlier age at final menstrual period (FMP). While no direct association between age at FMP and CAD has been observed in T1D, we evaluated if age at FMP modifies associations between clinical risk factors and 32-year CAD incidence. Methods: We analyzed n=121 postmenopausal women from the Epidemiology of Diabetes Complications T1D cohort (baseline mean age 28, baseline T1D duration 19 yrs, median age at FMP=50). Risk factors included HbA1c, estimated glucose disposal rate, lipids, blood pressure, makers of kidney damage/function, and BMI. Cox models for CAD tested for statistical interaction between age at FMP and baseline and time-varying risk factors (up to 9 measures over 30 yrs). Results: N=54 (44%) developed CAD over 32 yrs. Although age at FMP was not associated with CAD (HR=0.95, 95% CI 0.89, 1.01), it modified the association between baseline HDL-C (p=0.08), albumin excretion rate (p=0.09), and estimated glucose disposal rate (p=0.02) and CAD; associations with CAD were stronger in women with later FMP (Table 1). There were no interactions observed in time-varying analyses. Conclusion: Weaker associations between clinical risk factors and CAD in women with earlier FMP suggests early menopause may reflect advanced biological aging that outweighs the contribution of individual factors. Further research should explore mechanisms of CAD risk by FMP timing. Disclosure S. Romano: None. T. Costacou: None. S. El Khoudary: Consultant; Current; Novo Nordisk. T. Orchard: None. M. Feghali: None. R.G. Miller: None. Funding American Diabetes Association (7-23-ICTSWH-19), NIDDK (R01DK034818)
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ROMANO et al. (2026) conducted a cohort in Type 1 Diabetes (T1D) (n=121). Age at final menstrual period (FMP) was evaluated on Coronary Artery Disease (CAD) incidence (HR 0.95, 95% CI 0.89, 1.01). Age at final menstrual period was not directly associated with 32-year CAD incidence (HR 0.95; 95% CI 0.89-1.01), but modified the effect of baseline risk factors in women with type 1 diabetes.
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