Age at menarche and risks of all-cause and cardiovascular death: a systematic review and meta-analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational cohort studies
PubMed 24920784 · doi:10.1093/aje/kwu113
What was done
Searched Medline, Embase, Scopus, and Web of Knowledge through March 2013 for studies evaluating the association between age at menarche and all-cause or cardiovascular mortality (total cardiovascular disease, ischemic heart disease, and stroke) in adult women. Nine eligible articles were included, providing 5 estimates for all-cause mortality, 5 for total cardiovascular mortality, 6 for ischemic heart disease, and 7 for stroke.
What was found
Each 1-year increase in age at menarche was associated with a 3% reduction in all-cause mortality risk (pooled HR = 0.97, 95% CI: 0.96 to 0.98; I² = 32.2%). Analysis of 2 cohorts showed early menarche (<12 vs. ≥12 years) was associated with higher all-cause mortality (pooled HR = 1.23, 95% CI: 1.10 to 1.38; I² = 0%). An inverse association between menarche age and ischemic heart disease mortality was present only in nonsmoking populations or populations with low smoking prevalence. There was no evidence of association with total cardiovascular mortality or stroke mortality.
Why it matters
This review links earlier menarcheal age to a modest increase in lifetime all-cause mortality risk, while demonstrating that broad links to total cardiovascular death and stroke are not supported by the aggregated evidence.
Limits
The total number of included studies is small (9 articles), and the categorical early-menarche comparison was based on only 2 cohorts. Total participant numbers and follow-up times are not provided in the abstract. Observational designs carry risk of residual confounding from childhood adiposity, socioeconomic factors, and lifestyle variables. Ischemic heart disease findings were sensitive to population smoking prevalence.
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