Ascending aortic disease is associated with earlier menopause and shorter reproductive life span

Objectives: The incidence of cardiovascular morbidity and mortality in premenopausal women is comparatively low, but increases sharply after menopause. The principal aim of this study was to determine whether women with ascending aortic disease (AAD) have a different reproductive history from that of an age-matched control group.

Methods: In this retrospective study, women who had undergone ascending aortic aneurysm repair between 2000 to 2010 were asked to complete a questionnaire concerning risk factors and reproductive history. Data from 142 women with AAD was evaluated, and a subgroup (n = 64) with ascending aortic aneurysm AscAA≥5 cm was analysed and compared to an age-matched random control group without known aortic diseases.

Results: Almost all women were menopausal at the time of the questionnaire (98.4% vs. 90.6%, AscAA≥5 cm subcohort vs. control, p = 0.12), and all subjects presented with a comparable age of menarche (13.7 ± 2.6yrs vs. 14.2 ± 1.8yrs, AscAA≥5 cm subcohort vs. control, log-rank 0.04, p = 0.84). However, mean menopausal age was significantly lower in the AscAA≥5 cm subcohort than in controls (48.1 ± 4.8yrs vs. 50.6 ± 5.8yrs, AscAA≥5 cm subcohort vs. control, log-rank 8.35, p = 0.004), and reproductive life span was correspondingly shorter (34.2 ± 5.2yrs vs. 36.2 ± 5.7yrs, p = 0.04). Furthermore, hypertension was more prevalent in women with AscAA≥5 cm compared to controls (89.1% vs. 61.9%, AscAA≥5 cm subcohort vs. control, p < 0.001).

Conclusion: Women who experience menopause at an earlier age (≤48yrs) than the regional mean (51yrs) might benefit from screening for cardiovascular disease in general and particularly for AAD. Screening could enable early aneurysm detection, and might therefore reduce morbidity and mortality.