Menstrual cycle irregularities associated with cardiovascular disease risk

Huijie Zhang, M.D., Ph.D.

Credit: American Heart Association

New findings from a large, prospective study of more than 58,000 women found that irregular menstrual cycles were significantly associated with an increased risk of: Cardiovascular disease (CVD)) independent of other risk factors over 12 years.¹

Analyzes showed that long (≥35 days) or short (≤21 days) menstrual cycles were associated with increased risk of CVD and atrial fibrillation compared to normal menstrual cycles. However, the data did not show a significant association between menstrual cycle length and regularity with stroke or heart failure.

“The association between menstrual cycle characteristics and adverse cardiovascular outcomes remains unclear,” said Huijie Zhang, M.D., Ph.D., chief physician and professor at Southern Hospital, Southern Medical University, in a statement.² “Considering the increasing prevalence of heart disease, with 45% of women in Western countries suffering from heart disease, and the associated mortality, there is a need to investigate these risk factors.”

A regular menstrual cycle lasting 22–34 days over a woman’s reproductive life reflects normal functioning of the hypothalamic-pituitary-ovarian axis and is an important sign of overall female health. Irregular menstrual cycles are a common endocrine disorder, with approximately 20% of women experiencing menstrual cycles of varying length. Irregular cycles have been associated with increased risk of insulin resistance, metabolic disorders, hyperandrogenism, chronic inflammation, and menstrual cycle hormonal fluctuations and arrhythmias, according to the literature.

However, the association between cardiovascular disease-induced menstrual cycle characteristics and cardiovascular disease-related mortality is limited, and data from large prospective studies are needed to fill these knowledge gaps. The researchers used data from the UK Biobank (2006–2010) to analyze menstrual cycle length to determine its association with her CVD overall and specific her CVD events in women. bottom. All female participants in the UK Biobank were asked to self-report their current menstrual cycle length and regularity, with irregular cycles defined as a cycle length of 21 days or less, or a cycle of 35 days or more. It has been.

The primary outcomes of this study included the incidence of CVD events, as well as the incidence of CHD, myocardial infarction, heart failure, atrial fibrillation and stroke. At the time of analysis, health outcome data were available through November 2020. The analysis included health data for a total of 58,056 women, excluding women who had reached menopause.

During a median follow-up of 12 years, a total of 16223 cardiovascular events were recorded among the participants, including 827 CHD events, 199 myocardial infarctions, 271 strokes, 174 heart failure events, There were 393 cases of atrial fibrillation. Analyzes found that the cumulative incidence of CVD was higher in women with irregular menstrual cycles than in women with regular menstrual cycles (adjusted hazard ratio). [HR]1.19; 95% CI, 1.07–1.31).

Additionally, women with a menstrual cycle of 21 days or less had a 29% higher risk of a CVD event (HR, 1.29). [95% CI, 1.11 – 1.50]), including CHD, heart attack, atrial fibrillation, stroke, and heart failure compared to normal menstrual cycles. A woman with a longer menstrual cycle than her 35 days had an 11% higher risk of a CVD event (HR, 1.11) [95% CI, 0.98 – 1.56]), compared with a normal-length menstrual cycle.

With respect to cardiovascular disease subtypes, women with irregular menstrual cycles were significantly associated with a higher risk of atrial fibrillation (HR, 1.40; 95% CI, 1.14–1.72) in multivariate-adjusted models, whereas CHD Analyzes found no association with the development of myocardial infarction or myocardial infarction. , heart failure, stroke. Compared to normal menstrual cycles, short menstrual cycles were associated with a 38% higher risk of atrial fibrillation, and longer menstrual cycles were associated with a 30% higher risk of atrial fibrillation. Furthermore, the model found that people with short menstrual cycles had a significantly higher chance of CHD and myocardial infarction than those with normal cycles (adjusted heart rate, 1.41 [95% CI, 1.16 – 1.72] and 1.69 [95% CI, 1.13 – 2.52]), but the results were not significant in women with long cycles.

The increased risk of CVD was even after further adjustment for other risk factors such as age, ethnicity, BMI, smoking status, alcohol drinking status, physical activity, baseline cholesterol levels, history of hypertension or type 2 diabetes, and history of oral treatment. remained statistically significant. Contraceptive use or hormone replacement therapy, family history of heart disease or stroke.

Zhang et al. emphasized the need to raise awareness that people with irregular menstrual cycle patterns are more likely to develop heart disease, which can adversely affect cardiovascular health.

“These findings have important public health implications for the prevention of atrial fibrillation and heart attacks in women, and highlight the importance of monitoring menstrual cycle characteristics throughout a woman’s reproductive life,” said Zhang. the professor said.²

References

1. Huang C, Lin B, Yuan Y et al. Association between menstrual cycle regularity and length and cardiovascular disease: a prospective study by the UK Biobank [published online ahead of print, 2023 May 24]. J. Am Hart Society 2023;e029020. Doi: 10.1161/JAHA.122.029020
2. heart news. A long or short menstrual cycle increases her risk of CVD, including atrial fibrillation. Yulek Alert! May 24, 2023. Accessed May 25, 2023. https://www.eurekalert.org/news-releases/989933.