Women with ascending aorta diseases reach menopausal age earlier

Objectives: Cardiovascular morbidity/mortality is comparatively low in premenopausal women, but increase sharply following menopause. Research has been limited to women with abdominal aortic aneurysms where earlier onset of menopause was associated with larger aneurysms. The aim was to determine whether women with ascending aortic disease (AAD) have a different reproductive history compared to aged matched controls.

Methods: Women who had undergone repair of the ascending aorta were asked about risk factors and reproductive history. The response of 142 women with AAD with a follow-up of 6.7 ± 3.1 yrs(1.9-12.6 yrs) was compared to an age-matched control group of 64 women (age 70.8 ± 10.5 yrs and 70.1 ± 11.4 yrs, p = 0.596; BMI 25.9 ± 5.6 kg/m² vs 25.2 ± 4.1 kg/m², p = 0.601). A subgroup of the AAD cohort with validated ascending aortic aneurysms (TAA) ≥5cm were further investigated (n = 64, age 71.4 ± 10.8 yrs, p = 0.331; BMI 24.4 ± 4.6 kg/m², p = 0.625).

Results: Hypertension and Hypercholesterolemia were more prevalent in women with AAD compared to controls (88.7% vs 61.9%,p < 0.001, and 49.3% vs 30.6%, p = 0.010). There were more smokers amongst women with AAD (24.6% vs 6.3%, p = 0.001; current 8.5% in AAD, p = 0.419). Coronary artery disease (bypass grafts or percutaneous coronary intervention) (CAD) was more evident in women with AAD (12.6% vs 3.4, p = 0.037). Menopausal age had been reached in 97.1% of women with manifest AAD and in 90.6% of controls (p = 0.054). Comparing all women with AAD and the subgroup with TAA ≥ 5 cm, to controls demonstrated the same age of menarche (first menstruation at 14.0 ± 1.7 yrs, or 14.0 ± 1.8 yrs, vs 14.2 ± 1.8 yrs, p = 0.813, resp. p = 0.837), but a clearly earlier last menstruation age for women with AAD (menopausal age 49.7 ± 5.9 yrs, or 48.1 ± 4.9 yrs, vs 50.6 ± 5.8 yrs, p = 0.023 or p = 0.012). This results in a clear trend of a shorter time period between menarche and menopause in women found to have AAD and those with TAA ≥ 5 cm, both compared to the controls (34.9 ± 5.7 yrs, and 34.2 ± 5.2 yrs, both vs 36.2 ± 5.7 yrs, p = 0.060, and 0.036 for TAA ≥ 5 cm).

Conclusion: Women with AAD more commonly presented with known cardiovascular risk factors and relevant CAD. In AAD and TAA a significant shortening of the reproductive period and therefore an abbreviated endogenous production of female sex hormones was observed as compared to controls. This suggests yet again a relevant role of the endocrine system in the development of aortic disease.