Abstract P415: Multivitamin Use and the Risk of Cardiovascular Disease in Men

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Susanne Rautiainen ◽  
Robert J Glynn ◽  
Julie E Buring ◽  
J. Michael Gaziano ◽  
Howard D Sesso
Keyword(s):  
Cardiovascular Disease ◽  
Cox Proportional Hazards ◽  
Health Study ◽  
Inverse Association ◽  
Healthy Men ◽  
Wide Range ◽  
Multivitamin Use ◽  
Incident Cases

Background: Although multivitamins are widely used by US adults, few prospective studies have investigated their association with the long- and short-term risk of cardiovascular disease (CVD). The aim of this study was to investigate how multivitamin use is associated with the risk of CVD in initially healthy men free of CVD at baseline. Methods: We studied 21,981 male physicians aged ≥40y from the Physicians Health Study I cohort who were free of CVD and cancer at baseline starting in 1982. All men provided a wide range of self-reported lifestyle and clinical factors plus intake of selected food and dietary supplements. Men were categorized at baseline as (1) no current use and (2) current use of multivitamins. Men were followed from baseline to the end of PHS I follow-up. Cox proportional hazards models were used to calculate multivariable-adjusted rate ratios (RR) (95% confidence intervals (CI)). Results: During an average of 13.7 y (total of 301,480 person-years) of follow-up, there were 1,269 incident cases of major CVD (defined as nonfatal myocardial infarction (MI), nonfatal stroke, and CVD death). In multivariable analyses, there were no statistically significant RRs (95% CIs) observed when comparing current multivitamin use versus no use for the risk of major CVD events (0.97 (0.79-1.04)), MI (0.94 (0.76-1.16), stroke (0.97 (0.77-1.23), or CVD death (1.02 (0.83-1.14)) but an inverse association was observed for cardiac revascularization (0.87 (0.75-1.00)). Conclusion: In this long-term prospective study among initially healthy men, baseline multivitamin use was not associated with the long-term risk of major CVD events.

Abstract P196: Bidirectional Association Between Hypertension and Gout: The Singapore Chinese Health Study

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
An Pan ◽  
Gim Gee Teng ◽  
Jian-Min Yuan ◽  
Woon-Puay Koh
Keyword(s):  
Smoking Status ◽  
Final Analysis ◽  
Normal Weight ◽  
Cox Proportional Hazards ◽  
Health Study ◽  
Increased Risk ◽  
Bidirectional Association ◽  
Singapore Chinese ◽  
Incident Cases

Introduction: Although it has been hypothesized that the hypertension-gout relation is bidirectional, few studies have addressed this hypothesis in a prospective setting, particularly in the Asian populations. Methods: We analyzed data from the Singapore Chinese Health Study (SCHS), a cohort of 63,257 Chinese aged 45-74 years at recruitment from 1993-98. The information about self reports of physician-diagnosed hypertension and gout was enquired at follow-ups I (1999-2004) and II (2006-2010). We included participants with complete data for both follow-ups and who were free of heart disease, stroke and cancer at follow-up I. For the analysis of hypertension and risk of incident gout, participants with prevalent gout were further excluded and the final analysis included 31,694 participants. For the analysis of gout and risk of incident hypertension, participants with prevalent hypertension were further excluded and the final analysis included 20,490 participants. Cox proportional hazards models were used to estimate multivariable-adjusted relative risks (RRs) and 95% confidence intervals (CIs) with adjustment for age, sex, years of interview, dialect group, education, smoking status, alcohol intake, physical activity, body mass index (BMI) and history of diabetes. Results: The mean age of the participants at baseline was 60.1 (SD 7.3) years, and the average follow-up year was 6.8 (SD 1.4) years. In the analysis of hypertension and risk of gout, 836 incident cases were identified. Compared to normotensive participants, hypertensive patients had a 93% increased risk of developing gout (RR 1.93; 95% CI 1.66-2.24). The association was slightly stronger in women (RR 2.09; 95% CI 1.69-2.58) compared to men (RR 1.72; 95% CI 1.39-2.14; P for interaction=0.056). The association was also stronger in normal weight adults (BMI <24 kg/m2; RR 2.25; 95% CI 1.82-2.77) compared to overweight/obese individuals (BMI ≥24 kg/m2; RR 1.66; 95% CI 1.34-2.04; P for interaction=0.03). In the parallel analysis of gout and risk of hypertension, 5491 participants reported to have newly diagnosed hypertension during the follow-up. Compared to participants without gout, those with gout had a 17% increased risk of developing hypertension (RR 1.17; 95% CI 1.01-1.35). The association was evident in men (RR 1.29; 95% CI 1.07-1.55) but not in women (RR 0.94; 95% CI 0.73-1.20; P for interaction=0.03). The association was present in normal weight adults (RR 1.34; 95% CI 1.09-1.64) but not among overweight/obese individuals (RR 0.99; 95% CI 0.80-1.23; P for interaction=0.03). Conclusions: Our results provide compelling evidence that the hypertension-gout association is bidirectional in Chinese population. The potential interactions of the bidirectional association with sex and obesity deserve further investigations.

Abstract P175: High-density Lipoprotein Cholesterol and Mortality Prior to Age 90 in a Cohort of Male Physicians

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Catherine Rahilly-Tierney ◽  
Howard D Sesso ◽  
J. Michael Gaziano ◽  
Luc Djousse
Keyword(s):  
High Density Lipoprotein ◽  
Lower Risk ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Cox Proportional Hazards ◽  
High Density ◽  
Health Study ◽  
Inverse Association ◽  
Cvd Mortality

BACKGROUND: Few studies have examined prospectively the relationship between baseline high-density lipoprotein (HDL) cholesterol and longevity. OBJECTIVES: We sought to examine whether higher HDL levels were associated with lower risk of all-cause, cardiovascular (CVD), and non-CVD mortality prior to age 90 in the Physicians’ Health Study (PHS). METHODS: We considered a baseline cohort of 1351 PHS participants who provided bloods between 1997 and 2001 and were old enough to reach age 90 by March 4, 2009. Included subjects had complete baseline data on HDL and total cholesterol; lifestyle factors including smoking, exercise, alcohol consumption, and BMI; and comorbidities including hypertension, diabetes mellitus, congestive heart failure, cancer, and stroke. We used Cox proportional hazards to determine the HRs and 95% CIs for all-cause, CVD, and non-CVD mortality prior to age 90, adjusting for baseline age, co-morbidities, and non-HDL cholesterol. RESULTS: At baseline, the cohort had a mean (SD) age of 81.9 (2.9) years and a mean (SD) HDL cholesterol of 44.8(16.5) mg/dL. After a mean follow-up of 6.8 years (maximum 12.3 years), 501 (37.1%) of men died prior to age 90. In multi-variable adjusted analyses, men in the highest HDL-C quartile (≥54.1 mg/dL) had a 28% lower risk (HR 0.72, 95% CI 0.55-0.95) of all-cause mortality prior to age 90 compared to men in the lowest HDL-C quartile (<32.8 mg/dL). From the lowest to highest HDL quartile, age-adjusted HR(95%CI) for CVD mortality prior to age 90 were 0.66 (0.44-0.99), 0.58 (0.38-0.90), and 0.53 (0.34-0.82) (p for trend 0.004). There was no significant association between baseline HDL cholesterol and non-CVD death. CONCLUSION: In a cohort of older male physicians with long-term follow-up, baseline HDL cholesterol was inversely associated with the risk of dying prior to age 90, largely explained by an inverse association between HDL and CVD mortality.

scholarly journals Mushroom consumption, biomarkers, and risk of cardiovascular disease and type 2 diabetes: a prospective cohort study of US women and men

2019 ◽  
Vol 110 (3) ◽  
pp. 666-674 ◽  
Author(s):  
Dong Hoon Lee ◽  
Meng Yang ◽  
Edward L Giovannucci ◽  
Qi Sun ◽  
Jorge E Chavarro
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Chronic Diseases ◽  
Prospective Cohort ◽  
Cox Proportional Hazards ◽  
Health Study ◽  
Potential Health ◽  
Cardiometabolic Diseases

ABSTRACT Background Mushrooms are good dietary sources of important vitamins, minerals, and bioactive compounds which may be important in the prevention of chronic diseases. However, studies have not prospectively evaluated the potential health effects of mushrooms with respect to major cardiometabolic diseases. Objectives The aim of this study was to examine the association of mushroom consumption with major cardiometabolic diseases and mediating biomarkers in 2 large prospective US cohorts. Methods We followed 67,139 women from the Nurses’ Health Study (1986–2012) and 43,541 men from the Health Professionals Follow-up Study (1986–2012) who were free of chronic diseases. Mushroom consumption was assessed at baseline through the use of a food-frequency questionnaire. Cardiometabolic biomarkers were collected in subpopulations of the 2 cohorts. Cox proportional hazards models were used to estimate HRs and 95% CIs of cardiovascular disease (CVD), including coronary heart disease (CHD) and stroke, and type 2 diabetes (T2D), associated with mushroom consumption. Results We identified total 11,894 CVD (7,616 CHD; 4,278 stroke), and 10,206 T2D cases in &gt;2 million person-years of follow-up. In the pooled multivariable-adjusted analysis, participants who consumed ≥5 servings of mushrooms per week had no significantly different risk of total CVD (HR: 1.02; 95% CI: 0.91, 1.14), CHD (HR: 1.00; 95% CI: 0.87, 1.16), stroke (HR: 1.05; 95% CI: 0.87, 1.25), or T2D (HR: 1.04; 95% CI: 0.93, 1.16) than participants who consumed mushrooms &lt;1 time/mo. We consistently found no association between mushroom consumption and the aforementioned cardiometabolic diseases, in subgroups of sex, lifestyle factors, and medical conditions. Moreover, mushroom consumption was not associated with plasma biomarkers of lipids, insulin, and inflammation. Conclusions We found no association of mushroom consumption with biomarkers and risks of CVD and T2D in US adults. More large prospective cohort studies are warranted to investigate this association in other racial/ethnic groups.

scholarly journals A Prospective Study of Dietary Flavonoid Intake and Risk of Glioma in US Men and Women

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 263-263
Author(s):  
Alaina Bever ◽  
Aedin Cassidy ◽  
Eric Rimm ◽  
Meir Stampfer ◽  
David Cote
Keyword(s):  
Total Flavonoid ◽  
Health Study ◽  
Men And Women ◽  
Funding Sources ◽  
Flavonoid Intake ◽  
Glioma Risk ◽  
Dietary Flavonoid ◽  
Incident Cases

Abstract Objectives Flavonoids are a diverse group of plant constituents with demonstrated neuroprotective and anti-tumor effects. Flavonoid intake may decrease glioma risk, an association that has not yet been investigated in humans. The objective of this study was to evaluate the association between dietary flavonoid consumption and glioma risk in participants in the female Nurses’ Health Study (1984–2014, n = 81,688) and Nurses’ Health Study II (1991–2017, n = 95,228), and the male Health Professionals Follow-up Study (1986–2014, n = 49,884). Methods Exposure was average long-term (up to 30 years) and recent (up to 12 years) intake of total flavonoids and six flavonoid subclasses, derived from validated quadrennial food frequency questionnaires. The primary outcome was incident glioma, confirmed by medical record review. Results We documented 536 incident cases of glioma across 5,936,386 person-years of follow-up. Long-term total flavonoid, flavan-3-ol, and polymer intake was associated with decreased glioma risk in pooled analyses comparing highest to lowest quintile of consumption (total flavonoid hazard ratio (HR) = 0.79, 95% CI: 0.59–1.05, P-trend = 0.04; flavan-3-ol HR = 0.76, 95% CI: 0.57–1.01, P-trend = 0.04; polymer HR = 0.82, 95% CI: 0.61–1.09, P-trend = 0.05). Associations with recent intake were weaker and not statistically significant. There were no associations with other flavonoid subclasses. After additional adjustment for tea consumption, there was no significant association between flavan-3-ol or polymer consumption and glioma. Conclusions Increased dietary intake of flavan-3-ol and polymeric flavonoids, especially those predominant in tea, was associated with decreased glioma risk in a prospective cohort of men and women. Habitual consumption of foods and beverages containing flavan-3-ols and polymeric flavonoids may protect against the development of glioma. Funding Sources This work was supported by the U.S. National Institutes of Health.

scholarly journals Effect of antihypertensive drug treatment on long-term blood pressure reduction: An individual patient-level data meta-analysis of 352,744 Participants from 51 large-scale randomised clinical trials

2021 ◽  
Author(s):  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Clinical Trials ◽  
Antihypertensive Treatment ◽  
Large Scale ◽  
Meta Analysis ◽  
Level Data ◽  
Wide Range

ABSTRACTObjectivesEvidence from randomised trials on long-term blood pressure (BP) reduction from pharmacologic treatment is limited. To investigate the effects of antihypertensive drugs on long-term BP change and examine its variation over time and among people with different clinical characteristicsDesignIndividual participant-level data meta-analysisSetting and data sourceThe Blood Pressure Lowering Treatment Trialists’ Collaboration involving 51 large-scale long-term randomised clinical trialsParticipants352,744 people (42% women) with mean age of 65 years and mean baseline systolic/diastolic BP of 152/87 mmHg, of whom 18% were current smokers, 50% had cardiovascular disease, 29% had diabetes, and 72% were taking antihypertensive treatment at baselineInterventionPharmacological BP-lowering treatmentOutcomeDifference in longitudinal changes in systolic and diastolic BP between randomised treatment arms over an average follow-up of four yearsResultDrugs were effective in lowering BP, with the maximum effect becoming apparent after 12-month follow-up and with gradual attenuation towards later years. Based on measures taken ≥12 months post-randomisation, more intense BP-lowering treatment reduced systolic/diastolic BP (95% confidence interval) by −11.2 (−11.4 to −11.0)/−5.6 (−5.8 to −5.5) mmHg than less intense treatment; active treatment by −5.1 (−5.3 to −5.0)/−2.3 (−2.4 to −2.2) mmHg lower than placebo, and active arm by −1.4 (−1.5 to −1.3)/−0.6 (−0.7 to −0.6) mmHg lower than the control arm for drug class comparison trials. BP reductions were consistently observed across a wide range of baseline BP values and ages, and by sex, history of cardiovascular disease and diabetes, and prior antihypertensive treatment use.ConclusionPharmacological agents were effective in lowering long-term BP among individuals with a wide range of characteristics, but the net between-group reductions were modest, which is partly attributable to the intended trial goals.

scholarly journals Long term follow-up of pediatric-onset Evans syndrome: broad immunopathological manifestations and high treatment burden

Haematologica ◽  
2021 ◽  
Author(s):  
Thomas Pincez ◽  
Helder Fernandes ◽  
Thierry Leblanc ◽  
Gérard Michel ◽  
Vincent Barlogis ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Second Line ◽  
Treatment Burden ◽  
Evans Syndrome ◽  
Subsequent Increase ◽  
Wide Range ◽  
Pediatric Onset

Pediatric-onset Evans syndrome (pES) is defined by both immune thrombocytopenic purpura (ITP) and autoimmune hemolytic anemia (AIHA) before the age of 18 years. There have been no comprehensive long-term studies of this rare disease, which can be associated to various immunopathological manifestations (IMs). We report outcomes of the 151 patients with pES and more than 5 years of follow-up from the nationwide French prospective OBS’CEREVANCE cohort. Median age at final follow-up was 18.5 (6.8–50.0) years and the median follow-up period was 11.3 (5.1–38.0) years. At 10 years, ITP and AIHA were in sustained complete remission in 54.5% and 78.4% of patients, respectively. The frequency and number of clinical and biological IMs increased with age: at 20 years old, 74% had at least one clinical cIM. A wide range of cIMs occurred, mainly lymphoproliferation, dermatological, gastrointestinal/hepatic and pneumological IMs. The number of cIMs was associated with a subsequent increase in the number of second-line treatments received (other than steroids and immunoglobulins; hazard ratio, 1.4; 95% confidence interval, 1.15–1.60; p = 0.0002, Cox proportional hazards method). Survival at 15 years after diagnosis was 84%. Death occurred at a median age of 18 (1.7–31.5) years, and the most frequent cause was infection. The number of second-line treatments and severe/recurrent infections were independently associated with mortality. In conclusion, longterm outcomes of pES showed remission of cytopenias but frequent IMs linked to high secondline treatment burden. Mortality was associated to drugs and/or underlying immunodeficiencies, and adolescents-young adults are a high-risk subgroup.

scholarly journals Dietary Nicotine Intake and Risk of Parkinson Disease: A Prospective Study

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1222-1222
Author(s):  
Chaoran Ma ◽  
Samantha Molsberry ◽  
Yanping Li ◽  
Michael Schwarzschild ◽  
Alberto Ascherio ◽  
...  
Keyword(s):  
Lower Risk ◽  
Environmental Tobacco Smoke Exposure ◽  
Tobacco Smoke Exposure ◽  
Health Study ◽  
Inverse Association ◽  
Nicotine Intake ◽  
Funding Sources ◽  
A Prospective Study ◽  
Incident Cases

Abstract Objectives To prospectively examine the association between dietary nicotine intake and subsequent PD risk among never-smokers. Methods The current study was based on never-smoker participants from two large prospective cohorts: the Nurses’ Health Study (n = 31,615) and the Health Professionals’ Follow-up Study (n = 19,523). The studies contained information on dietary nicotine intake from 1986 from validated food frequency questionnaires. Dietary nicotine intake was calculated based on consumption of peppers, tomatoes, processed tomatoes, potatoes, and tea. Incident cases of PD were identified via questionnaires and subsequently confirmed by reviewing medical records. We used Cox proportional hazard models to calculate cohort-specific hazard ratios (HRs), and used fix-effects models to calculate the pooled hazard ratio. Results During 26 years of follow-up, we identified 601 incident PD cases (296 women, and 305 men). After adjusting for potential covariates, the pooled HR for the highest vs. lowest quintile of dietary nicotine intake was 0.70 (95% confidence interval [CI], 0.51–0.94). The significant inverse association was, however, only observed in women (adjusted HR, 0.64; 95% CI, 0.42–0.96), but not in men (adjusted HR, 0.77; 95% CI, 0.50–1.20). Further adjusting for environmental tobacco smoke exposure generated similar significant results in women. Consistently, greater consumption of peppers was associated with lower risk of PD (adjusted HR for ≥5 times/week vs. ≤3 times/month, 0.49; 95% CI, 0.25–0.94) in women but not in men (adjusted HR, 1.04; 95% CI, 0.57–1.90). Conclusions Women with greater consumption of dietary nicotine intake had a lower risk of PD, relative to those with lower consumption. Funding Sources This work was supported by the National Institute of Neurological Disorders and Stroke at the National Institutes of Health (NINDS 1R03NS093245–01A1 to X.G.). The NHS is funded by the National Institute of Health through grant UM1 CA186107. The HPFS cohort is funded by the National Institute of Health through grant UM1 CA 167,552.

scholarly journals Dietary nicotine intake and risk of Parkinson disease: a prospective study

2020 ◽  
Vol 112 (4) ◽  
pp. 1080-1087
Author(s):  
Chaoran Ma ◽  
Samantha Molsberry ◽  
Yanping Li ◽  
Michael Schwarzschild ◽  
Alberto Ascherio ◽  
...  
Keyword(s):  
Parkinson Disease ◽  
Lower Risk ◽  
Fixed Effects ◽  
Tobacco Smoke Exposure ◽  
Health Study ◽  
Potential Candidate ◽  
Inverse Association ◽  
Nicotine Intake ◽  
Incident Cases

ABSTRACT Background Tobacco use was observed to be associated with a lower risk of Parkinson disease (PD) in previous epidemiologic studies, with nicotine as a potential candidate. The association between dietary nicotine and PD risk has, however, not been examined in prospective studies yet. Objectives We aimed to examine prospectively the association between dietary nicotine intake and subsequent PD risk among never-smokers. Methods The current study was based on never-smoker participants from 2 large prospective cohorts: the Nurses’ Health Study (n = 31,615) and the Health Professionals Follow-up Study (n = 19,523). The studies contained information on dietary nicotine intake from 1986 from validated FFQs. Dietary nicotine intake was calculated based on consumption of peppers, tomatoes, processed tomatoes, potatoes, and tea. Incident cases of PD were identified via questionnaires and subsequently confirmed by reviewing medical records. We used Cox proportional hazard models to calculate cohort-specific HRs, and used fixed-effects models to calculate the pooled HR. Results During 26 y of follow-up, we identified 601 incident PD cases (296 women and 305 men). After adjusting for potential covariates, the pooled HR for the highest compared with the lowest quintile of dietary nicotine intake was 0.70 (95% CI: 0.51, 0.94). The significant inverse association was, however, only observed in women (adjusted HR: 0.64; 95% CI: 0.42, 0.96), not in men (adjusted HR: 0.77; 95% CI: 0.50, 1.20). Further adjusting for environmental tobacco smoke exposure, family history of PD, and use of ibuprofen generated similar significant results in women. Consistently, greater consumption of peppers was associated with lower risk of PD (adjusted HR for ≥5 times/wk compared with ≤3 times/mo: 0.49; 95% CI: 0.25, 0.94) in women but not in men (adjusted HR: 1.04; 95% CI: 0.57, 1.90). Conclusions Women with greater dietary nicotine intake had a lower risk of PD than those with lower intake.

The Inflammatory Potential of the Diet is Directly Associated with Incident Depressive Symptoms Among French Adults

2019 ◽  
Vol 149 (7) ◽  
pp. 1198-1207 ◽  
Author(s):  
Moufidath Adjibade ◽  
Cédric Lemogne ◽  
Mathilde Touvier ◽  
Serge Hercberg ◽  
Pilar Galan ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Proportional Hazards ◽  
Middle Age ◽  
Scientific Evidence ◽  
Depression Scale ◽  
Cox Proportional Hazards ◽  
Low Grade ◽  
Wide Range ◽  
Incident Cases

ABSTRACTBackgroundLow-grade chronic inflammation has been suggested to play a substantial role in the etiology of depression; however, studies on the prospective association between the inflammatory potential of the diet and depression are limited.ObjectiveThe aim of this study was to investigate the association between the inflammatory potential of the diet (measured using the Alternate Dietary Inflammatory Index, ADII) and incident depressive symptoms. We also tested the potential modulating effect of sex, age, BMI, and lifestyle indicators.MethodsThe study sample consisted of 26,730 participants (aged 18–86 y) from the NutriNet-Santé study. Baseline ADII was computed using repeated 24-h dietary records collected during the first 2 y of the follow-up. Incident cases of depressive symptoms were defined by a Center for Epidemiologic Studies Depression scale ≥17 for men and ≥23 for women at least once during follow-up. HR and 95% CI were estimated using multivariable Cox proportional hazards models.ResultsA total of 2221 incident cases of depressive symptoms were identified over a mean follow-up of 5.4 y. After accounting for a wide range of potential confounders, the highest quartile of the ADII was associated with a 15% (95% CI: 2, 31) increase in the risk of depressive symptoms compared with the lowest quartile. In the stratified analyses, associations were statistically significant only among women (HRquartile4 vs. quartile1: 1.19; 95% CI: 1.02, 1.37), middle-age adults (HRquartile4 vs. quartile1: 1.16; 95% CI: 1.00, 1.35), and participants with a BMI ≥25 (HRquartile4 vs. quartile1: 1.29; 95% CI: 1.04, 1.60).ConclusionsOverall, a proinflammatory diet was associated with a higher risk of depressive symptoms, especially among women, middle-age adults, and participants with overweight or obesity. These findings contribute to the increasing scientific evidence showing a detrimental role of the proinflammatory diet. The NutriNet-Santé study is registered at clinicaltrials.gov as NCT03335644.

scholarly journals Association of oral contraceptives and tubal ligation with risk of early natural menopause

2021 ◽  
Author(s):  
C R Langton ◽  
B W Whitcomb ◽  
A C Purdue-Smithe ◽  
L L Sievert ◽  
S E Hankinson ◽  
...  
Keyword(s):  
Oral Contraceptives ◽  
Proportional Hazards ◽  
Reproductive Factors ◽  
Cox Proportional Hazards ◽  
Tubal Ligation ◽  
Health Study ◽  
Early Menopause ◽  
Natural Menopause ◽  
Increased Risk

Abstract STUDY QUESTION What is the association of oral contraceptives (OCs) and tubal ligation (TL) with early natural menopause? SUMMARY ANSWER We did not observe an association of OC use with risk of early natural menopause; however, TL was associated with a modestly higher risk. WHAT IS KNOWN ALREADY OCs manipulate hormone levels, prevent ovulation, and may modify the rate of follicular atresia, while TL may disrupt the blood supply to the ovaries. These mechanisms may be associated with risk of early menopause, a condition associated with increased risk of cardiovascular disease and other adverse health outcomes. STUDY DESIGN, SIZE, DURATION We examined the association of OC use and TL with natural menopause before the age of 45 years in a population-based study within the prospective Nurses’ Health Study II (NHSII) cohort. Participants were followed from 1989 to 2017 and response rates were 85-90% for each cycle. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants included 106 633 NHSII members who were premenopausal and aged 25-42 years at baseline. Use, duration and type of OC, and TL were measured at baseline and every 2 years. Menopause status and age were assessed every 2 years. Follow-up continued until early menopause, age 45 years, hysterectomy, oophorectomy, death, cancer diagnosis, or loss to follow-up. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% CIs adjusted for lifestyle, dietary, and reproductive factors. MAIN RESULTS AND THE ROLE OF CHANCE Over 1.6 million person-years, 2579 members of the analytic cohort experienced early natural menopause. In multivariable models, the duration, timing, and type of OC use were not associated with risk of early menopause. For example, compared with women who never used OCs, those reporting 120+ months of OC use had an HR for early menopause of 1.01 (95% CI, 0.87-1.17; P for trend=0.71). TL was associated with increased risk of early menopause (HR = 1.17, 95% CI, 1.06-1.28). LIMITATIONS, REASONS FOR CAUTION Our study population is homogenous with respect to race and ethnicity. Additional evaluation of these relations in more diverse populations is important. WIDER IMPLICATIONS OF THE FINDINGS To our knowledge, this is the largest study examining the association of OC use and TL with early natural menopause to date. While TL was associated with a modest higher risk of early menopause, our findings do not support any material hazard or benefit for the use of OCs. STUDY FUNDING/COMPETING INTEREST(S) The study was sponsored by UO1CA176726 and R01HD078517 from the National Institutes of Health and Department of Health and Human Services. The work was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The authors have no competing interests to report. TRIAL REGISTRATION NUMBER N/A

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