BACKGROUND: Epidemiological studies have shown a higher risk of cardiovascular mortality associated
with early menopause, but the relation between menopausal age and extent of coronary artery disease after
menopause is unknown. We assessed the relation between menopausal age and extent of coronary disease
in postmenopausal women with an acute coronary syndrome.
METHODS: A prospective study was conducted in patients 55 years old undergoing coronary angiography
for an acute coronary syndrome. Enrollment was stratified by sex (women/men ratio 2:1) and age (55-64,
65-74, 75-85, and >85 years). Women were administered menopause questionnaires during admission. An
independent core lab quantified coronary artery disease extent using the Gensini Score, which classifies
both significant (>50%) and nonsignificant lesions. Linear correlation was used to appraise the association
between the Gensini score and menopausal age.
RESULTS: We enrolled 675 patients, 249 men and 426 women (mean age 74 years). The mean Gensini score
was 60 36 in men vs 50 32 in women (P <.001), being higher among men at any age. The median
menopausal age of women was 50 years. Risk factors and age at first acute coronary syndrome were
identical among women below and above the median menopausal age. The Gensini score in women showed
a weak association with age (R 1⁄4 0.127; P 1⁄4 .0129), but not with menopausal age (R 1⁄4 0.063; P 1⁄4 .228).
At multivariable analysis, ejection fraction, female sex, and ST elevation myocardial infarction were independent
predictors of the Gensini score in the overall population.
CONCLUSIONS: Menopausal age was not associated with the extent of coronary artery disease. Age at first
acute coronary syndrome presentation, risk factors, and prior cardiovascular events were not affected by
menopausal age.
