Ascending Aortic Disease is associated with earlier menopause -and shorter reproductive life span

Objectives

Cardiovascular morbidity and mortality in premenopausal women are comparatively low, but
increase sharply after menopause. Therefore, our aim was to determine whether women with
ascending aortic disease (AAD) have a different reproductive history compared to an agematched
control group.

Methods

During a ten year period between 2000 to 2010, women, who had undergone ascending aortic
aneurysm repair, were sent a questionnaire concerning risk factors and reproductive history.
Data from 142 women with AAD were evaluated, and a subgroup with ascending aortic
aneurysm (AscAA)≥5cm was analysed and compared to an age-matched random control
group without known aortic diseases (each group n=64).

Results

Almost all women were menopausal at the time of the questionnaire (97.1% in AAD; 98.4%
vs 90.6%, AscAA≥5cm subcohort vs control, p=0.115). While all women presented with a
comparable age of menarche (13.9±2.1yrs in AAD; 13.7±2.6yrs vs 14.2±1.8yrs, AscAA≥5cm
subcohort vs control, p=0.705), menopausal age was significantly lower in the AscAA≥5cm
subcohort (48.7±5.9yrs in AAD; 48.1±4.8yrs vs 50.6±5.8yrs, AscAA≥5cm subcohort vs
control, p=0.012). Hence, a shortened reproductive life span had resulted in the AscAA≥5cm
subcohort (2.0yrs difference of means; 34.2±5.2yrs vs 36.2±5.7yrs, p=0.036). Furthermore,
hypertension was more prevalent in women with AscAA≥5cm compared to controls (88.7%
in AAD; 89.1% vs 61.9%, AscAA≥5cm subcohort vs control, p<0.001).

Conclusions and clinical significance

Women with large AscAA showed a significant reduction of the reproductive life span and,
thus, an abbreviated duration of endogenous production of female sex hormones compared to
a control population. Once again, this suggests a high relevance of the endocrine system in the
development of aortic disease. Hence, gynaecologists may play a key role in defining risk
patients for CVD, if they pay attention to premature postmenopausal patients.
Interdisciplinary work could establish an earlier diagnosis of CVD in postmenopausal women,
which could offer an opportunity for early detection, and, therefore, may reduce morbidity
and mortality.