Reproductive Characteristics, Postmenopausal Obesity, and Cardiovascular Disease Incidence in the Women's Health Initiative
12 affiliations
- 1Northwestern University Chicago IL USA
- 2University of Toronto Ontario Canada
- 3Kaiser Permanente Center for Health Research Portland OR USA
- 4Unveristy of California San Diego La Jolla CA USA
- 5Department of Medicine IV Clinic Hietzing Vienna Austria
- 6Department of Epidemiology & Population Health Albert Einstein College of Medicine Bronx NY USA
- 7HOMICAREM (HOMburg Institute for CArdioREnalMetabolic Medicine) Saarland University Homburg/Saar Germany
- 8University of Texas Health Science Center at Houston Houston TX USA
- 9Penn State Hershey Medical Center Hershey PA USA
- 10George Washington University Washington DC USA
- 11Rowan‐Virtua SOM Stratford NJ USA
- 12Lurie's Children Chicago IL USA
Abstract
Background: Early menarche, menopause, and short reproductive lifespan are risk factors for cardiovascular disease (CVD), but whether these reproductive characteristics are independently associated with CVD or influenced by obesity is unclear. This study aimed to address this gap.
Methods: Postmenopausal women from the Women's Health Initiative longitudinal cohort study without CVD at baseline (October 1993 to December 1998) and followed through January 2025 were included. Early menarche (<12 years) and menopause (<40 years) were self‐reported. Reproductive lifespan was defined as the difference between age at menopause and menarche, with short duration as <35 years. Obesity was defined by baseline waist circumference of ≥88 cm. Cox regression models assessed associations of each reproductive characteristic and incident CVD, adjusting for demographic, lifestyle, medical, and reproductive history. Interactions and mediation of reproductive characteristics and CVD by waist circumference were also examined.
Results: Participants (N=119 182) reported an age of menarche and menopause at 12.6±1.5 and 48.2±6.3 years of age, yielding an average reproductive lifespan of 35.6±6.4 years. Over a median follow‐up of 12.8 years (interquartile range, 8.1–14.1), 12 731 CVD events occurred (rate=10.4/1000 person‐years). Early menarche (hazard ratio [HR], 1.07 [95% CI, 1.01–1.15]), early menopause (HR, 1.22 [95% CI, 1.11–1.35]), and short reproductive lifespan (HR, 1.21 [95% CI, 1.13–1.29]) were associated with CVD incidence. Waist circumference was a significant mediator of early menarche, early menopause, and a short reproductive lifespan.
Conclusions: Younger ages at menarche, menopause, and shorter duration of reproductive lifespan were independently associated with CVD incidence; waist circumference was a significant mediator of associations.
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BibTeX
@article{borrowman2026reproductive,
title = {{Reproductive Characteristics, Postmenopausal Obesity, and Cardiovascular Disease Incidence in the Women's Health Initiative}},
author = {Jaclyn D. Borrowman and Hailey Banack and Claire Cook and Erin S. LeBlanc and Aladdin H. Shadyab and Bernhard Haring and Hind A. Beydoun and Matthew Nudy and Matthew Allison and Lisa W. Martin and Peter F. Schnatz and Mercedes R. Carnethon and Amanda M. Perak and Sadiya S. Khan and Deepika Laddu},
journal = {Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease},
year = {2026},
month = sep,
doi = {10.1161/jaha.126.049882},
url = {https://doi.org/10.1161/jaha.126.049882},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Reproductive Characteristics, Postmenopausal Obesity, and Cardiovascular Disease Incidence in the Women's Health Initiative
AU - Jaclyn D. Borrowman
AU - Hailey Banack
AU - Claire Cook
AU - Erin S. LeBlanc
AU - Aladdin H. Shadyab
AU - Bernhard Haring
AU - Hind A. Beydoun
AU - Matthew Nudy
AU - Matthew Allison
AU - Lisa W. Martin
AU - Peter F. Schnatz
AU - Mercedes R. Carnethon
AU - Amanda M. Perak
AU - Sadiya S. Khan
AU - Deepika Laddu
PY - 2026
DA - 2026/09/24
JO - Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
DO - 10.1161/jaha.126.049882
UR - https://doi.org/10.1161/jaha.126.049882
AB - Background: Early menarche, menopause, and short reproductive lifespan are risk factors for cardiovascular disease (CVD), but whether these reproductive characteristics are independently associated with CVD or influenced by obesity is unclear. This study aimed to address this gap. Methods: Postmenopausal women from the Women's Health Initiative longitudinal cohort study without CVD at baseline (October 1993 to December 1998) and followed through January 2025 were included. Early menarche (<12 years) and menopause (<40 years) were self‐reported. Reproductive lifespan was defined as the difference between age at menopause and menarche, with short duration as <35 years. Obesity was defined by baseline waist circumference of ≥88 cm. Cox regression models assessed associations of each reproductive characteristic and incident CVD, adjusting for demographic, lifestyle, medical, and reproductive history. Interactions and mediation of reproductive characteristics and CVD by waist circumference were also examined. Results: Participants (N=119 182) reported an age of menarche and menopause at 12.6±1.5 and 48.2±6.3 years of age, yielding an average reproductive lifespan of 35.6±6.4 years. Over a median follow‐up of 12.8 years (interquartile range, 8.1–14.1), 12 731 CVD events occurred (rate=10.4/1000 person‐years). Early menarche (hazard ratio [HR], 1.07 [95% CI, 1.01–1.15]), early menopause (HR, 1.22 [95% CI, 1.11–1.35]), and short reproductive lifespan (HR, 1.21 [95% CI, 1.13–1.29]) were associated with CVD incidence. Waist circumference was a significant mediator of early menarche, early menopause, and a short reproductive lifespan. Conclusions: Younger ages at menarche, menopause, and shorter duration of reproductive lifespan were independently associated with CVD incidence; waist circumference was a significant mediator of associations.
SN - 2047-9980
ER -