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Tom and colleagues have recently reported that a later age at natural menopause was associated with increased all-cause and cardiovascular mortality [1]. The authors conducted an analysis of the data of the Iowa cohort of the Established Populations for the Epidemiologic Study of the Elderly (EPESE). The EPESE cohort is a longitudinal population-based study of adults aged 65 years and older in the United States. The study began in the early 1980s in several states. The Iowa cohort was the only EPESE cohort to ascertain information on menopause. A total of 2253 female study participants enrolled at baseline in 1981–1983. The presented analysis included 1684 women with complete data on menopause and all covariates.


Women were personally interviewed at baseline, where they reported the type and timing of their menopause. Type of menopause could only be categorized as natural or surgical; no request was made for further details on hysterectomy or ovariectomy. Women who reported another cause of menopause, did not know the cause, or did not answer the question were excluded from the analysis ([i]n[/i] = 290). Information on vital status and cause of death was obtained through linkage with the National Death Index; follow-up was complete until 31 December 2005. Endpoints studied were total mortality and total cardiovascular mortality. The role of type of menopause was studied in all women, and the role of age at menopause only in naturally menopausal women.


Over a follow-up of 24 years, 1477 (87.7%) women died, and 41% of deaths could be attributed to cardiovascular diseases. Type of menopause was not related to all-cause, cardiovascular, or non-cardiovascular mortality. The risk of all-cause mortality moderately increased with older age at natural menopause ([i]p[/i] = 0.03 for linear trend). Women with age at natural menopause ≥ 55 years had a 29% increased rate of cardiovascular mortality (hazard ratio 1.29; 95% confidence interval 1.02–1.63), compared with women with natural menopause at age 50–54 years. Further adjustment of confounding variables did not attenuate this relationship. Age at surgical menopause was not related to mortality risk.


  • Yvonne T. van der Schouw
    Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands


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