Twenty-year cardiovascular disease incidence in menopausal women: insights from the ATTICA study

OBJECTIVE: This study aimed to examine the 20-year incidence of cardiovascular disease (CVD) in menopausal women, exploring the interplay of traditional and menopause-specific risk factors. METHOD: The ATTICA study is a prospective cohort survey established in 2001-2002, with three consecutive follow-ups performed in 2006, 2012 and 2022. A total of 1001 women with complete data for CVD evaluation comprised the sample of the current study. For the purposes of this analysis, women were classified according to their menopausal status (at menopause, 276 out of 1001 women [27.6%]). RESULTS: The 20-year cumulative CVD incidence was 321 cases among 1001 women (32%); 274 out of the 337 (81.3%) who were at menopause developed CVD, whereas 47 out of 664 at premenopause developed CVD (7.1%). Age-adjusted analysis revealed that postmenopausal women had 2.25 times (95% confidence interval: 1.20, 4.24) higher risk of CVD, compared to women not at menopause. The fully adjusted model revealed that history of diabetes and hypercholesterolemia were significant predictors for the 20-year-CVD events. Moreover, high-sensitivity C-reactive protein was a significant predictor for CVD events only in women aged above 52 years at menopause. CONCLUSION: Postmenopausal women had an age-adjusted 2.25 times higher 20-year risk of CVD, as compared to women who were not at menopause. Prevailed hypercholesterolemia and diabetes were the most important determinants for long-term CVD events, whereas chronic systemic inflammation had significant predictive value only in women aged above 52 years at menopause.