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Association between reproductive lifespan and risk of incident type 2 diabetes and hypertension in postmenopausal women: Findings from a 20-year prospective study

  • Shiva R. Mishra
    Correspondence
    Corresponding author at: Centre for Longitudinal and Lifecourse Research, School of Public Health, The University of Queensland, 266 Herston Rd, Brisbane, QLD 4006, Australia.
    Affiliations
    Centre for Longitudinal and Lifecourse Research, School of Public Health, The University of Queensland, 266 Herston Rd, Brisbane, QLD 4006, Australia
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  • Michael Waller
    Affiliations
    Centre for Longitudinal and Lifecourse Research, School of Public Health, The University of Queensland, 266 Herston Rd, Brisbane, QLD 4006, Australia
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  • Hsin-Fang Chung
    Affiliations
    Centre for Longitudinal and Lifecourse Research, School of Public Health, The University of Queensland, 266 Herston Rd, Brisbane, QLD 4006, Australia
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  • Gita D. Mishra
    Affiliations
    Centre for Longitudinal and Lifecourse Research, School of Public Health, The University of Queensland, 266 Herston Rd, Brisbane, QLD 4006, Australia
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      Highlights

      • A shorter reproductive lifespan was associated with higher risk of type 2 diabetes and hypertension.
      • The risks of type 2 diabetes and hypertension were more pronounced in women experiencing a short reproductive lifespan and obesity at midlife.
      • Reproductive lifespan combined with obesity/weight gains could serve as a marker of cardiovascular risk factors at midlife.

      Abstract

      Background

      This study examined the association between reproductive lifespan and incident type 2 diabetes mellitus (T2DM) and hypertension in mid-age women. Also, the combined effect of reproductive lifespan and body mass index (BMI) on the risks of T2DM and hypertension were explored.

      Methods

      Reproductive lifespan was defined as the difference between age at menopause and age at menarche, and categorized as <35, 35–37, 38–40, and ≥41 years based on the quartile distribution. A multivariable Cox proportional hazard regression was used, adjusting for socio-demographic, lifestyle, and reproductive factors.

      Results

      Of 6357 postmenopausal women included (mean [SD] age at last follow-up, 66.3[3.3] years), a total of 655 developed incident T2DM (10.3%) and 1741 developed hypertension (30.0%) during 20 years of follow-up. The total sample had a mean (SD) reproductive lifespan of 37.9 (4.5). Compared with the women who had a reproductive lifespan of 38–40 years, those with a short reproductive lifespan (<35 years) had a 30% increased risk of T2DM and twice the risk of hypertension. Under the combined model, women who had a short reproductive lifespan (<35 years) and who had a BMI ≥30 kg/m2 at baseline showed a higher risk of T2DM (HR: 6.30, 95% CI: 4.41–8.99) and hypertension (HR: 6.06, 4.86–7.55) compared with women who had a reproductive lifespan of 38–40 years and a BMI < 25 kg/m2.

      Conclusions

      A higher risk of both incident T2DM and hypertension at midlife was found among women experiencing a shorter reproductive lifespan, with pronounced risk for women experiencing both a short reproductive lifespan (<35 years) and a higher baseline BMI (≥30 kg/m2). Women with a short reproductive lifespan may benefit from maintaining healthy body weight in midlife.

      Keywords

      Abbreviations:

      BMI (body mass index), CVD (cardiovascular disease), HR (hazard ratio), MHT (menopausal hormone therapy), RLS (reproductive lifespan), SD (standard deviation), T2DM (type 2 diabetes mellitus)
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