Mohpichai, Nopavit

Introduction: Menopause is known to be associated with myocardial infarction (MI). However, the association between menopause age and MI onset in a nationally representative population remains unknown. Objective: To examine the correlation between age of menopause and age of MI onset in the general population and the association between early menopause (onset of menopause ≤ 40 years old) and early onset of MI (onset of MI ≤ 40 years old). Methods: A cross-sectional study was conducted using a population from the 2017-2020 National Health and Nutrition Examination Survey (NHANES). The questionnaire collected self-reported data on the participants' menopause age and their age of first MI. The relationship between these two parameters was analyzed by multivariate linear and logistic regression analyses. Multivariate analysis was adjusted for race, age, body mass index (BMI), smoking status, diabetes mellitus (DM), hypertension, and dyslipidemia status. Results: Among 2,200 postmenopausal females, 90 (4.1%) have had MI. The study involved 85 postmenopausal females who reported both menopause age and MI onset, with a mean ± SD age of 55 ± 13 years. This study found a significant association between menopause age and MI onset. After adjusting for confounders, it was found that every 1-year increase in the age of menopause will delay the onset of MI by 0.28 years, with a 95% CI of 0.013 to 0.552 (Table 1A, Graph 1A, Graph 1B). Additionally, early menopause carries an almost significantly increased risk of 2.11 times (95% CI: 1.00, 4.45) for early-onset MI. After adjusting for confounders, the magnitude of the association was lower and not statistically significant, but the direction remains (OR (95% CI): 2.08 (0.87, 4.95)). However, after stratification with comorbidities, DM status was identified as an effect modifier, with early MI significantly observed in patients with DM in both univariate and multivariate analyses, with OR (95% CI) of 3.03 (1.10, 8.37) and 4.88 (1.26, 18.96), respectively (Table 2A). Conclusion: This study demonstrated a positive association between menopause age and MI onset in a generally representative population. This suggests that prolonged estrogen exposure due to late menopause may delay the onset of MI. Additionally, early menopause was associated with early MI onset in the DM population. Further longitudinal studies are required to examine the potential mechanisms involved in menopause onset and MI onset.

Background: Although BP is associated with kidney outcomes, its clinical significance in living kidney donors (LKD) is unknown. We aim to examine the association between pre-donation BP and the risk of kidney function decline in LKD. Methods: A retrospective cohort study using OPTN/SRTR including adult LKD, who underwent donation between 6/1972 and 9/2022, was utilized to examine the association of quartile (Q) of pre-donation SBP and DBP with time-to-event of ≥35% decline in post-donation eGFR from pre-donation eGFR by multiple Cox regression. Results: Of 174,311 adult LKD, mean±SD age was 41±12 years and 60% were female. Mean pre-donation SBP and DBP were 122±13 and 74±9 mmHg, respectively. Mean pre-donation SBP in Q 1, 2, 3, and 4 were 106±6, 117±2, 126±3, and 140±9 mmHg, respectively and the corresponding DBP were 62±5, 71±2, 78±2, and 86±5 mmHg, respectively. The median (IQR) of pre-donation eGFR was 91 (75, 111) mL/min/1.73 m2. Median(IQR) eGFR at immediate post-donation, 6-, 12-, and 24-months post-donation were 50 (40, 62), 54 (44, 67), 55 (45, 68), and 57 (47, 70) mL/min/1.73 m2, respectively. Out of 38,780 LKD with post-donation eGFR data at 6, 12, or 24 months, 31,054 had the event of ≥35% decline in post-donation eGFR from pre-donation eGFR with a median time to follow-up of 6.77 months(IQR 5.93, 12.67). The incidence rate of the event was 0.08 person-months. Compared to patients with SBP in Q 1, those with SBP in Q 2, 3, and 4 had a significantly increased risk for the event(HRSBP Q2,3,4 1.05, 1.08, and 1.15; P <0.001 – 0.003) but only patients with DBP in Q 3 and 4 had a significantly increased risk for the event (HRSBP Q3,4 1.04 and 1.09). After adjusting for age, gender, race/ethnicity, U.S. citizenship, education level, history of pre-donation HTN, diabetes, pre-donation BMI, DBP, and urine protein:creatinine ratio, there was a J-shaped association between pre-donation SBP and post-donation eGFR decline and only patients in the Q 2 became significantly associated with lower the risk for the event (HR 0.87, 95%CI 0.76, 0.99; Fig1). The pre-donation DBP – post-donation eGFR association was similar to the SBP – eGFR association but there was no statistically significant in all Q (Fig2). There was no effect-measured modifier for all covariates. Conclusions: Pre-donation SBP in a normal range(113 - 120 mmHg) is associated with the lowest risk for a post-donation eGFR decline. BP control in the normal range should be achieved for potential LKD.