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Cited by 147

The DOI matches its Crossref record; 15 of the 15 references it cites were found in a registry or an index.

Premature Menopause, Clonal Hematopoiesis, and Coronary Artery Disease in Postmenopausal Women

Honigberg, Michael C., Zekavat, Seyedeh M., Niroula, Abhishek, Griffin, Gabriel K., Bick, Alexander G., Pirruccello, James P., Nakao, Tetsushi, Whitsel, Eric A., Farland, Leslie V., Laurie, Cecelia, Kooperberg, Charles, Manson, JoAnn E., Gabriel, Stacey, Libby, Peter, Reiner, Alexander P., Ebert, Benjamin L., NHLBI Trans-Omics for Precision Medicine Program, Natarajan, Pradeep·2021·Circulation
DOI 10.1161/circulationaha.120.051775PMC PMC7911856
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Abstract

Background: Premature menopause is an independent risk factor for cardiovascular disease in women, but mechanisms underlying this association remain unclear. Clonal hematopoiesis of indeterminate potential (CHIP), the age-related expansion of hematopoietic cells with leukemogenic mutations without detectable malignancy, is associated with accelerated atherosclerosis. Whether premature menopause is associated with CHIP is unknown. Methods: We included postmenopausal women from the UK Biobank (n=11 495) aged 40 to 70 years with whole exome sequences and from the Women’s Health Initiative (n=8111) aged 50 to 79 years with whole genome sequences. Premature menopause was defined as natural or surgical menopause occurring before age 40 years. Co–primary outcomes were the presence of any CHIP and CHIP with variant allele frequency >0.1. Logistic regression tested the association of premature menopause with CHIP, adjusted for age, race, the first 10 principal components of ancestry, smoking, diabetes, and hormone therapy use. Secondary analyses considered natural versus surgical premature menopause and gene-specific CHIP subtypes. Multivariable-adjusted Cox models tested the association between CHIP and incident coronary artery disease. Results: The sample included 19 606 women, including 418 (2.1%) with natural premature menopause and 887 (4.5%) with surgical premature menopause. Across cohorts, CHIP prevalence in postmenopausal women with versus without a history of premature menopause was 8.8% versus 5.5% ( P <0.001), respectively. After multivariable adjustment, premature menopause was independently associated with CHIP (all CHIP: odds ratio, 1.36 [95% 1.10–1.68]; P =0.004; CHIP with variant allele frequency >0.1: odds ratio, 1.40 [95% CI, 1.10–1.79]; P =0.007). Associations were larger for natural premature menopause (all CHIP: odds ratio, 1.73 [95% CI, 1.23–2.44]; P =0.001; CHIP with variant allele frequency >0.1: odds ratio, 1.91 [95% CI, 1.30–2.80]; P <0.001) but smaller and nonsignificant for surgical premature menopause. In gene-specific analyses, only DNMT3A CHIP was significantly associated with premature menopause. Among postmenopausal middle-aged women, CHIP was independently associated with incident coronary artery disease (hazard ratio associated with all CHIP: 1.36 [95% CI, 1.07–1.73]; P =0.012; hazard ratio associated with CHIP with variant allele frequency >0.1: 1.48 [95% CI, 1.13–1.94]; P =0.005). Conclusions: Premature menopause, especially natural premature menopause, is independently associated with CHIP among postmenopausal women. Natural premature menopause may serve as a risk signal for predilection to develop CHIP and CHIP-associated cardiovascular disease.

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Metadata

Authors
Honigberg, M. C., Zekavat, S. M., Niroula, A., Griffin, G. K., Bick, A. G., Pirruccello, J. P., Nakao, T., Whitsel, E. A., Farland, L. V., Laurie, C., Kooperberg, C., Manson, J. E., Gabriel, S., Libby, P., Reiner, A. P., Ebert, B. L., Program, N. T.-O. F. P. M., & Natarajan, P.
Affiliations
  • Cardiology Division (M.C.H., J.P.P., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston.
  • Broad Institute of Harvard and MIT, Cambridge, MA (M.C.H., S.M.Z., A.N., G.K.G., A.G.B., J.P.P., T.N., S.G., B.L.E., P.N.).
  • Cardiovascular Research Center and Center for Genomic Medicine (M.C.H., J.P.P., T.N., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston.
  • Gillings School of Global Public Health and School of Medicine, University of Chapel Hill, NC (E.A.W.).
  • Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (L.V.F.).
  • Department of Biostatistics, University of Washington, Seattle (C.L.).
  • Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (C.K., A.P.R.).
  • Division of Preventive Medicine (J.E.M.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA.
  • Cardiovascular Division, Brigham and Women’s Hospital Heart &amp; Vascular Center, Boston, MA (P.L.).
ORCID
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2021-02-02
Volume
143
Issue
5
Pages
410-423
ISSN
  • 0009-7322
  • 1524-4539
DOI
10.1161/circulationaha.120.051775
PMC
PMC7911856
Cited by
147
References
15
Language
en

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