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Available online 19 November 2021
Lifestyle and cardiovascular mortality in menopausal women: a population-based cohort study
Hábitos de vida y mortalidad cardiovascular de las mujeres menopáusicas: estudio de cohortes de base poblacional
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José A. Quesadaa, Vicente Bertomeu-Gonzáleza,b,c, Juan M. Ruiz-Nodara,c,d, Adriana López-Pinedaa,
Corresponding author
adriannalp@hotmail.com

Corresponding author: Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, Ctra. N-332 Alicante-Valencia s/n, 03550 San Juan de Alicante, Alicante, Spain.
, Francisco Sánchez-Ferrera,e
a Grupo de Investigación Cardiovascular (GRINCAVA), Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, San Juan de Alicante, Alicante, Spain
b Sección de Cardiología, Hospital Universitario de San Juan de Alicante, San Juan de Alicante, Alicante, Spain
c Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain
d Servicio de Cardiología, Hospital General Universitario de Alicante, Alicante, Spain
e Departamento de Farmacología, Pediatría y Química Orgánica, Universidad Miguel Hernández de Elche, San Juan de Alicante, Alicante, Spain
Received 28 April 2021. Accepted 10 August 2021
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Figures (1)
Tables (4)
Table 1. Cumulative incidence of cardiovascular mortality and morbidity due to other causes according to lifestyle habits and chronic disease
Table 2. Multivariate Cox model for cardiovascular mortality with adjustment for competing risks from other causes of death
Table 3. Risk scale for each category of predictor variables from the multivariate model
Table 4. Probability of cardiovascular death over 6 years according to risk scale
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Additional material (1)
Abstract
Introduction and objectives

There are models for cardiovascular risk prediction in the general population, but the prediction of risk in postmenopausal women has not been specifically studied. This study aimed to determine the association of lifestyle habits and chronic diseases with cardiovascular risk in menopausal women, as well as to build a risk scale.

Methods

Retrospective population-based cohort study using data from the 2011 National Health Survey of Spain as a data source, Women ≥ 50 years were included. The characteristics that best defined the life habits of the study women were collected, as well as their health status and self-reported medical history at the time of the survey. Follow-up data on all-cause mortality were obtained from participants from 2011 to 2017.

Results

A total of 5953 women ≥ 50 years of age were included, with a mean age of 66.4 ± 11.4 years. The incidence of cardiovascular mortality in the follow-up period was 4%. Vegetable consumption less than 1 time/week (HR, 1.758), smoking (HR, 1.816) or excess hours of sleep (≥ 9h/day, HR, 1.809), or o have main daily activity sitting most of the time (HR, 2.757) were related to cardiovascular mortality. The predictive model presents an honest C-index in test sample of 0.8407 (95%CI, 0.8025-0.8789).

Conclusions

Life habits such as the consumption of vegetables, daily main activity, sleeping hours or smoking are risk factors for cardiovascular mortality of great relevance among menopausal women. A simple 6-year self-reported risk scale with high predictive capacity is provided.

Keywords:
Heart disease risk factors
Postmenopause
Women
Mortality
Cardiovascular disease
Abbreviations:
BMI
CVD
ENSE11
HR
Resumen
Introducción y objetivos

Existen modelos de predicción de riesgo cardiovascular en población general, pero no se ha estudiado de modo específico la predicción del riesgo de las mujeres posmenopáusicas. El objetivo de este estudio es conocer los hábitos de vida y las enfermedades crónicas asociados con mayor riesgo cardiovascular en mujeres menopáusicas, así como construir una escala de riesgo.

Métodos

Estudio de cohortes retrospectivo de base poblacional cuya fuente de datos es la Encuesta Nacional de Salud de España de 2011. Se incluyó a mujeres de edad ≥ 50 años. Se recogieron las características que mejor definían los hábitos de vida de las mujeres del estudio, así como su estado de salud y los antecedentes médicos declarados por ellas en el momento de la encuesta. Se realizó seguimiento de la mortalidad de las mujeres del estudio desde 2011 hasta 2017.

Resultados

Se incluyó a 5.953 mujeres con una media de edad de 66,4±11,4 años. La incidencia de mortalidad cardiovascular en el periodo de seguimiento fue del 4%. Se relacionaron con la mortalidad cardiovascular el consumo de verduras menor de 1 vez/semana (HR=1,758), el tabaquismo (HR=1,816) el exceso de horas de sueño (≥ 9 h/día, HR=1,809) o tener actividad principal diaria sentada la mayor parte del tiempo (HR=2,757). El modelo predictivo presenta un estadístico C «sincero» en muestra de prueba de 0,8407 (IC95%, 0,8025-0,8789).

Conclusiones

Hábitos de vida como el consumo de verduras, la actividad principal diaria, las horas de sueño o el tabaquismo son factores de riesgo de mortalidad cardiovascular de gran relevancia entre las mujeres menopáusicas. Se aporta una sencilla escala de riesgo autorreferida a 6 años con elevada capacidad predictiva.

Palabras clave:
Factores de riesgo cardiovascular
Posmenopausia
Mujeres
Mortalidad
Enfermedad cardiovascular

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