Menopause and risk of non-fatal acute myocardial infarction: an Italian case-control study and a review of the literature

The relationship between menopause and non-fatal acute myocardial infarction (AMI) was considered by analysing data from a case-control study conducted in Italy between 1983 and 1992. Cases were 429 women, below age 75 years, with a first episode of non-fatal AMI, admitted to 30 coronary care units; controls were 863 women admitted to the same network of hospitals for acute diseases other than cardiovascular, neoplastic, or hormone-related. Postmenopausal women were not at higher risk of AMI than pre/perimenopausal women, after adjustment for age and other selected covariates [multivariate odds ratio (OR) 0.99]. With reference to age at menopause, compared with women reporting menopause when <45 years, the multivariate OR were 1.54 for those aged 45-49 at menopause, 1.36 for those aged 50-52 years, and 0.97 for those aged >/=53, in the absence of any trend in risk. No meaningful relationship emerged with time since menopause (OR 0.85 for <10 years since menopause). The results were similar in women aged <60 and >/=60 years at AMI. Although the present study does not support a substantial relationship between menopause and non-fatal AMI, the overall epidemiological evidence is compatible with a moderate association.