AIMS Early age at menarche has been reported to be associated with increased risks of developing type 2 diabetes (T2D) and coronary heart disease (CHD) in adulthood, but a late menarche has also been found to be associated with an increased risk of CHD. Both T2D and CHD are important risk factors for developing heart failure (HF). We examined the relationship between age at menarche (AAM) and HF incidence in women from the European Prospective Investigation into Cancer and Nutrition - Netherlands (EPIC-NL) cohort study. METHODS AND RESULTS The EPIC-NL cohort comprised 28,504 women aged 20-70 years at baseline (1993-1997). Mean age at menarche was 13.3 (standard deviation 1.6) years. During a median follow-up of 15.2 years HF occurred in 631 women. Cox proportional hazard regression models, stratified by cohort and adjusted for potential confounders, were used to investigate the associations between AAM and HF incidence. After confounder adjustment, each year of older age at menarche was associated with a 5% lower risk of HF (hazard ratio 0.95 (95% CI, 0.91-1.00), p-value 0.048). Further adjusting for body mass index (BMI), prevalent CHD, hypertension, or prevalent T2D as potential mediators between early menarche and risk of HF attenuated the associations between AAM and risk of HF to non-significance. CONCLUSION Older AAM reduced the risk of HF in this study. BMI, prevalent CHD, hypertension and prevalent T2D seemed to mediate this association. Future research with a longer follow-up should establish whether there is an independent effect of AAM on HF risk. Also, further phenotyping of HF cases is necessary to enable whether the associations differ for the various subtypes of HF.

中文翻译：

---

初潮年龄和心力衰竭风险：EPIC-NL 研究

AIMS 据报道，初潮过早与成年后患 2 型糖尿病 (T2D) 和冠心病 (CHD) 的风险增加有关，但也发现初潮晚与 CHD 风险增加有关。T2D 和 CHD 都是发生心力衰竭 (HF) 的重要危险因素。我们研究了欧洲癌症和营养前瞻性调查 - 荷兰 (EPIC-NL) 队列研究中女性初潮年龄 (AAM) 与 HF 发病率之间的关系。方法和结果 EPIC-NL 队列包括 28,504 名年龄在 20-70 岁之间的女性（1993-1997 年）。初潮时的平均年龄为 13.3（标准差 1.6）岁。在中位随访 15.2 年期间，631 名女性发生了心衰。Cox 比例风险回归模型，按队列分层并针对潜在混杂因素进行了调整，用于研究 AAM 和 HF 发生率之间的关联。混杂因素调整后，初潮年龄每增加一岁，心衰风险降低 5%（风险比 0.95（95% CI，0.91-1.00），p 值 0.048）。进一步调整体重指数 (BMI)、流行的冠心病、高血压或流行的 T2D 作为早期初潮和 HF 风险之间的潜在中介，将 AAM 与 HF 风险之间的关联减弱为非显着性。结论 在本研究中，老年 AAM 降低了 HF 的风险。BMI、流行的冠心病、高血压和流行的 T2D 似乎介导了这种关联。未来更长时间随访的研究应确定 AAM 是否对 HF 风险有独立影响。还，