Relations of Menopause Timing With Pressure Pulsatility in the Framingham Study

BACKGROUND: Women have lower pulse pressure (PP) than men as young adults, but higher PP after a midlife PP nadir. This PP reversal is often attributed to lower estrogen levels at menopause. However, a detailed analysis of hemodynamic changes around the time of menopause has not been performed. METHODS: Relations between the timing of menopause and sex differences in PP were assessed in the Framingham Heart Study cohorts (N=6760 unique participants) across 3 visits spanning 14 years. Women were categorized into 4 groups by age at menopause: persistently premenopausal or postmenopausal with early (<25th percentile, age <48 years), average (25th to 74th percentile, age 48-53), or late (≥75th percentile, age >53 years) menopause age. RESULTS: PP decreased with increasing age in women and men under 40 years of age, being lower in women than in men. PP increased with age in women and men after midlife and was higher in women than in men after age 60. Nadirs in midlife PP, adjusted for vascular risk factors, occurred at 47 years of age in men and at 39, 38, 37, and 37 years of age in the 4 menopause groups, respectively, with nadirs in the postmenopausal groups occurring an average of 6, 14, and 19 years before menopause. CONCLUSIONS: PP transitions from a falling to a rising profile approximately a decade earlier in women than in men, and up to 2 decades before the onset of menopause in women, suggesting that factors other than age of menopause are involved.