Date of Award

January 2023

Document Type


Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Judith Lichtman

Second Advisor

Yuan Lu


Background: Current knowledge is limited on the association between early age at menopause (AAM) and angina during recovery from acute myocardial infarction (AMI) in young women. We assessed the differences in 1-year angina burden post-AMI among women in pre/peri-menopause phases compared to post-menopausal women stratified by their AAM. Methods: Among patients in the VIRGO study, 1,948 women were categorized into four groups: a reference group of those in their pre/peri-menopause phase (n=917), post-menopausal women who reached AAM at 40 years or younger (n=337), AAM between 41-49 years (n=476), and AAM between 50-55 years (n=218). Angina burden was assessed from Seattle-Angina Questionnaire (SAQ) scores for angina frequency, physical limitation, treatment satisfaction, and quality of life. We tested associations between menopausal status and angina burden using linear mixed effects models, testing unadjusted and adjusted associations across all four SAQ domains. Results: Compared to the three groups of post-menopausal women stratified by AAM, women in their pre/peri-menopause phase were least likely to have clinical and cardiovascular risk factors. Early menopause (AAM ≤40 years) was associated with higher angina burden and more physical limitation with this group exhibiting lower scores on angina frequency (2.3 points lower, standard error 0.9, p=0.010) and physical limitation (3.2 points lower, Standard Error 1.0, p<0.001) during the 12-month post-AMI period compared to women still in pre/peri-menopause. These were the only associations which remained significant after adjusting for time trends, socio-demographic, clinical, cardiovascular, menstruation, and reproductive risk factors. Conclusions: Early age at menopause is significantly associated with higher post-AMI angina burden in young women, independent of clinical conditions, risk factors, and comorbidities. Early AAM is a simple indicator for clinicians to utilize when assessing post-AMI angina risk and for decision making on angina management and AMI recovery related rehabilitative care.


This thesis is restricted to Yale network users only. It will be made publicly available on 05/10/2025