Age at Menarche and Cardiometabolic Risk in Adolescent Girls and Adult Women: A Systematic Review
Abstract
Introduction: The age of menarche may reflect early patterns of metabolic risk and has been linked to obesity, diabetes, hypertension, and cardiovascular disease in later stages. Objective: To compare cardiometabolic risk in adolescent and adult women with early, normal, and late menarche using a systematic review. Methodology: A systematic search was conducted in MEDLINE/PubMed and Scopus, following PRISMA 2020 guidelines. Observational, cohort, cross-sectional, case-control, population-based, and genetic studies published between 2021 and 2026 that assessed the age of menarche in relation to obesity, metabolic syndrome, type 2 diabetes mellitus, insulin resistance, hypertension, dyslipidemia, or cardiovascular disease were included. Selection was performed by two independent reviewers using Rayyan; discrepancies were resolved by consensus or a third reviewer. Methodological quality was assessed using NHLBI tools. Thirty-six studies were included for narrative synthesis. The protocol was registered in PROSPERO with the code CRD420261301527. Results: Most studies presented good or fair methodological quality. Early menarche was associated with a higher risk of general and abdominal obesity, metabolic syndrome, hypertension, dyslipidemia, insulin resistance, and type 2 diabetes mellitus. The association was more consistent for adiposity and metabolic syndrome; glycemic and cardiovascular outcomes showed greater heterogeneity. Some associations were attenuated after adjusting for body mass index, suggesting a mediating role of adiposity. Several studies identified nonlinear patterns, with a higher risk also associated with late menarche. Conclusions: Early menarche appears to be an early clinical marker of cardiometabolic susceptibility. Prospective cohorts are needed to clarify causality, mediators, and population cut-off points. Keywords: Menarche; Metabolic Syndrome; Cardiovascular Diseases; Metabolic Diseases (Source: MeSH, NLM).