Age at Menarche, Cardiometabolic Disease Prevalence, and Disease Control in Korean Women: Analysis of the Korea National Health and Nutrition Examination Survey.

BACKGROUND: Early menarche is linked to adverse cardiometabolic outcomes, but its relationship with disease management remains unclear. We examined associations between menarcheal age and the prevalence and control of cardiometabolic diseases in Korean women. METHODS: In 25,227 women aged ≥19 years from the Korea National Health and Nutrition Examination Survey (KNHANES), 2014-2023, menarcheal age was categorized as early (<12 years), intermediate (12-15 years; reference), and late (≥16 years). Multivariable logistic regression assessed the prevalence and control of type 2 diabetes mellitus (T2DM), hypercholesterolemia, and hyper-low-density lipoprotein (LDL) cholesterolemia, stratified by menopausal status. RESULTS: Among premenopausal women, unadjusted comparisons favored the early-menarche group, reflecting age confounding; no significant association persisted after full adjustment for body mass index, lifestyle, and socioeconomic factors. Among postmenopausal women, late menarche was independently associated with lower odds of having hypercholesterolemia (OR = 0.809, 95% CI: 0.736-0.889; p < 0.001) and hyper-LDL cholesterolemia (OR = 0.815, 95% CI: 0.741-0.897; p < 0.001); no association with T2DM was observed. In contrast, among postmenopausal women who already had hyper-LDL cholesterolemia, those with late menarche were less likely to reach adequate LDL control than those with menarche at 12 to 15 years (OR = 0.814, 95% CI 0.693-0.956; p = 0.019). Although both odds ratios are below 1, they carry opposite clinical meaning, reflecting a lower prevalence of disease but poorer control once disease has developed. CONCLUSIONS: The cardiometabolic effects of menarcheal age appear life-stage dependent, extending beyond prevalence to disease management. In postmenopausal women, late menarche was associated with lower odds of dyslipidemia yet, paradoxically, with poorer LDL control once disease had developed, indicating that a lower observed risk should not justify less vigilant management. These findings support integrating menarcheal age into cardiometabolic risk assessment.