Women Who Experience Premature Menopause at Increased Risk of Coronary Heart Disease

Priya Feaney, MD

Analysis of the Lifetime Risk Pooling Project indicates women who experience premature menopause were at an increased lifetime risk of coronary heart disease (CHD).

Presented at the American Heart Association’s Epidemiology, Prevention, Lifestyle and Cardiometabolic Health Conference 2021, results of the analysis suggest nonsurgical premature menopause was associated with a 40% greater risk of CHD and also shed light on disparities in incidence of premature menopause among women of different racial/ethnic backgrounds.

“These results indicate premature menopause is associated with higher lifetime risk of coronary heart disease. To mitigate this risk, clinicians need to start asking women about their menopause status earlier,” said Priya Freaney, MD, a cardiology fellow at Northwestern University’s Feinberg School of Medicine, in a statement. “If a woman experiences menopause before the age of 40, she should let her doctor know so they can be more proactive about optimizing her cardiovascular health—such as weight management and blood pressure—throughout her mid-life years and preventing heart disease over the course of her lifetime.”

With the 2019 AHA/ACC Primary Prevention Guidelines highlighting women who enter menopause before the age of 40 as being at risk for CHD, Freaney and a team of colleagues sought to explore race-specific prevalence of premature menopause and lifetime risk of CHD with the aim of improving risk stratification and prevention. Using pooled data from 6 cohorts within the Lifetime Risk Pooling Project, investigators obtained data related to a cohort of more than 10,000 women between 55-69 years of age with no history of CHD at baseline.

The earliest enrollment among women in the cohort began in 1964 and the latest follow-up date occurred in 2017. Of note, women who underwent surgical menopause were not included in the study. For the purpose of analysis, investigators used modified Kaplan Meier analysis and competing Cox models to estimate for risk for CHD or non-CV death with adjustment for clinical risk factors, such as age, smoking status, obesity, and presence of other comorbidities.

Of the 10,036 individuals identified for inclusion, 3522 were Black and 6514 were White—the mean age of these groups was 61.2±4.3 and 60.0±4.4 years, respectively.

Initial analysis indicated premature menopause was more common among Black women (15.5%) than White women (4.8%). Adjusted analyses indicated the lifetime risk of CHD morbidity and mortality was 41% (HR, 1.41; 95% CI, 1.04-1.90) greater in Black women and 39% (HR, 1.39; 95% CI, 1.03-1.87) greater in White women with premature menopause compared to their counterparts without premature menopause.

“We need to better understand what factors contribute to a woman’s lifetime risk of heart disease, and specifically, how timing of menopause may be connected to risk,” Freaney said.

This study, “Association Between Premature Menopause And Lifetime Risk Of Coronary Heart Disease: Lifetime Risk Pooling Project,” was presented at AHA EPI Lifestyle Conference 2021.