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Early menopause linked with increased CVD risk

By Rebecca Jenkins
Women who have early menopause are significantly more likely to have a nonfatal heart attack, stroke or angina before they turn 60 years old, compared with women who are aged 50 to 51 years at menopause, a large Australian-led observational study has shown.

Using data from more than 300,000 women, researchers found a dose-response relation between younger age at menopause and increased risk of a nonfatal cardiovascular disease (CVD) event.

Compared with women who had menopause aged 50 to 51 years, CVD risk was 1.3 times higher in women who experienced early menopause (40 to 44 years) and 1.55 times higher in women who had premature menopause (younger than 40 years).

‘When we analysed age at menopause as a continuous variable, each year of decrease in age was associated with a 3% increased risk of incident cardiovascular disease,’ researchers wrote in The Lancet Public Health.

The excess risk of incident CVD in women who had early or premature menopause was highest before they turned 60 years old, attenuated between 60 and 69 years and no longer significant at 70 years and older.

The data were drawn from 15 observational studies included in the International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease Events (InterLACE) consortium – an Australian National Health and Medical Research Council-funded project. 

‘Early or premature menopause might be considered an important factor in risk stratification of cardiovascular disease for women,’ wrote the researchers, led by senior author Professor Gita Mishra of the University of Queensland's School of Public Health.

Professor Rod Baber, Clinical Professor of Obstetrics and Gynaecology at the University of Sydney, said the findings should remind all clinicians that heart disease presents differently in women than in men and that more women die acutely of coronary heart disease (CHD) – probably due to missed diagnosis.

‘And very importantly that loss of oestrogen at the menopause increases CVD and CHD risk in women probably due to adverse effects on serum lipids, progression of atherosclerosis and vessel haemodynamics,’ he told Endocrinology Today.

All women who experienced early or premature menopause should be advised of the potential increased CVD risk and should be counselled on lifestyle measures such as diet and exercise.

‘There is abundant evidence from observational studies such as this, from randomised controlled trials in older women and from basic laboratory studies to show that oestrogen replacement can mitigate many of these adverse events and that, when used appropriately, benefits are maximised and risks minimised.’

Women must be properly screened before starting therapy, Professor Baber said, and regular follow up should be mandatory. Transdermal estradiol, and where necessary progesterone, was the preferred protocol.
Lancet Pub Health 2019; 4(11): e553-e564.