Obesity may drive HF risk in late-onset menopause
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Risk for developing HF is significantly greater for women with obesity compared with women with a lower BMI and waist circumference, particularly among those who begin menopause at age 55 years or older, data show.
“Avoiding excess body fat could protect against developing HF, especially among women who transition into menopause at age 55 years or older,” Imo A. Ebong, MD, MS, associate professor of medicine in the division of cardiology at University of California, Davis, told Healio. “Postmenopausal women who are obese should be targeted with aggressive risk factor modification and close monitoring, particularly if they had experienced menopause at age 55 years or greater.”
Ebong and colleagues analyzed data from 4,441 women participating in the ARIC cohort study who had begun natural (n = 3,636) or surgical menopause (n = 808) by the fourth study visit (1996-1998). Researchers assessed BMI and waist circumference; prevalent HF at the fourth visit was determined from hospital discharge lists. Participants were stratified by menopausal age: younger than age 45 years (n = 1,200); age 45 to 49 years (n = 1,515); age 50 to 54 years (n = 1,468) and age 55 years and older (n = 258). Researchers estimated HRs for incident HF associated with menopausal age, testing for effect modification by obesity and adjusting for HF risk factors.
The findings were published in the Journal of the American Heart Association.
HF incidence in late menopause
During 16.5 years of follow-up, researchers observed 903 incident HF events. The attributable risk of generalized and central obesity for HF incidence was greatest among women who experienced menopause at age 55 years or older, at 11.09 per 1,000 person-years and 7.38 per 1,000 person-years, respectively.
There were significant interactions of menopausal age with BMI and waist circumference for HF incidence, (P = .02 and .001 for interaction, respectively).
Risk for incident HF for a 1 standard deviation increase in BMI was elevated in women with early menopause (HR = 1.39; 95% CI, 1.05-1.84), those entering menopause at age 45 to 49 years (HR = 1.33; 95% CI, 1.06-1.67) and for those with late-onset menopause (HR = 2.02; 95% CI, 1.41-2.89). Higher BMI was not associated with increased HF risk among women who began menopause from age 50 to 54 years.
For every 6-inch increase in waist circumference, risk for developing HF almost tripled (HR = 2.93; 95% CI, 1.85-4.65) among women with late-onset menopause. Waist circumference did not raise HF risk for women in any of the other menopausal age groups.
HF, obesity and late menopause
“Although HF incidence was greatest among women with early menopause, the attributable risk of both generalized and central obesity for HF incidence was higher among those who had experienced late menopause,” the researchers wrote. “As obesity worsened, the risk of developing HF became significantly greater when compared with women with lower BMI and waist circumference, particularly for those who had experienced late menopause.”
The researchers added that maintenance of a healthy body weight and waist circumference may be protective against developing HF, especially for women with late menopause.
“First, our findings must be confirmed in other populations,” Ebong told Healio. “Future studies are needed to investigate the mechanisms through which obesity interacts with menopause to potentiate the risk for HF and why the age at which a woman undergoes menopause make a difference.”
For more information:
Imo A. Ebong, MD, MS, can be reached at iaebong@ucdavis.edu.
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