Premature menopause associated with HF, AF risk
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Women with a history of premature menopause, defined as menopause before age 40 years, are more likely to develop HF or atrial fibrillation over 9 years of follow-up compared with women without premature menopause, data show.
In a Korean database analysis of more than 1.4 million women, researchers also found that premature menopause was significantly associated with CHD compared with all other categories of age at menopause.
“Women with premature menopause should be aware that they may be more likely to develop heart failure or atrial fibrillation than their peers,” Ga Eun Nam, MD, of the department of family medicine at Korea University College of Medicine in Seoul, South Korea, said in a press release. “This may be good motivation to improve lifestyle habits known to be linked with heart disease, such as quitting smoking and exercising.”
Age at menopause and increasing risk
Nam and colleagues analyzed data from 1,401,175 postmenopausal women who underwent a health examination provided by the Korean National Health Insurance Service, which included reproductive histories. Researchers assessed rates of incident HF and AF according to the history of premature menopause and age at menopause. Mean follow-up was 9.1 years.
The findings were published in the European Heart Journal.
Within the cohort, 2% of women reported premature menopause; their mean age was 60 years.
During follow-up, 3% of women developed HF and 3.2% of women developed AF.
Researchers found that women with history of premature menopause were 33% more likely to develop HF compared with women without premature menopause (HR = 1.33; 95% CI, 1.26-1.4), as well as 9% more likely to develop AF (HR = 1.09; 95% CI, 1.02-1.16).
Additionally, compared with women aged 50 years or older at menopause, those aged 45 to 49 years, 40 to 44 years or younger than 40 years at menopause showed an increased trend in risk for incident HF and AF over time (P for trend < .001).
“The misconception that heart disease primarily affects men has meant that sex-specific risk factors have been largely ignored,” Nam said in the release. “Evidence is accumulating that undergoing menopause before the age of 40 [years] may increase the likelihood of heart disease later in life. Our study indicates that reproductive history should be routinely considered in addition to traditional risk factors such as smoking when evaluating the future likelihood of heart failure and atrial fibrillation.”
Consider ‘women-specific risk factors’
In a related editorial, Tina Torbati, DO, of the Barbra Streisand Women’s Heart Center at Cedars-Sinai Smidt Heart Institute, and colleagues noted that the analysis controlled for hormone therapy and menopause hormone therapy, suggesting the mechanism of increased risk cannot be blamed on estrogen alone.
“However, inflammation may mediate relations between estrogen loss and CV risk, which can predispose these women to AF and HF,” Torbati and colleagues wrote.
The researchers added that women-specific risk factors such as reproductive history should be considered for HF and AF risk prediction and preventive strategies.
“Women who experience premature or early menopause are at increased risk for adverse cardiovascular outcomes — it does not appear that estrogen alone can be blamed,” Torbati and colleagues wrote. “We commend the authors for adding to the existing and growing body of literature in regard to this topic. Further work investigating reproductive history including the menopause transition for CVD prediction and prevention in women is needed.”
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