Early menopause associated with CV events

The Endocrine Society 92nd Annual Meeting

SAN DIEGO — Women who experience early natural or surgical menopause face an elevated risk for cardiovascular disease events, independent of cardiovascular risk factors and hormone therapy, according to results of a large, multiethnic study.

“The risk for having a heart attack, stroke or other CV disease event or death in later life doubled in women who entered early menopause,” according to Melissa Wellons, MD, a fellow in the division of endocrinology, diabetes and metabolism at the University of Alabama, Birmingham.

The study included 2,509 women aged 45 to 84 years (40% white; 25% black; 22% Hispanic; 13% Chinese). Women self-reported their age at menopause or at bilateral oophorectomy; women who did not report menopause were considered unexposed to early menopause. Early menopause was defined as going through menopause before age 46 years.

Of the population, 639 (28%) women reported early menopause, 247 (10%) had early surgical menopause and 446 (18%) had early natural menopause. Using Kaplan-Meier curves, researchers demonstrated that women with early menopause were at an increased risk for CVD events (P=.0003), including myocardial infarction, resuscitated cardiac arrest, angina, stroke and CV-related death.

During follow-up, no CVD events were reported before age 55 years, after which time women with early menopause were more likely to experience a CV event compared with women who did not enter early menopause.

The association persisted after adjustment for current or previous use of HT or other major CV risk factors. Early menopause remained a risk factor on its own, although the researchers are unsure why, according to Wellons.

“We cannot conclude that early menopause actually causes these events, but it is important because or findings support using early menopause as a marker for increased CVD risk,” Wellons said. “Therefore, getting clinicians to ask women about menopause and when they went through menopause is important.” – by Matthew Brannon

This is a very important study because there are data on both sides of the fence. The problem is attributing causality to the association that the researchers have found. So the question is: Does early menopause cause CVD due to loss of hormones early in life or does CVD cause early menopause? CVD burden may well have a connection to earlier menopause, and there are a few cohort studies that have shown that. This study shows that in a sizable, multiethnic cohort - which is meaningful.

– Nanette Santoro, MD

Professor and E. Stewart Chair of Obstetrics and Gynecology,
University of Colorado at Denver School of Medicine

For more information:

Wellons MF. OR07-1. Presented at: The Endocrine Society 92nd Annual Meeting and Expo; June 19-22, 2010; San Diego.