Early menopause tied to higher risk for incident heart failure

Key takeaways:

• Women with early menopause had higher incident heart failure risk when adjusting for adipokine levels.
• Adiponectin was independently tied to greater incident heart failure risk, but leptin and resistin were not.

Women with menopause onset before age 45 years were more likely to develop incident heart failure regardless of serum adipokine levels, according to study findings published in Menopause.

“The most surprising finding was that elevated levels of adiponectin — which is an anti-inflammatory adipokine — was associated with an increased risk for incident heart failure despite the known vasculoprotective, antiatherosclerotic and antithrombotic effects of adiponectin,” Imo A. Ebong, MD, MS, associate professor at UC Davis in Sacramento, California, told Healio. “This is explained by the concept of adiponectin resistance, which is promoted by natriuretic peptide levels. The relationship of adiponectin with incident heart failure is complex. Just like natriuretic peptides, which are established biomarkers of heart failure, elevated adiponectin levels may signal individuals who are at higher risk for developing heart failure, such as those with obesity or postmenopausal women.”

Ebong and colleagues evaluated 746 postmenopausal women (mean age, 65.1 years) from the Multi-Ethnic Study of Atherosclerosis with data on menopausal age, adipokines and incident heart failure. Researchers obtained abdominal CT scans to assess fat tissue and visceral adipose tissue and collected fasting blood samples to measure sex hormones. Heart failure incidence was based on physician diagnosis and use of heart failure medications plus pulmonary congestion on chest radiography, dilated ventricle/decreased left ventricular function on echocardiography/ventriculography or the presence of left ventricular diastolic dysfunction.

During a median follow-up period of 17.8 years, 45 heart failure events occurred. Incident heart failure risk was higher for women with early menopause onset in models adjusting for adiponectin (HR = 4.5; 95% CI, 1.41-14.3), leptin (HR = 4.64; 95% CI, 1.46-14.7) and resistin (HR = 5.16; 95% CI, 1.59-16.7) when also adjusting for waist circumference, other cardiovascular risk factors and myocardial infarction.

In adjusted analyses, researchers observed an independent association between greater incident heart failure risk and increased serum adiponectin (HR = 2.2; 95% CI, 1.35-3.57). Leptin and resistin were not associated with incident heart failure.

Ebong said the measure of adiposity may be important and when available, abdominal CT scans should be used to estimate visceral adipose tissue.

“Further studies should evaluate the role of adipokines — adiponectin, leptin and resistin — with incident heart failure according to heart failure subtypes — heart failure with preserved ejection fraction and heart failure with reduced ejection fraction,” Ebong told Healio.

For more information:

Imo A. EbongMD, MS, can be reached at iaebong@ucdavis.edu.