Early Menopause May Increase Heart Failure Risk

Lara C. Pullen, PhD

May 19, 2014

Early natural menopause is significantly associated with heart failure (HF) when compared with menopause at age 50 to 54 years. The increase in risk is even more pronounced in women who smoke.

Iffat Rahman, PhD, from the Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden, and colleagues present their analysis of the population-based Swedish Mammography Cohort in an article published online May 12 in Menopause. The cohort included 22,256 women who self-reported their age at menopause. Menopause was not confirmed by biochemical tests.

The average age at menopause is 51 years. Typically, smokers reach menopause a year earlier than nonsmokers.

The authors identified 2,532 first-time hospitalizations for heart failure among the study population. Women who entered menopause between 40 and 45 years of age had a 40% increased risk for heart failure compared with women who entered menopause between age 50 and 54 years (hazard ratio, 1.40; 95% confidence interval, 1.19 - 1.64).

The risk was similar in never smokers (HR, 1.33; 95% CI, 1.06 to 1.66) and ever smokers (HR, 1.39; 95% CI, 1.09 to 1.78). In addition, ever smokers who entered menopause between the ages of 46 and 49 years also had an elevated risk (HR, 1.25; 95% CI, 1.06 to 1.47), but that was not the case for never smokers. The investigators explain that the menopausal transition may be associated with changes in blood lipids, causing lipids to become more proatherogenic.

"To the best of our knowledge, this is the first observational study to examine the association between age at natural menopause and future risk of HF. The observed increased risk of HF among women in early menopause in the present study is in line with what has been reported in previous observational studies on [coronary heart disease] and stroke. A meta-analysis found the pooled risk estimate of early menopause on [cardiovascular] risk to be 1.38 after controlling for age and smoking," the authors write.

Previous studies have indicated a relationship between atherosclerotic heart disease and early menopause. Despite this, most randomized clinical trials have failed to demonstrate that exogenous estrogens are cardioprotective.

"Menopause, early or late, is always a good time to take more steps to reduce heart disease risk through exercise, a healthy diet, weight loss, and quitting smoking," North American Menopause Society Executive Director Margery Gass, MD, noted in a society press release. "This thought-provoking study should encourage more research to find out how early menopause and heart failure are linked. Do the factors that cause heart failure also cause ovarian failure?"

This work was supported by the Swedish Research Council Committee for Medicine and the Swedish Research Council Committee for Infrastructure. The authors have disclosed no relevant financial relationships.

Menopause. Published online May 12, 2014. Abstract

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