Heart disease risk doubles with early menopause

JOHNS HOPKINS (US) — Women who go into early menopause are twice as likely to suffer from coronary heart disease and stroke, experts report.

The finding is the same for patients from a variety of ethnic backgrounds and is independent of traditional cardiovascular disease risk factors, scientists say.

“If physicians know a patient has entered menopause before her 46th birthday, they can be extra vigilant in making recommendations and providing treatments to help prevent heart attacks and stroke,” says Dhananjay Vaidya, assistant professor of general internal medicine at Johns Hopkins University and leader of the research. “Our results suggest it is also important to avoid early menopause if at all possible.”


For example, he says, research has shown that smokers reach menopause, on average, two years earlier than non-smokers do, so quitting smoking may delay onset.

The study, published in the October issue of the journal Menopause, suggested that the negative impact of early menopause was similar whether the women reached it naturally or surgically, via removal of reproductive organs, though more research on that point is needed. Often, Vaidya says, women who undergo hysterectomies have their ovaries removed, which precipitates rapid menopause.

“Perhaps ovary removal can be avoided in more instances,” he says. That might protect patients from heart disease and stroke by delaying the onset of menopause.

Cardiovascular disease is the number one killer of women in the United States, according to the Centers for Disease Control and Prevention. Previous studies have shown a link between early menopause and heart disease and stroke among white women, but similar associations had not been demonstrated in more diverse populations.

Hispanic and African-American women, he says, tend, on average, to go through menopause somewhat earlier than women of European descent.

Vaidya and his colleagues examined data from 2,509 women involved in the Multi-Ethnic Study of Atherosclerosis, a longitudinal, ethnically diverse cohort study of patients aged 45 to 84 years, all enrolled between 2000 and 2002 and followed until 2008. Of the women, 28 percent reported early menopause, before age 46.

Vaidya emphasizes that although the risk of heart attack and stroke was doubled in these groups, the actual number of cardiac and stroke events recorded among study participants was small. Only 50 women in the study suffered heart events, while 37 had strokes.

Menopause is a process during which a woman’s reproductive and hormonal cycles slow, her periods (menstruation) eventually stop, ovaries stop releasing eggs for fertilization and produce less estrogen and progesterone, and the possibility of pregnancy ends. Menopause takes place in most women between the ages of 45 and 55, but menopausal onset is influenced by a combination of factors including heredity, smoking, diet, and exercise.

Some women are treated with hormone replacement therapy to control menopause symptoms such as profuse sweating and hot flashes, but its widespread long-term use has been limited after large clinical trials showed that it increased the risk of heart attacks in some women. In Vaidya’s study, no role was detected for HRT in potentially modifying the impact of early menopause.

“Cardiovascular disease processes and risks start very early in life, even though the heart attacks and strokes happen later in life,” he says. “Unfortunately, young women are often not targeted for prevention, because cardiovascular disease is thought to be only attacking women in old age.

“What our study reaffirms is that managing risk factors when women are young will likely prevent or postpone heart attacks and strokes when they age.”

The research was supported by the National Institutes of Health’s National Heart, Lung, and Blood Institute. Researchers from the University of Alabama at Birmingham and Johns Hopkins were involved in the study.

Source: Johns Hopkins University