Women who are menopausal by the age of 40 had a 40% increased risk of developing coronary heart disease over their lifetime compared to women who did not go through early menopause, according to preliminary research to be presented at the American Heart Association’s Epidemiology, Prevention, Lifestyle & Cardiometabolic Health Conference 2021. The meeting is virtual, May 20-21 and offers the latest science on population-based health and wellness and implications for lifestyle.

Coronary heart disease is a very common type of heart disease in which arteries around the heart become blocked due to a buildup of plaque, which develops over time. Left undetected and untreated, women can suffer chest pain, a heart attack or even sudden cardiac arrest.

“We know from previous research that women who experience premature menopause are more likely to develop heart disease over the short-term. However, we don’t fully understand their long-term risk. No past studies have looked at this,” said lead study author Priya M. Freaney, MD, a third-year cardiology fellow at Northwestern University’s Feinberg School of Medicine in Chicago. “We need to better understand what factors contribute to a woman’s lifetime risk of heart disease, and specifically, how timing of menopause may be connected to risk.”

For this study, the researchers pooled data from six nationwide study groups. This analysis involved more than 10,000 Black and white women, between the ages of 55 and 69, who were free from coronary heart disease at the start of the studies. The dataset contained information on the timing of menopause and on the occurrence of coronary heart disease. Participants were included beginning in 1964, with follow-up through 2017.

The average age of natural menopause is 50. The study defined early-onset menopause as before the age of 40, indicating hormonal changes in the body led to menopause earlier than normal. Women who underwent surgical menopause were excluded from the analysis.

The researchers evaluated lifetime risk for coronary heart disease among all the participants. Cardiovascular outcomes were compared between Black women who experienced premature menopause and Black women who did not experience premature menopause. They performed the same analysis of white women from the studies.

Among the key findings:

• Black women were three times more likely than white women to experience premature menopause, 15.5% vs. 4.8%, respectively.
• Among Black and white women, those who experienced premature menopause had a 40% higher risk of developing coronary heart disease over their lifetime, compared to those who did not experience premature menopause. This held true, even after adjusting for known cardiovascular disease risk factors such as smoking, high blood pressure, Type 2 diabetes and obesity.

“These results indicate premature menopause is associated with higher lifetime risk of coronary heart disease. To mitigate this risk, clinicians need to start asking women about their menopause status earlier,” Freaney said. “If a woman experiences menopause before the age of 40, she should let her doctor know so they can be more proactive about optimizing her cardiovascular health – such as weight management and blood pressure - throughout her mid-life years and preventing heart disease over the course of her lifetime. This is an area where there is a big need for personalized, preventive cardiology care for women focused on lowering cardiovascular risk.”

According to a recent scientific statement from the American Heart Association, Menopause Transition and Cardiovascular Disease Risk: Implications for Timing for Early Prevention, published Nov. 30, 2020, the menopause transition, the years leading up to menopause, is a time of increasing heart disease risk for women. Monitoring women’s health and lifestyle while integrating early intervention strategies for optimal cardiovascular health are important, especially during midlife and during menopause to help prevent heart disease.

Co-authors are Hongyan Ning, MD; Mercedes R. Carnethon, PhD, FAHA; John T. Wilkins, MD; Norrina B. Allen, PhD; Donald M. Lloyd-Jones, MD, ScM, FAHA; and Sadiya S. Khan, MD, MSc. Author disclosures are in the abstract.

The American College of Cardiology/Merck Research Fellowship funded the study.