It’s true that women have a lower risk of heart disease than men do—when both are young. But once women reach menopause, their risk skyrockets. As estrogen drops, blood pressure, triglycerides, and cholesterol increase, and heart disease earns the dubious distinction of being the No. 1 killer of women.
While all postmenopausal women need to take care to protect their heart health, one subset is particularly vulnerable: those who begin menopause early. For most women, menopause begins around the age of 50, give or take a few years. But up to 4% of women begin the process before 40, which puts them at a higher risk of developing cardiovascular disease long after, according to a report in the November issue of JAMA.
Study Results. Researchers looked at the medical records of 144,260 postmenopausal women who were 40 to 69 years old. Among them, 3.4% had natural premature menopause and 0.4% had surgical menopause through ovary removal before age 40. The investigators then looked for coronary artery disease, heart failure, aortic stenosis, mitral regurgitation, atrial fibrillation, ischemic stroke, peripheral artery disease, and venous thromboembolism. A total of 3.9% of women who experienced menopause after age 40 experienced at least one of those cardiovascular conditions. In women who underwent menopause early, however, that number rose to 6% for natural menopause and 7.6% for surgical menopause. The earlier that menopause began, the greater the cardiovascular risk.
A related study was published in The Lancet Public Health in October 2019. After looking at more than 300,000 women in 15 studies, researchers agreed that women who experienced premature menopause before 40 were nearly twice as likely as those who hit menopause at 50 to have a nonfatal cardiovascular event before the age of 60. But they also found an elevated risk in the 40- to 44-year-old age bracket. Those women were 40% more likely to suffer a cardiovascular event.
How This Relates to Current Guidelines. The American College of Cardiology/American Heart Association already recommends that physicians consider a history of early menopause when assessing cardiovascular risk and when considering prescribing a statin for asymptomatic women at intermediate risk of atherosclerotic cardiovascular disease. But this study adds new information: After controlling for other risk factors, the authors note that the risk is greater than was previously known. Premature menopause may not simply occur along with other cardiovascular risk factors, they stressed: It may independently increase the chance of developing those risk factors. Atherosclerotic cardiovascular disease isn’t the only disease to watch for, they added. Early menopause is associated with risk factors that may cause valvular heart disease, coronary artery disease, atrial fibrillation, and venous thromboembolism.
Primordial Prevention. Women who experience early menopause then, are ideal candidates for primordial prevention. While primary prevention addresses risk factors once they appear, primordial prevention aims to prevent them from ever developing. That means that even if a woman has no other risk factors, if she experienced early menopause, it is even more important to make healthy food choices, lower sodium intake exercise, avoid smoking, and limit alcohol consumption.
Role of Hormone Therapy. Women who experience premature menopause are often given hormone-replacement therapy (HRT) to address menopause-related symptoms such as hot flashes, sleep problems, and bone loss. The role of HRT on cardiovascular health is not clear. There is some evidence that it may provide protection if used close to the time of menopause (within the first 10 years), but it may increase risk after that or in women over the age of 60.
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