Early-Onset Menopause Linked With Poor Cardiovascular Outcomes

Physicians should pay especially close attention to and consider more aggressive risk factor management for their female patients who go through early natural menopause, according to new data.

It has become increasingly evident that cardiovascular disease affects women differently than men and that treatments and prevention mechanisms have varying levels of success between the sexes. But cardiologists are still awaiting specific clinical recommendations to help them best tailor treatment for all of their patients.

“Our results indicate that menopause might be a critical period to evaluate women’s risk for future cardiovascular events and that it may be an appropriate time to introduce interventions to reduce the risk,” lead author Taulant Muka, MD, PhD (Erasmus University Medical Center, Rotterdam, the Netherlands), told TCTMD in an email. “For instance, women going into menopause before age 45 may consider [controlling] medical conditions such as hypertension, dyslipidemia, insulin resistance, and other cardiometabolic risk factors, since it may help them to identify whether they are at high risk for developing cardiovascular disease and [might] profit from lifestyle or pharmacological interventions.”

Results of a 32-study meta-analysis of more than 50,000 women published online September 14, 2016, ahead of print in JAMA Cardiology demonstrate that those who experience menopause before they turn 45 have higher risks of coronary heart disease (RR 1.50; 95% CI 1.28-1.76), stroke-related mortality (RR 1.19; 95% CI 1.08-1.31), and all-cause mortality (RR 1.12; 95% CI 1.03-1.21) compared with those who reach menopause later in life.

In a different analysis comparing women who experienced menopause between the ages of 50 to 54 with those who reached it before age 50, cardiovascular death was less likely (RR 0.87; 95% CI 0.80-0.96) among those who met that milestone at an older age. There was no longer an effect on stroke-related mortality.

In addition to increased physician scrutiny of women with premature menopause, Muka said, “more work should be done though to increase awareness among women who experience early menopause that they might be at increased risk of heart disease.”

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