Early Menopause May Raise Risk for Heart Attack & Stroke
by Chris Kaiser for MedPage Today:Women who go through menopause at age 46 or younger may have an increased risk for heart attacks and strokes, researchers report.Kaplan-Meier curves for coronary artery disease- (CAD) and stroke-free survival were significantly lower for women with early menopause (log rank P=0.008 and P=0.015, respectively), reported Melissa Wellons, MD, MHS, of the University of Alabama at Birmingham, and colleagues.When researchers adjusted for age, race/ethnicity, and geography, they found that early menopause was an independent predictor of both CAD (HR 2.11, 95% CI 1.19 to 3.75, P=0.010) and stroke (HR 2.10, 95% CI 1.08 to 4.07, P=0.028), according to the study published online in the journalMenopause.After adjusting for traditional risk factors, the relative risk was reduced but it remained significant -- roughly 85% higher for CAD and a doubling of risk for stroke."[These results] may suggest that early menopause, if possible, should be avoided and that women with early menopause may be a group to target for aggressive cardiovascular disease prevention strategies," researchers concluded.Additionally, decreasing the number of elective oophorectomies "may be an important step to reduce cardiovascular disease," they wrote.The findings are consistent with other studies looking at CAD; however, the patient populations in many of those studies were mostly European and white, Wellons and colleagues pointed out.In the current study, participants were part of the Multi-Ethnic Study of Atherosclerosis (MESA), a longitudinal study that comprised white, black, Hispanic, and Chinese people recruited from Maryland, Illinois, North Carolina, California, New York, and Minnesota.Regarding the association between early menopause and stroke, previous findings have been inconsistent, the investigators wrote.In this study, a total of 693 women experienced early menopause and 1,816 did not. Participants self-reported early menopause as either occurring naturally or via surgery before age 46.Researchers said that the study did not have the power to determine whether differences in cardiovascular risk existed between the types of menopause.Because smoking has been linked with earlier menopause, researchers adjusted for ever-smokers as part of the traditional risk factors. They did not have enough power, however, to isolate the effect of smoking and early menopause on cardiovascular outcomes.In the model that adjusted for family history of cardiovascular disease (which also included early menopause, demographics, and traditional cardiovascular risk factors), early menopause was no longer a statistically significant predictor of CAD (HR 1.80, 95% CI 0.99 to 3.29, P=0.054) or stroke (HR 1.98, 95% CI 0.98 to 4.00, P=0.058).They suggested that family history of cardiovascular disease may be a better predictor of CAD or stroke than early menopause. In addition, they noted that the age of menopause and cardiovascular disease risk "appear highly heritable," which has led to a few cross-cohort studies of genetic variations of cardiovascular disease and reproductive aging that are currently under way.But they also called for studies examining family history of menopause and family history of cardiovascular disease.The study was limited by the self-reported nature of early menopause and the potential of survival bias because the women were free of cardiovascular disease at baseline enrollment in MESA.