Women who stop menstruating before they reach age 40 have a significantly higher risk of coronary heart disease over their lifetime, a new study reports, and the risk is even more pressing as black women are three times more likely to experience premature menopause than white women.
It is not known why this reproductive transition is associated with a 40% increased risk of heart attack. The study, published Wednesday in JAMA Cardiology, did not distinguish between what causes risk and what is a sign of risk. Nevertheless, the authors argue that it remains clear that early menopause should be part of the prevention discussion.
“There’s a lot of potential for raising awareness for everyone living with premature menopause,” co-author Priya Freney, a cardiologist and director of the Women’s Heart Care Program at Northwestern University, told STAT. “We encourage patients to be more proactive in discussing this with their doctors as a means of planning prevention. We encourage clinicians to ask about age at menopause and other reproductive factors known to be associated with long-term heart disease.”
A 2019 JAMA study that followed female UK Biobank participants for seven years had previously linked early menopause to short-term coronary heart disease. The new study pooled a more diverse cohort from six ongoing studies of more than 10,000 women without coronary heart disease whose health was tracked from 1964 to 2018. Of the 3,522 black women studied, 15.5% had premature menopause; Of the 6,514 white women, 4.8% did so. Women who had surgically induced menopause were excluded from the study.
“If a woman goes through menopause early, she is young and the short-term risk is low,” Pradeep Natarajan, director of preventive cardiology at Massachusetts General Hospital, told STAT in an email. Although he was not involved in the new research, he was a co-author on an earlier UK Biobank paper. “This study shows that continued early menopause is an important lifelong signal that can be incorporated into cardiovascular risk optimization early in life.”
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It’s unclear why more black women experience early menopause, but this group has higher rates of early menarche. Factors associated with the onset of menstruation at a younger age include low birth weight, high childhood weight, and weathering, which is the sum of lifelong racial stressors such as discrimination, poverty, residential segregation, pollution, and fear for personal safety.
These differences between black and white women are likely caused by a combination of social and health factors, Freeney said, and merit additional research dedicated to learning how to narrow these disparities.
“This disparity reflects many other disparities in heart disease risk factors and heart disease itself between black and white women,” she said. “We have a lot to learn about why this happens more often for Black women and what we can do to alleviate these disparities.”
Menopause usually occurs around age 51. Before the age of 45 is called early menopause, and before the age of 40 is called premature menopause. Other reproductive factors that can affect heart disease include pre-eclampsia, which causes blood pressure to spike during pregnancy, and gestational diabetes, which causes uncontrolled blood sugar levels.
The authors added that it is unclear whether early menopause poses cardiovascular risks or whether it is due to other factors that contributed to the onset of early menopause, but these risks cannot be addressed.
And earlier recognition of risk raises the hope that cardiovascular disease outcomes will improve.
“This study adds to the growing literature that closed history can provide meaningful information for cardiovascular disease prevention strategies,” Natarajan said.
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