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Characteristics of Menopause: What Impact on Risk of CHD?
Veronica Hackethal, MD
A new study found that age at menopause accounts for 10% of the link between menopause and coronary heart disease. Get more details in this quick slideshow.
While earlier age at menopause has been linked to an increased risk of coronary heart disease (CHD), factors influencing that link as well as the role of established cardiovascular disease (CVD) risk factors is unclear. Researchers led by Veerle Dam, PhD, of the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Netherlands Heart Institute, Utrecht, The Netherlands examined the association between menopausal characteristics and CHD risk and the extent to which the association is explained by established CVD risk factors. The results, published in the February issue of the International Journal of Epidemiology, are highlighted in the short slide show above.
Menopause: What Effect on CHD Risk? At menopause, estrogen levels decrease and established CVD risk factors increase, but how much and when do these menopausal changes start to affect CHD risk?
EPIC-CVD Study. The EPIC-CVD case cohort study examined 15 402 women in 23 centers across 10 European countries. Of the 15 402 women included, 5486 were pre-menopausal and 9916 were post-menopausal. Analyses were adjusted for age, education, smoking, physical activity, body mass index (BMI), and reproductive and cardiovascular risk factors. The average follow-up was 11 years.
CHD Risk Greater with Early, Surgical Menopause. Women with menopause aged <40 years had a 51% higher risk of CHD vs women aged ≥55 years and for each 1 year decrease in age at menopause, CHD risk increased by 2%. Women with surgical menopause were at a 25% increased risk of CHD vs those with natural menopause.
Links: Early Menopause and Higher BMI, CVD Risk Factors, Age at Menopause. Each 1 year decrease in age at menopause was tied to a 2% increased CHD risk in women with a BMI between ≥25 and <30 kg/m2 and a 4% increased risk in women with a BMI ≥30 kg/m2. Established CVD risk factors accounted for 20% of the link between menopause and CHD. Age at menopause accounted for 10% of the link between menopause and CHD.
Take Home Points:
- Women with early or surgical menopause are at an increased risk for CHD
- The association is stronger in overweight/obese women
- Women with early or surgical menopause may need closer monitoring for CHD, especially if they are overweight/obese
- Residual association between menopause and CHD remains unexplained, needs further research
Reference: Dam V, van der Schouw YT, Onland-Moret NC, et al. Association of menopausal characteristics and risk of coronary heart disease: a pan-European case-cohort analysis [published ahead of print February 22, 2019]. Int J Epidemiol. doi: 10.1093/ije/dyz016.