Study: “Detrimental” Effects of Obesity on Risk of Heart Failure Greatest Among Women Who Experience Late Menopause

Obesity significantly increased the risk of heart failure (HF) among women who experienced menopause at age ≥55 years, according to new research published in the Journal of the American Heart Association (AHA).

“There is a gap in knowledge about the possible influence of late menopause – occurring at age 55 or older – on the incidence of heart failure,” said lead study author Imo A. Ebong, MD, MS, associate professor of medicine, Division of Cardiovascular Medicine, University of California Davis, in an AHA press release.

“We know that obesity increases the risk of developing heart failure, and the onset of menopause is associated with increased body fatness,” continued Ebong. “In our study, we investigated if and how obesity affects the relationship between menopausal age and the future risk of developing heart failure.”

Ebong and colleagues analyzed health data for 4441 postmenopausal women participating in the Atherosclerosis Risk in Communities (ARIC) study who had started natural (n=3636) or surgical (n=808) menopause by the fourth study visit (1996-1998). The mean age of participants was 63.5 years. Women were categorized by menopausal age: <45 years (n=1200), 45-49 years (n=1515), 50-54 years (n=1468), and ≥55 years (n=258).

Researchers assessed body mass index (BMI) and waist circumference (WC), and prevalent HF at the fourth visit was determined from hospital discharge lists or death certificates. Participants were classified as normal weight if BMI was between 18.5 and 24.9 kg/m2, overweight if BMI was between 25.0 and 29.9 kg/m2, and obese if BMI was ≥30.0 kg/m2. Women were classified as having central obesity if their WC was >88 cm.

During 16.5 years of follow-up, there were 903 incident HF events, according to the study. Ebong et al found the greatest incidence rates of HF among women with generalized or central obesity who had also experienced menopause before age 45 years at <21.3/1000 and 16.3/1000 person‐years, respectively.

The attributable risk of generalized and central obesity for HF incidence was greatest, however, among women who experienced menopause at age ≥55 years, at 11.09/1000 person-years and 7.38/1000 person-years, respectively. The researchers also found the lowest probability of a HF-free survival during follow-up was in women with early menopause.

Results showed there were significant interactions of menopausal age with BMI and WC for HF incidence (P=0.2 and .001 for interaction, respectively). Risk for incident HF for a standard deviation (SD) increase in BMI was elevated in women with menopausal age <45 years (HR=1.39; 95% CI, 1.05-1.84), 45-49 years (HR=1.33; 95% CI, 1.06-1.67), and ≥55 years (HR=2.02; 95% CI, 1.41-2.89). The HR of incident HF for a SD increase in WC was elevated only in women who experienced late menopause (2.93; 95% CI, 1.85-4.65).

“Maintenance of a healthy body weight and waist circumference may be protective against developing HF, particularly among women who have experienced late menopause,” wrote researchers. “These findings support a public health campaign advocating weight management in postmenopausal women, particularly among those with late menopause.”

A limitation to the study was the fact that it did not include enough women to analyze for different types of HF separately.

“Our analysis should be repeated according to heart failure subtypes, preserved and reduced ejection fraction heart failure, to more clearly understand heart failure risk estimation and provide guidance on screening and prevention programs,” said Ebong in the press release.