Menopause age not associated with heart disease finds study

By Dr. Ananya Mandal, MDFeb 26 2020

There has been conflicting evidence regarding early menopause and an increased risk for heart disease among women. This connection has been attributed to the lowering of female hormone estrogen levels in the blood. Now, a new study reveals that there is no association between early menopause and the development of risk factors that are associated with cardiovascular disease. The study titled, “Age at period cessation and trajectories of cardiovascular risk factors across mid and later life,” was published today in the journal Heart.

Image Credit: fizkes / Shutterstock

What is known, and what is this study about?

There have been several studies in the past that look at the age of menopause and risk factors for cardiovascular disease in women. Researchers explained that the risk was considered greater if the menopause occurred before the age of 45 years. They added that there had been no studies that look at the time of menopause and risk factors for heart disease such as weight gain, blood pressure, glycated hemoglobin (HbA1c that indicates altered blood sugar levels) raised lipids or dyslipidemia.

What was done?

For this study, the data on women from the UK Medical Research Council National Survey of Health and Development was gathered. The women were between middle age to 69 years. An association between the age of menopause in the women and several factors was checked. These factors included –

• Systolic blood pressure (SBP)
• Diastolic blood pressure (DBP)
• Body mass index (BMI)
• Waist circumference (WC) between ages 36 and 69 years
• Triglyceride, low-density lipoprotein cholesterol (LDL-­C), high-density lipoprotein cholesterol (HDL-­C)  between 53 and 69 years
• HbA1c between 53 and 69 years

Data from over 1,000 women were collected and analyzed for the study.

Results

Results showed that there was no association between age of menopause and alterations or rise in lipid fractions such as triglyceride, LDL-­C, and HDL-­C between 53 and 69 years or changes in systolic and diastolic blood pressure between 36 and 69 years among the women. Both natural menopause as well as menopause due to hysterectomy or removal of the uterus surgically (causing menopause) were considered in the study, and the results were similar. The age of menopause was, however, associated with some of the factors such as BMI, waist circumference, and HbA1c. However, these differences faded at the age of 69 years. Overall no statistical difference was noted associating early menopause and cardiovascular risk factors, wrote the researchers.

Implications and way forward

The team wrote in conclusion, “How and when women experience period cessation is unlikely to adversely affect conventional cardiovascular risk factors across mid and later life. Women and clinicians concerned about the impact of type and timing of period cessation on conventional cardiovascular intermediates from midlife should be reassured that the impact over the long term is small.”

The team of researchers warns that this was just an observational study, and thus exact association could not be determined. They wrote, “...studies with larger sample sizes in more heterogeneous populations are required to replicate our findings and provide more precise estimates of associations.”

Linked editorial

Dr. Carl Lavie, of John Ochsner Heart and Vascular Institute, and Dr. Felice Gersh of the Division of Integrative Medicine, University of Arizona College of Medicine, wrote a linked editorial on this study in the same issue of the journal. Their editorial was titled, “Menopause and hormone replacement therapy in the 21st century”.

The authors explained that the loss of the female hormone estrogen in the blood due to menopause could still affect women adversely. They wrote that estrogen has been proven to be beneficial for the health of the heart. However, they added, the recent guidelines from the American Heart Association states that HRT and selective estrogen-receptor modulators (SERMs) should be used with caution in menopausal women and should not be used for “primary or secondary prevention of cardiovascular (CV) disease (CVD).”

They wrote, “There is...no doubt that with the arrival of menopause, the progression of the insidious diseases of aging, and [cardiovascular] dysfunction, accelerate. Estradiol, the principal estrogen produced by the ovaries, supports all aspects of the [cardiovascular system.”

The doctor duo wrote that hormone replacement therapy could help menopausal women in multiple ways. They said that many women receive HRT for other indications such as “osteoarthritis, vision loss due to cataracts, tooth loss due to periodontal disease and fractures from osteoporosis,” and prevention of heart disease risk should be considered equally important and should be treated with HRT.

They recommend that menopausal women “deserve to be offered HRT, using hormones identical to those produced by human ovaries, and the hormones should be prescribed in the most physiological manner possible.”