Early menopause increases cardiovascular risk

By Piriya Mahendra, medwireNews Reporter

Women who reach the menopause early have a doubled risk for coronary heart disease (CHD) and stroke, study findings show.

An analysis of 2509 women aged 45-84 years revealed that those who reached menopause before the age of 46 years, either naturally or through surgical removal of the ovaries, (defined as early menopause) were at a 2.08-fold increased risk for CHD and a 2.19-fold increased risk for stroke compared with those who reached menopause after this age.

Co-author Melissa Wellons (Vanderbilt University Medical Center, Nashville, Tennessee, USA) explained: "this is a persuasive finding that early menopause and CVD are related.

"My hope is that getting this message out will motivate women with early menopause to engage in the lifestyle and medical strategies known to reduce risk of CVD - like controlling cholesterol, blood pressure, and excess weight and by exercising."

The findings come from the study population of the Multi-Ethnic Study of Atherosclerosis, a cohort of US men and women enrolled in 2000-2002 and followed-up until 2008. Of the 2509 women included in the current study, 987 were White, 331 Chinese, 641 Black, and 550 Hispanic. All participants were free from cardiovascular disease (CVD) at baseline.

Overall, 693 (28%) reported either surgical or natural early menopause. Over a median follow-up period of 4.78 years, 50 CHD events occurred, 23 of which were in women with early menopause versus 27 without. In addition, 37 stroke events occurred, 18 of which were in women with early menopause versus 19 without.

The results also showed that there was no significant effect of hormone replacement therapy or type of menopause (natural or surgical) on CHD or stroke risk with early menopause.

Wellons said that there are many different possibilities as to the underlying cause for the association between early menopause and CVD. "Hormones produced by the ovary that disappear with menopause could be in the causal pathway in the development of atherosclerosis - a hypothesis that is intensely debated and studied," she explained.

"Atherosclerosis could compromise the blood flow to the ovary as well as to the heart and brain - and the two could be linked because of common pathophysiology that affects both organs. CVD and early menopause could be linked genetically but not develop through the same pathophysiologic mechanism."

Wellons said that there are many different possibilities as to the underlying cause for the association between early menopause and CVD. "Hormones produced by the ovary that disappear with menopause could be in the causal pathway in the development of atherosclerosis - a hypothesis that is intensely debated and studied," she explained.

"Atherosclerosis could compromise the blood flow to the ovary as well as to the heart and brain - and the two could be linked because of common pathophysiology that affects both organs. CVD and early menopause could be linked genetically but not develop through the same pathophysiologic mechanism.

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