More evidence that menopause before age 45 years is linked with CVD

By Melanie Hinze

Australian researchers report that women with premature or early menopause are at a higher risk for cardiovascular disease (CVD) when compared with women who experience menopause at a later age and that a healthy lifestyle can mitigate this risk.

Their study, published in Heart, included 46,238 women (mean age 62.1 years) from the Sax Institute’s 45 and Up Study and compared the risk of CVD in women with premature (<40 years) or early (40 to 44 years) menopause with the risk in those with menopause between 50 and 52 years.

After adjustment, the researchers found that premature and early menopause were independently associated with 36% and 15% increased odds, respectively, for CVD over 15-years’ follow up. Additionally, they found that healthy lifestyle adherence, including not smoking, sitting less, improving sleep, exercise and a healthy diet, significantly reduced the risk of CVD among all menopause groups.

Lead author and University of Sydney PhD candidate, Ms Anushriya Pant, said, ‘General practice is usually the first point of contact for many people and can be a safe place for high-risk women, especially those going through menopause, to talk about their heart health.’

Although annual heart health checks were Medicare-funded and free for everyone aged 45 years and above, many women were still unaware of their risk and missed out on these screenings, she told Medicine Today. As such, she said GPs were pivotal for making sure women at high-risk were being screened for CVD risk and encouraging them to start making lifestyle changes.

Despite a large body of evidence already confirming that female-specific risk factors, such as early menopause, were risk enhancers for CVD, they were not incorporated into the absolute CVD risk score of the recently updated CVD risk guidelines, Ms Pant said.

‘These findings bring urgency for guideline makers and clinicians to understand the importance of these risk factors and [for them] to be included in the absolute CVD risk score,’ said Ms Pant, adding that they also showed the importance for more thorough screening in high-risk women and prioritising women’s heart health across the life course.

The researchers noted that there was an unmet need to implement preventative interventions and management of CVD risk factors in high-risk women with premature or early menopause.

‘The menopause change offers an ideal time to screen women for cardiovascular risk factors and intervene with healthy lifestyle advice,’ they wrote.

Heart 2024; 0: 1-7; doi: 10.1136/ heartjnl-2024-324602.