Premature menopause associated with a 40% risk of coronary heart disease

Women who undergo menopause before the age of 40 have approximately a 40% higher risk of coronary heart disease than women who enter menopause later, according to the results of a recent Northwestern Medicine study published in JAMA Cardiology. This is the first study to calculate lifetime heart disease risk with premature menopause, highlighting its importance as a clinical risk factor in long-term cardiovascular health.

“This suggests that premature onset of menopause is an important risk-enhancing factor for lifetime risk and should be routinely assessed in clinical practice to consider intensification of preventive efforts,” lead author Priya Freaney, M.D., assistant professor of medicine in the Division of Cardiology at Northwestern University, writes in the study.

A woman is in menopause when she goes one full year after her last period.

The average age of menopause in the United States is 51. Menopause is early if it begins between the ages of 40 and 45 and menopause is considered premature if it occurs before the age of 40. Premature menopause is recognized by the 2019 American College of Cardiology/American Heart Association Primary Prevention guidelines as a risk factor for atherosclerotic cardiovascular disease.

Coronary heart disease is characterized by the narrowing or blocking of the heart’s arteries by fatty deposits called plaque, which can build up and restrict blood flow to the heart. This gradual damage can result in weakened heart muscles or sudden heart attacks, caused by blocked circulation in the heart.

In this study, Freaney and her team pooled heart health data of 10,036 women who had participated in six long-running studies in the United States, including the Women’s Health Initiative, the Framingham Heart Study and the Atherosclerosis Risk in Communities Study. Freaney’s analysis included 3,522 Black women and 6,514 White women. All women were followed between 1964 and 2018 depending on the cohort. There were more than 1,000 cases of coronary heart disease events, with 260 occurring in White women and 748 occurring in Black women.

“While the etiology of premature menopause is not known, it is likely variable between racial groups and is associated with a variety of genetic, biological and environmental factors, including early menarche, health behaviors, obesity and weathering,” Freaney writes.

Freaney and her team also found that Black women were more likely than White women to not only undergo premature menopause but also to be diagnosed with coronary heart disease as well.

Specifically, Black women had a 41% higher relative risk of coronary heart disease and a 16% rate of premature menopause, whereas White women had a 39% risk of heart disease and a 5% incidence rate of premature menopause.

This was true even after accounting for cardiovascular risk factors such as obesity, smoking and diabetes.

“It remains unclear if the menopausal transition truly represents a more disease-permissible vascular environment or whether those who experience premature menopause are the same individuals who already have a disease-permissible vascular environment where risk is unmasked and premature menopause is a marker,” Freaney writes. “However, these data support the perimenopausal period as a unique window of opportunity to measure, monitor, and modify cardiovascualr disease risk in women.”