A new study has found that premature menopause increases the risk of heart problems such as heart failure and atrial fibrillation.
Premature menopause occurs before women turn 40 years old, and according to a new study published in the European Heart Journal, a journal of the European Society and Cardiology (ESC), this elevates the risk of heart failure and atrial fibrillation. The study of over 1.4 million women found that the younger the woman experiences menopause, the higher risk of new-onset heart failure and atrial fibrillation.
“Women with premature menopause should be aware that they may be more likely to develop heart failure or atrial fibrillation than their peers,” said study author Dr Ga Eun Nam of Korea University College of Medicine, Seoul, Republic of Korea. “This may be good motivation to improve lifestyle habits known to be linked with heart disease, such as quitting smoking and exercising.”
Premature menopause affects 1% of women under 40
Premature menopause affects 1% of women under the age of 40 years. Prior studies linked premature menopause (before 40), early menopause (before age 45) and cardiovascular disease. However, evidence for heart failure or atrial fibrillation is limited.
The new study investigated the associations between premature menopause, age at menopause and incident heart failure and atrial fibrillation. The researchers utilised data from the Korean National Health Insurance System (NHIS), which provides health screening at least every two years and includes 97% of the population.
The study involved 1,401,175 postmenopausal women aged 30 years and older who completed the NHIS health check-up in 2009. Participants were followed up until the end of 2018 for new-onset heart failure and atrial fibrillation. They collected information on demographics, health behaviour and reproductive factors, including age at menopause and use of hormone replacement therapy (HRT). Age at menopause was categorised as below 40, 40 to 44, 45 to 49, and 50 years or older and premature menopause were classed as the final menstrual period occurring before 40 years old.
The study found that 2% of participants had a history of premature menopause, and the average age of menopause was 36.7 years. Furthermore, the average age of the study’s participants was 60 and 61.5 years.
Analysing the risk of heart conditions
The researchers adjusted for age, smoking, alcohol, physical activity, income, body mass index, hypertension, type 2 diabetes, dyslipidaemia, chronic kidney disease, coronary heart disease, HRT and age at menarche. By doing this, they discovered that women who experienced premature menopause had a 33% higher risk of heart failure and a 9% higher risk of atrial fibrillation compared to those who did not.
Furthermore, they analysed the associations between age at menopause and incidence of heart failure and atrial fibrillation after adjusting for the key factors. The risk of incident heart failure increased as the age at menopause decreased. Compared with women aged 50 years and above at menopause, those aged 45 to 49, 40 to 44, and below 40 years at menopause had 11%, 23%, and 39% greater risks of incident heart failure. Similarly, the risk of incident atrial fibrillation increased as the age at menopause decreased, with 4%, 10%, and 11% higher risks for those aged 45 to 49, 40 to 44, and under 40 years at menopause, respectively, compared with women aged 50 years and above at menopause.
The authors said that several factors may explain the associations between menopausal age, heart failure and atrial fibrillation, such as the drop in oestrogen level and changes in body fat distribution.
Dr Nam concluded: “The misconception that heart disease primarily affects men has meant that sex-specific risk factors have been largely ignored. Evidence is accumulating that undergoing menopause before the age of 40 may increase the likelihood of heart disease later in life. Our study indicates that reproductive history should be routinely considered in addition to traditional risk factors such as smoking when evaluating the future likelihood of heart failure and atrial fibrillation.”