Premature menopause increases cardiovascular disease: Research

Evelyn Lewin

7/10/2019 2:33:13 PM

New research has discovered a dose-response relationship between cardiovascular disease and onset of menopause.

Young menopausal woman
Women who experience premature menopause are 40% more likely to have a non-fatal cardiovascular event compared to those who reach menopause at the expected age.

Women who experience premature menopause are 40% more likely to have a non-fatal cardiovascular event compared to those who reach menopause at the expected age of 50 to 51.
That is the key finding from new research published in The Lancet Public Health.
The research drew together insights from more than 300,000 women in 15 observational studies around the world. It found that early menopause puts women at increased risk of suffering a non-fatal cardiac event like heart attack, stroke, or angina.
‘The relationship with non-fatal cardiovascular events was unclear until now,’ senior author Professor Gita Mishra said.
‘Smoking, being overweight or obese, and having lower education levels can also strengthen the link between early menopause and a woman’s risk of cardiovascular disease.’
Dr Monique Watts is a cardiologist at Women’s Heart Clinic at the Alfred Hospital in Melbourne.
She told newsGP the new research ties in with current thinking about onset of menopause and its effects on women’s cardiovascular risks, but was impressed by the ‘dose-responsive relationship’ between the two.
‘So it’s not just that early menopause increases one’s cardiovascular risk. It’s the earlier the menopause, the greater that risk,’ she said.
‘That’s an important point. A woman who goes through menopause at 40 is at higher risk than someone who experiences menopause at 48, which is still early and still conveys an increased risk.
‘The other thing that’s important to point out is that the risk is not affected by exogenous hormonal therapy [HRT].’
Dr Watts noted it is not recommended to prescribe HRT to reduce cardiovascular risk.
‘But it’s always good to see the evidence for that coming out,’ she said.

‘Menopause is a good time to take stock of cardiovascular health,’ cardiologist Dr Monique Watts said.

Another aspect of the paper that interested Dr Watts was the association between early menopause and the increased risk of cardiovascular disease for smokers.
‘That’s very interesting,’ she said. ‘We know that some risk factors carry a greater “potency” – for want of a better term – in women than in men, and smoking is one of them.
‘So to see that there’s an increased risk in smokers who undergo early menopause is interesting and important as it again indicates a patient group that we can really focus on.’
Dr Watts said this new research highlights the need to implement preventive measures for women as they reach menopause, which is a time when cardiovascular risk profile starts to change, including changes in blood pressure and lipid profile).
A commentary published in response to the research discussed how the new findings could be used to help guide healthcare.
‘The doubling of cardiovascular disease risk in women below the age of 60 years who have premature menopause is concerning and indicates an urgent need to raise awareness of cardiovascular disease risk in younger women,’ the commentary authors wrote.  
‘A common misconception already exists among health professionals and the general public, that cardiovascular disease predominantly affects men, at least until older age.
‘This sex-bias needs to addressed, with emphasis on the increasing risk in younger women, in addition to new sex-specific preventative and therapeutic strategies for reducing and managing cardiovascular disease in women.’
Dr Watts agrees the new paper should fuel discussions on implementing preventive cardiovascular measures in women who reach menopause.
‘I think menopause is a good time to take stock of cardiovascular health,’ she said.
‘It’s a time when we see that risk of cardiovascular disease start to increase, so it’s an appropriate time to have that discussion with your patient  about what can be done to minimise a woman’s risk.’
Dr Watts believes menopause at any age is also an important time for GPs to take the opportunity to educate women on these risks, as patients may lack understanding.
‘Certainly patients don’t tend to be aware of the rise in cardiovascular risk that occurs with menopause, so that’s always something that I try to educate my patients on,’ she said.
‘They don’t always know that there is a correlation between early menopause and CVD [either].
‘So there’s a role for education and it’s a good opportunity to start that conversation with the patient and say, “Okay, you’re going through menopause or you’re peri-menopausal, this is a time to talk about cardiovascular risk factors because risk starts to more sharply increase at this time”.’

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