Early Menopause Increases Heart Disease Risk, but Lifestyle Matters

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Women who experience premature (<40 years) or early menopause (40-44 years) have a higher risk of cardiovascular disease (CVD) compared with those whose menopause occurs between ages 50 and 52. However, adhering to a healthy lifestyle, including smoking cessation, regular physical activity, healthy diet, sufficient sleep and limited sitting time, significantly reduces the odds of developing CVD, particularly for those with premature menopause.

“The menopause stage is a critical window to intervene and potentially reduce a woman’s likelihood of developing CVD through lifestyle modification,” wrote a team of investigators including Sarah Zaman, MBBS, Ph.D., an academic interventional cardiologist at Westmead Hospital and the University of Sydney, Australia. “This may involve targeting key cardiometabolic changes relevant in these women, especially those with earlier menopause.”

Previous research has revealed a link between earlier menopause and adverse cardiovascular outcomes, including heart failure, coronary heart disease (CHD) and even death.

Investigators evaluated the association between premature and early menopause and the likelihood of developing CVD as well as whether a healthy lifestyle is linked to lower odds of CVD using participants from The Sax Institute’s 45 and Up Study. These women were aged 45 years and older between 2005 and 2009 (Wave 1), were menopausal age at baseline and had no prior CVD.

The main outcome of the observational study was the onset of CVD, defined as self-reported heart disease, heart failure or stroke, based on the survey data at Wave 2 (2015-2015) and/or Wave 3 (2018-2020). Logistic regression models were used to determine any link between CVD and premature or early menopause and were adjusted for clinical and sociodemographic variables. These factors included age, ancestry, education, body mass index (BMI), smoking status (either current, previous or nonsmoker), hypertension, diabetes mellitus and receiving menopausal hormone therapy.

Adherence to a healthy lifestyle was measured using five factors: smoking, sitting, sleep, diet and physical activity.

A total of 46,238 women were included in the study, with a mean age of 62.1 years. During the 15-year follow-up period, 11.7% of women reported cases of CVD.

After adjusting for variables, the risk of developing CVD was higher in women with premature menopause and early menopause when compared with women who entered menopause between 50 and 52 years. Despite this higher risk, a high score (9-10) of healthy lifestyle adherence led to a 23% lower likelihood of developing CVD compared with those who scored low (0-5). In women with premature menopause in particular, a high score reduced these odds by 52%. The lifestyle effect did not differ significantly among the three categories of menopause.

Investigators said future studies should focus on creating interventions designed to improve healthy lifestyles and those that evaluate the impact of this long-term CVD.

Missing data and the observational design limited the study as unmeasured confounders could have affected the findings. Additionally, as the surveys were self-reported and lost patients to follow up during the 15-year span, investigators could not determine the proportion of fatal CVD cases. Further, lifestyle behaviors were self-reported and only assessed at baseline, even though investigators noted these habits can change over time and affect the odds of developing CVD.

“Menopause is a timely opportunity to screen women, especially those with early menopause, for cardiovascular health and promote healthy lifestyle initiatives across the life course,” investigators concluded.