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Early menopause associated with increased coronary heart disease risk

A recent study showed earlier age at natural menopause and surgical menopause are both associated with increased risk for coronary heart disease (CHD). The findings were published in the International Journal of Epidemiology
Researchers examined the associations between menopausal characteristics and CHD risk using data from women participants in the EPIC-CVD (European Prospective Investigation into Cancer and Nutrition-Cardiovascular Disease), a case–cohort study, nested within the EPIC study which included data from 23 centres across 10 European countries. They included a random sub-cohort of 10,880 women supplemented with 4522 women outside the sub-cohort.
Results showed that compared with pre-menopausal women, post-menopausal women were not at higher CHD risk after adjustment for confounders. Earlier menopause was linearly associated with higher CHD risk among post-menopausal women. Compared with women with natural menopause, those with surgical menopause were at higher risk of CHD but this attenuated after additional adjustment for age at menopause and intermediates.
Age at menopause had an approximately linear association with CHD risk, with women in the lowest category (menopausal age <40 years) having a 51% higher risk than those in the highest category (menopausal age ≥55 years). In addition,for each 1-year decrease in age at menopause, CHD risk was 2%.

Authors concluded that age at menopause has an inverse dose–response relationship with risk of CHD. Surgical menopause is also associated with an increased CHD risk, even once the earlier age at menopause is accounted for. A proportion of the risk appears to be explained by cardiovascular risk factors that have been postulated to mediate the associations of menopausal characteristics with risk of CHD.Earlier age at menopause and surgical menopause are both associated with higher risk of CHD, which might suggest that these women need close monitoring in clinical practice. The excess risk is, in part, explained by conventional cardiovascular risk factors. Therefore, these risk factors should play an important role in the monitoring of these women. However, there is still a residual association between menopausal characteristics and CHD, of which the mechanism is not fully understood and which merits further research.