The study pooled data from 15 observational studies conducted in five countries and regions (Australia, Scandinavia, USA, Japan and UK) between 1946 and 2013. The primary endpoint was the occurrence of first non-fatal CVD, which was defined as a composite outcome of incident coronary heart disease (CHD) or stroke.
Of the 301,438 women analyzed, 4.3% had a first non-fatal CVD event after menopause – primarily coronary heart disease.
Compared with women who had menopause at age 50 or 51, women under age 40 with premature menopause had the highest risk of CVD: hazard ratio (HR) 1.55; 95% confidence interval (CI): 1.38 to 1.73 (P < 0.0001). The study concluded that early menopausal women who smoked, were underweight or obese, and those with lower socioeconomic status were more likely to develop CVD.
“These findings add to previous evidence showing increased influence of some traditional cardiovascular disease risk factors in women compared with men and further emphasizes the need for risk stratification by sex,” the comment writers stated. Furthermore, additional research is needed to determine whether the connection between early or premature menopause and the frequency of cardiovascular disease differs by ethnicity.
Meanwhile, research by the study authors “is timely and underpins the importance of precision medicine across the cardiovascular disease life course,” the comment writers noted.
The differences in CVD pathogenesis between men and women stem from both genetic and biological mechanisms, explained the writers, as well as from complex interactions between behavioral and socioeconomic factors. Studies that further illuminate the complex associations between sex and CVD risk are needed to redesign primary and secondary prevention guidelines.
The writers also said there must be a shift away from a one-size-fits-all approach to a more patient-centered strategy to alleviate the increasing global burden of CVD.