Women who experience menopause before age 46 have an increased risk of heart disease, and smoking status can modifying this risk in older women.
Women who experience an early natural menopause are at significantly greater risk for heart failure than woman who experience menopause between the ages of 50 and 54 years, according to the results of a study published in Menopause.
Iffat Rahman, PhD, from Karolinska Institute, Stockholm, and colleagues found that smoking modified this association by increasing the risk for heart failure even among women aged 46 to 49 years at menopause.
“Women who experience menopause at younger ages could benefit from screening for their increased risk of developing heart failure,” Rahman and colleagues wrote. “This could especially be promoted in smokers as a means for improving heart failure prevention strategies.”
The study used data from 22,256 postmenopausal women in the Swedish Mammography Cohort, which included information on the age of natural menopause. The researchers obtained information on heart failure through the Swedish National Patient Register and the Cause of Death Register. The median age at menopause for these women was 51 years.
Women who had early menopause, defined as occurring between ages 40 and 45 years, had an almost 40% increased risk of heart failure compared with women who experienced menopause at a later age (HR=1.36; 95% CI, 1.16-1.60). In comparison, women whose menopause occurred between ages 46 and 49 years only had a 13% increased risk of heart failure (HR=1.13; 95% CI, 1.02-1.26). Each 1-year increase in age at menopause had a 2% lower risk of heart failure.
The researchers wrote that “a plausible explanation for the connection between age at menopause and cardiovascular disease is that the menopausal transition induces alterations in blood lipids, causing them to become more proatherogenic.”
The researchers also looked at how smoking status affected menopause and the risk for heart failure and found a significant association between age at menopause and smoking (P=.019). In the youngest age group of women, a similar increased risk of heart failure was observed regardless of smoking status. However, in women aged 46 to 49 years there was a 28% increased incidence of heart failure among ever smokers compared with 3% among never smokers.