Women who go through menopause before turning 40 have a significantly higher lifelong risk of heart attacks than women who go through the transition later, according to a new study.
The study found that women who went through what is referred to as premature menopause had 40 percent more fatal and nonfatal heart attacks throughout the course of their lives than those who went through menopause after 40.
Black women, who are at heightened risk for cardiovascular disease, were three times as likely as white women to say they had experienced premature menopause, the study said. Research going back decades has noted that Black women experience menopause at earlier ages than white women, with some studies suggesting environmental factors and psychosocial stress may be the causes.
The new paper, published Wednesday in JAMA Cardiology, is not the first to highlight the increased risks of coronary heart disease associated with premature menopause.
It underscores the need to include reproductive history and age of menopause in any assessment of a woman’s cardiovascular risk, said Dr. Priya Freaney, the paper’s lead author, who is a cardiologist and the director of Women’s Heart Care at Northwestern University.
“Pregnancy is often compared to a stress test, and you can think of menopause in a similar way, as a window into your cardiovascular risk,” she said
“Menopause at any age unmasks adverse metabolic profiles: Lipids go up by 20 percent, blood pressure profiles go up, activity levels go down, body fat distribution shifts to the belly, muscle mass become lower, and fat mass becomes higher,” Dr. Freaney said, adding that physical activity may drop because of severe menopausal symptoms. “All these things are compounding cardiovascular risk in this short period of time.”
A much larger 2019 study of women in Britain found significant increases in a broad swath of cardiovascular diseases — including coronary artery disease, heart failure, ischemic stroke, blood clots, atrial fibrillation and other cardiac syndromes — in those who had undergone premature menopause naturally. In women who underwent premature menopause because their ovaries had been surgically removed, the risks were even higher.
But that study followed women for only seven years on average, and it included very few nonwhite women. The new study, which excluded women who had undergone surgical menopause, was much smaller but more heterogenous, including 6,514 white women and 3,522 Black women.
About 15 percent of the Black women in the study and just under 5 percent of the white women reported that they had gone through premature menopause. For both groups, the lifetime risk of having a fatal or nonfatal heart attack was raised, with an increase of 41 percent for the Black women and 39 percent for the white women.
The percentage of women going through premature menopause was significantly higher than the 1 percent typically expected to experience such early menopause, the study found. The researchers said they had relied on self-reporting, which might have caused some confusion and inflated the figures. The average age of menopause, which is the end of menstruation and is defined as 12 months without a period, is 51 to 52.
The study was not designed to identify why Black women experienced premature menopause at higher rates. Overall, blood pressure and body mass index were higher among the Black women in the study than among the white women. White women with premature menopause had higher rates of smoking, while Black women with premature menopause had higher rates of diabetes, the study found.
While the relative increase in risk was similar for all women, Dr. Rachel Bond, a cardiologist with the Dignity Health Medical Group in Arizona, said, “Black women are starting at a higher base-line risk to begin with, so when you add premature menopause on top of that, the overall impact is greater.”
She said Black women are in general more likely to have high blood pressure and to have it earlier in life than white women. Chronic stress and exposure to discrimination might drive other risk factors like metabolic disorders, she added.
“Social and environmental exposures further compound this, including differences in access to high-quality preventive care, nutrition, safe environments for physical activity and continuity of care,” Dr. Bond said.
Dr. Freaney said she encourages women to exercise 150 minutes a week and to do strength training at least twice a week, because decreased estrogen levels accelerate muscle loss. “It’s also really important to monitor the various cardio-metabolic markers — blood pressure, cholesterol and glucose — more closely in the years before and after menopause,” she said.
Being proactive is in line with new guidance issued last week by the American Heart Association, the American College of Cardiology and nine other organizations, which urges those at risk of heart disease to start lowering cholesterol as early as age 30 to reduce deaths. The group recommended testing for levels of LDL, or so-called bad cholesterol, in childhood, beginning at about age 10.
Heart disease does not develop overnight, Dr. Freaney said. “It develops over decades and decades of exposure to risk factors, and the majority happens silently.”
Roni Caryn Rabin is a Times health reporter focused on maternal and child health, racial and economic disparities in health care, and the influence of money on medicine.
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