women in menopause before 40 face risk of heart failure, atrial fibrillation: study

it's a misconception that heart disease affects mostly men, says experts, who point out that "sex-specific risk factors have been largely ignored" in research.

by dave yasvinski

published aug 08, 2022

last updated apr 12, 2023

4 minute read

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4 minute read

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in menopause before 40? you could be at risk for heart disease

the decline in estrogen that accompanies menopause is thought to increase vulnerability to cardiovascular disease. getty

a new study has found that women who experience menopause before the age of 40 may be at greater risk of suffering from heart failure and atrial fibrillation, with the risk increasing the earlier menopause arrives. according to the study, published in european heart journal, heart disease generally occurs a decade later in women than men, likely because of the protective effect estrogen may have on the cardiovascular system. the decline in estrogen that accompanies menopause is thought to increase vulnerability to cardiovascular disease. around one per cent of women under the age of 40 are affected by premature menopause.

“women with premature menopause should be aware that they may be more likely to develop heart failure or atrial fibrillation than their peers,” said ga eun nam, the author of the study from korea university college of medicine in seoul, republic of korea. “this may be good motivation to improve lifestyle habits known to be linked with heart disease, such as quitting smoking and exercising.”

heart disease is the second-leading cause of death in canada

heart disease, an umbrella term used to describe a variety of conditions that affect the function and structure of the heart, is the second-leading cause of death in canada, according to the public health agency of canada. roughly one in 12 canadians 20 years of age or older — or 2.4 million people — live with a diagnosed case of heart disease, with roughly 12 of them dying every hour. the disease affects men and women differently: men tend to be diagnosed 10 years earlier and face twice the risk of suffering a heart attack.

diabetes, arterial hypertension, raised cholesterol, smoking, obesity and inactivity are the most recognized modifiable risk factors for cardiovascular disease. but recent research has pointed to the significant risk that comes from non-traditional factors, such as workplace pressure and difficulty sleeping.

the study, which examined the relationship between premature menopause, age at menopause and incident heart failure and atrial fibrillation, relied on data from the korean national health insurance system, a database that covers 97 per cent of the population of south korea. it included 1,401,175 post-menopausal women 30 years of age or older who completed a health checkup in 2009 and were followed until 2018 for signs of new onset heart failure and atrial fibrillation.

the study also collected information on health behaviours, demographics and reproductive factors, dividing age at menopause into four groups: below 40, 40-44, 45-49 and 50 years or older. premature menopause was defined as having a final menstrual period before the age of 40.

researchers found that two per cent (28,111) of subjects in the pool had a history of premature menopause, with an average age of occurrence of 36.7 years. the average age of enrolment in the study was 61.5 for women with a history of premature menopause and 60 for women without such a history. during an average follow up of 9.1 years, three per cent of women (42,699) had experienced heart failure and 3.1 per cent (44,834) had developed atrial fibrillation.

the team then analyzed the association between a history of premature menopause and incident heart failure and atrial fibrillation after accounting for age, smoking, alcohol, physical activity, bmi, income, hypertension, type 2 diabetes, chronic kidney disease, coronary heart disease, hrt and age at the occurrence of first menstrual cycle. they found that women who experienced premature menopause had a 33 per cent higher risk of heart failure and a nine per cent higher risk of atrial fibrillation compared to those without a history of premature menopause.

a lower age of menopause means higher risk of heart failure

they also analyzed the association between age at menopause and incidence of heart failure and atrial fibrillation after adjusting for the same factors. this revealed that the risk of heart failure increased as the age of menopause decreased. compared with women aged 50 or older at menopause, those aged 45 to 49, 40 to 44 and below 40 at menopause had an 11 per cent, 23 per cent and 39 per cent greater risk, respectively, of heart failure. a similar pattern emerged for atrial fibrillation, with higher risks for those aged 45 to 49 at menopause (four per cent), 40 to 44 (10 per cent) and under 40 (11 per cent).

“the misconception that heart disease primarily affects men has meant that sex-specific risk factors have been largely ignored,” nam said. “evidence is accumulating that undergoing menopause before the age of 40 may increase the likelihood of heart disease later in life.

“our study indicates that reproductive history should be routinely considered in addition to traditional risk factors such as smoking when evaluating the future likelihood of heart failure and atrial fibrillation.”

dave yasvinski is toronto-based writer.

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