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Title Early Menopause Doubles CVD Risk Regardless of Race
Date 25 September 2012
Full Story New research from the University of Alabama, Birmingham published in October 2012 issue of Menopause has shown that women who experience early menopause--before their 46th birthday--are twice as likely to suffer from coronary heart disease and stroke as women who don't enter menopause prematurely, and this finding is independent of traditional risk factors.

These new data from the Multiethnic Study of Atherosclerosis (MESA) add to previous work in this field by extending the results to females of all ethnicities--prior research has found a similar association in white women.

The findings demonstrate a moderate association between early menopause and future CHD and stroke. This adds to the body of evidence that early menopause may identify the at-risk woman who may benefit from aggressive CVD primary prevention. The results suggest it is also important to avoid early menopause if at all possible.

Wellons and colleagues say that early menopause has been associated with increased CVD events in some predominantly white populations, but not consistently so. They decided to investigate this phenomenon with data from MESA, an ethnically diverse cohort of US men and women aged 45 to 86 years enrolled in 20002002 and followed until 2008.

The association between a personal history of early menopause (either natural or surgical removal of ovaries at an age <46 years) and future coronary heart disease and stroke was assessed in 2509 women (987 white, 331 Chinese, 641 black, and 550 Hispanic) who were free of CVD at baseline.

Of the women, 693 (28%) reported either surgical or natural early menopause (with the latter defined as 12 months of amenorrhea following the final menstrual period). Women with early menopause had worse CHD and stroke survival.
In models adjusted for age, race/ethnicity, MESA site, and traditional cardiovascular risk factors, this risk for CHD and stroke remained (hazard ratio 2.08 and 2.19, respectively). The number of events, however, was small--only 50 CHD events and 37 strokes.

Adjusting for the traditional risk factors did not include family history of MI, however, and when this was accounted for, the statistical significance of the relationship between early menopause and CVD disappeared, although the pattern was still similar.

It is thought that family history could be a modifier of the relationship--that early menopause and CVD are genetically linked and run in families together but one does not cause the other. Or it could be that early menopause does contribute pathophysiologically to CVD but having another family member with CVD is still the better predictor of future events as compared with early menopause."

The report stresses that it's important that doctors do not overlook younger women who are often not targeted for prevention, because CVD is thought to be attacking women only in old age.

Furthermore, key to reducing risk will be strategies to prevent early menopause, such as avoidance of smoking--smokers reach menopause, on average, two years before nonsmokers--and oophorectomy (surgical removal of the ovaries), which may have significant public-health relevance for the prevention of CVD in women.

Regarding the use of HRT, the study did not find that the patterns in the relationship between early menopause and CVD were significantly different between women taking and not taking HRT. While it is accepted that women who have an early menopause should be offered HRT for both control of menopausal symptoms and reduction of risk of later health problems, particularly osteoporosis, it seems that much more research is needed to fully understand the relationship between hormones, menopause and cardiovascular disease.

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