According to the US Centers for Disease Control and Prevention, heart disease is the leading cause of death in the US. Coronary heart disease (CHD) is a condition where fatty deposits build up in the arteries, reducing blood flow to the heart muscle, and in severe cases, causing heart attacks and heart failure. Although men typically experience high rates of heart disease, women may face a unique set of risk factors linked to their reproductive biology. In particular, the menopausal transition is of interest because it is marked by a steep decline in estrogen levels. When estrogen declines, cholesterol and blood pressure increase, more body fat is stored in the abdomen, and muscle mass reduces, alongside metabolic and arterial changes. All of these factors have been established as risk factors in CHD. When menopause occurs earlier than expected, such as before the age of 40 years, the loss of hormonal protection that would otherwise be provided by estrogen also happens earlier. Priya Freaney and colleagues have published a study in JAMA Cardiology investigating the lifetime risk of CHD in relation to the timing of the menopause. They showed that the premature onset of menopause was associated with an approximately 40% heightened lifetime risk of CHD.
The study used pooled data from six prospective cohort studies in the US, which resulted in a sample of over 10,000 women followed between 1964 and 2018. Premature menopause was classified as the onset of menopause occurring before the age of 40 years. The premature menopause group was compared to those whose onset of menopause occurred after the age of 40 years. The results were stratified by race, which is an established risk factor in CHD. Even after accounting for other risk factors like obesity and diabetes, premature menopause was associated with a 41% higher risk of CHD in Black women and a 39% higher risk of CHD in white women. Premature menopause was over three times more common among Black participants, occurring in 16% of Black participants, compared to just 5% among white counterparts.
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GlobalData epidemiologists forecast that there will be a considerable increase in the diagnosed incident cases of congestive heart failure, which is most prominently arising as a consequence of CHD, among women in the US, from approximately 924,000 cases in 2026 to 1.05 million cases by 2032. Therefore, these findings present an important clue in understanding sex-specific modifiable risk in CHD, and present the perimenopausal period as a unique window of opportunity to intervene with CHD risk in women. Although the aetiology of premature menopause is not fully understood, it is likely impacted by a combination of genetic and environmental risk factors, such as the onset of the menstrual cycle, obesity, and health behaviours. While further study is needed to validate these findings, establishing premature menopause as a contributor to CHD risk would highlight a critical window for targeted prevention.
