Premature menopause, surgical or not, is tied to increased CVD risk

  • Honigberg MC & al.
  • JAMA
  • 18 Nov 2019

  • International Clinical Digest
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Takeaway

  • People who have premature menopause (
  • Risk is slightly higher with surgically induced menopause.

Why this matters

  • Although guidelines suggest asking about history of early menopause in women, “robust data” on the association have been lacking, these authors say.

Key results

  • Primary composite CVD outcome occurred in:
    • 3.9% women with no premature menopause.
    • 6.0% with natural premature menopause.
    • 7.6% with surgically induced premature menopause.
    • These groups differed significantly (P<.001>
  • HR with natural premature menopause, 1.36 (95% CI, 1.19-1.56; P<.001>
  • HR with surgically induced premature menopause, 1.87 (95% CI, 1.36-2.58; P<.001>
  • Authors also found significant associations (aHRs) of premature natural menopause with:
    • Venous thromboembolism: 1.70 (P<.001>
    • Aortic stenosis: 2.37 (P<.001>
    • Ischaemic stroke: 1.50 (P=.04).
    • Coronary artery disease: 1.39 (P=.02).
    • Afib: 1.25 (P=.05).
    • But not with heart failure, mitral regurgitation, or peripheral artery disease.
  • Premature surgical menopause was associated (aHRs) with:
    • Mitral regurgitation: 4.13 (P=.002).
    • Venous thromboembolism: 2.73 (P=.002).
    • Heart failure: 2.57 (P=.01).
    • Coronary artery disease: 2.52 (P<.001>

Study design

  • Analysis of UK Biobank data for 144,260 postmenopausal women aged 40-69 years (natural premature menopause, 4904; surgical premature menopause, 644).
  • Median follow-up, 7 years.
  • Funding: National Heart, Lung, and Blood Institute; others.

Limitations

  • Small event numbers.
  • No causation established.