Menopausal age and the risk of cardiovascular disease in American women: evidence from the National Health and Nutrition Examination Survey

Summary

Cardiovascular disease (CVD) is a significant contributor of female deaths, and in this sense premature menopause contributes in increasing this risk. Bearing this in mind, recently Zhang et al. [1] aimed to investigate the age of menopause and the incidence of CVD in American females using data from the National Health and Nutrition Examination Survey (NHANES). The authors analyzed using multivariate logistic regression data from 6,347 women to investigate the association between the age at menopause and the risk of CVD. They found that a later age at menopause onset reduces the risk of developing CVD (odds ratio [OR] = 0.74, 95% confidence interval [CI] = 0.63 – 0.88, p < 0.001). Moreover, women with CVD of early-onset had an increased risk of premature menopause before 40 years of age (OR = 2.44, 95% CI = 1.60 – 3.72, p < 0.001). The authors conclude that the age of menopause is associated with the risk of developing CVD in American females. Specifically, if menopause occurs earlier, there is an increased risk of CVD. Also, early-onset CVD significantly raises the risk of premature menopause, which in turn has important implications for reproductive health of women.

Commentary

This article by Zhang et al. [1] presents a compelling analysis of the correlation between menopausal age and CVD in American women, using data from the National Health and Nutrition Examination Survey. The study highlights an important association regarding women’s health, as it identifies a critical link between the timing of menopause and subsequent cardiovascular health outcomes [2]. They provide robust evidence that earlier onset of menopause is associated with a higher risk of CVD, a finding that has significant implications for clinical practice and public health policies [3]. These findings are consistent with a previous study that also found a higher CVD risk associated with surgical menopause rather than natural menopause of the same age [4].

One strength of the study is the use of a large, nationally representative dataset, which enhances the generalizability of the findings. The detailed statistical analysis used by the authors ensures that the results are reliable and account for potential confounding factors. By adjusting for variables such as age, smoking status, body mass index, and other relevant factors, the study provides a clear picture of the independent effect that age at menopause onset has on CVD risk. Moreover, the article underscores the importance of early intervention and monitoring for women who experience menopause at a younger age. This could lead to more personalized healthcare strategies aimed at reducing CVD risk among this vulnerable population. The study’s findings may prompt healthcare providers to consider menopausal age when assessing a woman’s overall cardiovascular risk profile. In addition, the study showed that females who develop CVD before age 30 years have a 2.4 fold higher risk of premature menopause (before age 40 years) than those without CVD, thus indicating the effect of CVD on the reproductive lifespan [5]. However, one limitation of the study is its observational nature, which precludes the establishment of a definitive causal relationship. While the association between early menopause and increased CVD risk is evident, further research, including longitudinal studies, is necessary to explore the underlying mechanisms and causal pathways.

In conclusion, the commented study makes a significant contribution to the understanding of how menopausal age influences cardiovascular health. It calls for heightened awareness and tailored preventive measures to address the elevated risk of CVD among women undergoing early menopause.

Take home key points

• Early menopause increases CVD risk that highlights the need for targeted preventive measures for this group.
• Healthcare providers should incorporate menopausal age when it comes to evaluating cardiovascular risk in mid-aged women, and develop personalized strategies to mitigate CVD risk in women who experience early menopause.

Pablo Carpintero, MD, PhD, FACOG
President of AAPEC (Asociación Argentina para el Estudio del Climaterio)
Professor Universidad Maimónides, Buenos Aires, Argentina

References

1. 1. 1. Zhang Z, Hu Y, Cui X, Lu M, Zhang M, Li C. Menopausal age and cardiovascular disease risk in American women: evidence from the National Health and Nutrition Examination Survey. Climacteric. 2024;27(2):159-164.
         https://pubmed.ncbi.nlm.nih.gov/37921228/
      2. El Khoudary SR, Shields KJ, Janssen I, et al. Cardiovascular fat, menopause, and sex hormones in women: the SWAN cardiovascular fat ancillary study. J Clin Endocrinol Metab. 2015;100(9):3304–3312.
         https://pubmed.ncbi.nlm.nih.gov/26176800/
      3. Anagnostis P, Paschou SA, Katsiki N, Krikidis D, Lambrinoudaki I, Goulis DG. Menopausal hormone therapy and cardiovascular risk: where are we now? Curr Vasc Pharmacol. 2019;17(6):564–572.
         https://pubmed.ncbi.nlm.nih.gov/29984659/
      4. Honigberg MC, Zekavat SM, Aragam K, et al. Association of premature natural and surgical menopause with incident cardiovascular disease. JAMA. 2019;322(24):2411–2421.
         https://pubmed.ncbi.nlm.nih.gov/31738818/
      5. Zhu D, Chung HF, Pandeya N, et al. Premenopausal cardiovascular disease and age a natural menopause: a pooled analysis of over 170,000 women. Eur J Epidemiol. 2019;34(3):235–246.
         https://pubmed.ncbi.nlm.nih.gov/30721378/

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