Women whose menstrual periods end before they reach age 40 face a sharply higher risk of coronary heart disease over their lifetimes, a new study reports, a danger more pressing for Black women because they are three times more likely than white women to enter premature menopause.
Why this reproductive transition is tied to a 40% greater risk of heart attacks isn’t understood. The study, published Wednesday in JAMA Cardiology, didn’t make a distinction between what could be causing risk and what could be a signal of risk. Nonetheless, the authors assert, it’s still clear that premature menopause should be part of the conversation about prevention.
“In all individuals who have premature menopause, there’s a ton of potential for raising awareness,” co-author Priya Freaney, a cardiologist and director of the Women’s Heart Care Program at Northwestern University, told STAT. “I encourage patients to be more proactive about bringing it up with their physicians as a means to develop a prevention plan, and clinicians to inquire about age of menopause and other reproductive factors that we know are connected with long-term heart disease.”
Premature menopause had been tied to short-term coronary heart disease before, in a 2019 JAMA study that followed female UK Biobank participants for seven years. The new study pooled more diverse cohorts from six ongoing studies of more than 10,000 women without coronary heart disease whose health was tracked from 1964 to 2018. Among the 3,522 Black women studied, 15.5% had premature menopause; among the 6,514 white women, 4.8% did. Women who had surgically induced menopause were excluded from the study.
“When women sustain premature menopause, they are young and have low near-term risk,” Pradeep Natarajan, director of preventive cardiology at Massachusetts General Hospital, told STAT via email. He was not involved in the new study but was a co-author of the earlier UK Biobank paper. “This study indicates that having sustained premature menopause is an important lifelong signal, which could be incorporated into cardiovascular risk optimization earlier in life.”
Why more Black women entered premature menopause isn’t known, but rates of early menarche are higher in this group. Factors linked to starting menstruation at a young age are lower weight at birth, higher weight in childhood, and weathering, the sum total of lifelong racial stressors owing to discrimination, poverty, housing segregation, pollution, and fears about personal safety.
These differences between Black and white women are likely driven by a combination of social and health factors, Freaney said, and deserve dedicated additional study to learn how to narrow these gaps.
“This disparity reflects many other disparities we see in heart disease risk factors and heart disease itself in Black versus white women,” she said. “There’s a lot more to be learned about why this is occurring more often in Black women, and then what we can do to mitigate these disparities.”
Menopause typically happens around age 51. Before 45 is termed early menopause and before 40 is called premature. Other reproductive factors that affect heart disease include preeclampsia, when blood pressure spikes during pregnancy, and gestational diabetes, when blood glucose is uncontrolled.
It’s not known whether premature menopause drives cardiovascular risk, or if the other factors that contributed to the development of premature menopause are to blame, the authors wrote, adding that it doesn’t mean those risks can’t be addressed.
And recognizing risk sooner raises hope of better cardiovascular outcomes.
“This work adds to the growing literature that menopausal history can meaningfully inform cardiovascular disease prevention strategies,” Natarajan said.
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.
