Premature menopause was associated with about a 40% higher lifetime risk of coronary heart disease in Black and White women in a pooled US cohort study with 163,600 person-years of follow-up.
In a prospective cohort analysis published in JAMA Cardiology, researchers evaluated postmenopausal women from 6 US cohorts, including 3,522 Black women and 6,514 White women aged 55 to 69 years. Premature menopause, defined as menopause before age 40 years, occurred in 15% of Black women and 5% of White women.
Over follow-up, 260 coronary heart disease events occurred in Black women and 748 in White women. Coronary heart disease was defined as fatal or nonfatal myocardial infarction or coronary heart disease death.
Event rates were higher among patients with premature menopause vs those without in both groups: 8.26 vs 5.29 per 1,000 person-years in Black women and 8.77 vs 6.21 per 1,000 person-years in White women.
Following adjustment for demographic and clinical factors, premature menopause was associated with a similar magnitude of increased coronary heart disease risk across racial groups.
Modified Kaplan-Meier analyses were used to estimate lifetime risk, showing that women with premature menopause had higher lifetime risk of coronary heart disease.
Restricted mean survival analyses showed that mean years lived free of coronary heart disease were similar between patients with and without premature menopause. Black women lived 18.2 years free of coronary heart disease compared with 19.1 years among those without premature menopause, while White women lived 22.5 vs 24.1 years, respectively.
Cardiovascular risk factor levels were similar across groups, although Black women with premature menopause were more likely to have a history of diabetes and White women were more likely to report current smoking.
The analysis used harmonized individual-level data from the Cardiovascular Disease Lifetime Risk Pooling Project, including the Atherosclerosis Risk in Communities Study, Framingham Heart Study, Framingham Offspring Study, Multi-Ethnic Study of Atherosclerosis, Cardiovascular Health Study, and Women’s Health Initiative. Lifetime risk estimates incorporated competing risks for non–coronary heart disease death, and models were adjusted for age, smoking, education, obesity, hypertension, and diabetes.
Researchers noted several limitations, including reliance on self-reported menopause timing, lack of adjustment for hormone therapy, and restriction to patients surviving to age 55 years, which may lead to an underestimation of the association between premature menopause and coronary heart disease. Findings were not generalizable to patients with surgically induced menopause, and analyses were limited to Black and White women due to sample size constraints.
“These data emphasize the importance of reproductive factors in cardiovascular disease risk assessment,” wrote lead study author Priya M. Freaney, MD, of the Northwestern University Feinberg School of Medicine, and colleagues.
Disclosures can be found in the study.
Source: JAMA Cardiology