Women with premature menopause have a 36% higher likelihood of developing cardiovascular disease, but adherence to a healthy lifestyle can reduce this risk by over 50%, according to a recent study. 

Researchers investigated the relationship between age at menopause, adherence to a healthy lifestyle, and cardiovascular disease (CVD) outcomes in a large Australian cohort. Their findings, published in Heart, provide new insights into the role of menopause timing and lifestyle factors in modulating CVD risk among women.

This study analyzed data from 46,238 women enrolled in the Sax Institute’s 45 and Up Study, a population-based cohort in New South Wales. Participants, aged 45 years and older, had no prior history of CVD and reported menopausal age at baseline. Women were categorized by age at menopause as premature (<40 years), early (40–44 years), relatively early (45–49 years), median (50–52 years), or late (>52 years). The primary outcome was self-reported new-onset CVD, including heart disease and stroke, collected through follow-up surveys conducted over 15 years.

Logistic regression analyses revealed that women with premature menopause had a 36% higher likelihood of CVD compared with those who experienced menopause at the median age of 50 to 52 years (odds ratio [OR] 1.36, 95% confidence interval [CI] 1.17–1.59; p<0.0001). Women with early menopause had a 15% higher likelihood (OR 1.15, 95% CI 1.03–1.28; p=0.013). No significant associations were observed for relatively early or late menopause groups. These results persisted after adjusting for confounders, including age, BMI, hypertension, diabetes, and menopausal hormone therapy.

The researchers also evaluated lifestyle factors using a composite score based on five domains: smoking, physical activity, sitting time, sleep duration, and diet quality. Women with high lifestyle adherence (score 9–10) had 23% lower odds of CVD compared with those with low adherence (score 0–5) (OR 0.77, 95% CI 0.68–0.86; p<0.0001). Among women with premature menopause, high lifestyle adherence reduced CVD likelihood by 52% (OR 0.48, 95% CI 0.30–0.77; p=0.002).

The observational nature of the study and reliance on self-reported data introduce potential biases, including unmeasured confounders, outcome misclassification, and attrition bias due to missing data. Additionally, the underpowered nature of the interaction analyses should be noted, as it limits definitive conclusions about the consistency of lifestyle effects across menopause categories. While efforts like multiple imputations and comparisons to similar cohorts help mitigate these issues, limitations such as baseline-only lifestyle assessments, a less comprehensive dietary measure, and a potentially underpowered sample for interaction analyses highlight the need for cautious interpretation of the findings.

The study identifies an increased risk of CVD associated with premature and early menopause and notes that healthy lifestyle modifications are associated with a consistent reduction in CVD risk across all menopause groups, regardless of timing. It also highlights menopause as an opportunity for cardiovascular screening and intervention and notes the need for further research on the effectiveness of lifestyle changes in higher-risk populations, such as those experiencing earlier menopause.

Full disclosures can be found in the published study.