What does menopause have to do with cardiovascular events? Quite a lot – and yet none of this is mentioned in European guidelines. You can read here why an early menopause can be dangerous.
Cardiovascular diseases are the leading cause of death among women in Europe. In addition to the classic cardiovascular risk factors, women-specific and existing cardiovascular effects also play a role.
It is known that estrogens basically show numerous cardioprotective effects. With the beginning of Menopause this protective effect is lost and the risk of cardiovascular disease increases. studies were able to show in 2016 that the time of menopause also has a decisive influence on the risk of heart disease. According to the meta-analysis with 32 studies and more than 50,000 participants, women whose menopause begins early or prematurely are at increased cardiovascular risk.
Menopause and cardiovascular risk
In the published data, women who were under 45 years old at the start of their menopause had a 50% higher relative risk of coronary artery disease heart disease to suffer than older women at that time. The risk of dying from cardiovascular disease was increased by 19%; all-cause mortality was 12% higher. Women who started menopause between the ages of 50 and 54 had a 13% lower cardiovascular risk than women whose menopause started between the ages of 45 and 49. Recently published studies went into the question of whether an earlier beginning of menopause not only increases the risk of coronary artery disease, but also the occurrence of atrial fibrillation or heart failure influenced.
The Study analyzed more than 1.4 million insured persons’ data from postmenopausal women who had a health check carried out in South Korea in 2009. The average follow-up period for the women was 9.2 years. Reported onset of menopause was related to documented hospitalizations or doctor visits for an initial diagnosis, heart failure, or atrial fibrillation.
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A multivariate regression analysis showed a significant correlation between the onset of menopause and the risk of developing heart failure and atrial fibrillation. This connection also existed following adjustment for the classic cardiovascular risk factors.
Women whose menopause began before the age of 40 had a 33% higher relative risk of developing heart failure than women with a later onset of menopause (hazard ratio, HR: 1.33; p˂0.001). The risk of atrial fibrillation was increased by 9% in the case of early or premature onset of menopause (HR: 1.09; p= 0.008). There was a trend showing that the earlier the onset of menopause, the higher the risk. One hormone replacement therapy showed no effect on the described increased risk of atrial fibrillation or heart failure.
Is it the estrogen?
in one Editorial However, it was not only the declining estrogen production at the onset of menopause that was held responsible for the observed increase in risk. The scientists justify their assumption with the fact that in the current study, taking hormone replacement therapy had no effect on the described increased risk of atrial fibrillation or heart failure.
In addition to the well-known influence of estrogen, she believes that the reduction in ovarian function might also play a role because, among other things, it is associated with an increase in certain inflammatory markers. According to the authors, vascular inflammation might possibly promote the development of coronary microvascular dysfunction and thus the development of heart failure.
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What does that mean for everyday life?
The scientists hope that the current study results might be used to develop new therapy strategies to prevent heart failure and atrial fibrillation in women.
For everyday clinical practice, the study results may mean that, in addition to asking regarding classic cardiovascular risk factors, women should also have a gynecological anamnesis. This aspect is discussed controversially in the guidelines. the guideline The American Heart Association has listed a premature onset of menopause (before the age of 40) as a “risk enhancer” for atherosclerotic diseases – there is no such reference in the European guidelines. Even in the conventional risk calculators, the start of the menopause has not been taken into account.
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