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Heart disease risk determines menopausal age rather than the reverse
Helen S Kok1, Kristel M van Asselt, Yvonne T van der Schouw
1Julius Center for Health Sciences and Primary Care, Utrecht University, Utrecht, The Netherlands.
Insights
Harmful cardiovascular risk factors, including high cholesterol and weight gain, are linked to earlier menopause. This suggests heart disease risk influences menopausal timing, offering new insights into cardiovascular disease and hormone replacement therapy studies.
Area of Science:
- Cardiovascular Health
- Reproductive Endocrinology
- Epidemiology
Background:
- Early menopause increases cardiovascular disease (CVD) risk in women.
- While menopause is often seen as a risk factor for CVD, this study explores the reverse hypothesis.
- Investigating premenopausal cardiovascular risk as a determinant of menopausal age is crucial.
Purpose of the Study:
- To determine if an adverse cardiovascular risk profile accelerates the onset of menopause.
- To examine the relationship between premenopausal cardiovascular health markers and age at natural menopause.
Main Methods:
- Utilized data from the Framingham Heart Study cohort (n=695) of premenopausal women.
- Assessed premenopausal levels and changes in serum total cholesterol, relative weight, blood pressure, and Framingham risk score.
- Followed participants biennially to determine age at natural menopause.
Main Results:
- Higher premenopausal serum total cholesterol and increases in cholesterol, relative weight, and blood pressure were associated with earlier menopause.
- Decreased serum total cholesterol correlated with later menopause; decreased blood pressure showed a non-significant trend towards later menopause.
- A 1% increase in premenopausal Framingham risk score was linked to an 1.8-year earlier menopause.
Conclusions:
- Findings support the hypothesis that cardiovascular risk influences the age of menopause.
- This provides a novel explanation for observed inconsistencies in CVD rates related to menopausal age.
- Results may impact understanding of hormone replacement therapy effects in relation to menopausal timing and cardiovascular health.
Objectives:
The purpose of this study was to investigate whether a harmful cardiovascular risk profile accelerates menopause.
Background:
Women with an early menopause are at an increased risk of cardiovascular disease. Although increased cardiovascular risk has been proposed as consequence of menopause, the alternative hypothesis, that increased premenopausal cardiovascular risk promotes early menopause, needs to be examined.
Methods:
We used data from the Framingham Heart Study cohort. This study started in 1948 and has followed up participants biennially since then. Women who were premenopausal at study entry and who reached natural menopause after at least two examination rounds were included in the study (n = 695). Premenopausal age-independent levels of serum total cholesterol, relative weight, blood pressure, and Framingham risk score were determined, as well as premenopausal changes in cholesterol, body weight, and blood pressure.
Results:
A higher premenopausal serum total cholesterol level was statistically significantly associated with an earlier age at menopause, as were increases in total serum cholesterol, relative weight, and blood pressure in the premenopausal period. A decrease in total serum cholesterol during premenopause was statistically significantly associated with later age at menopause. Decreasing blood pressure was associated with a later menopausal age, but this association was not statistically significant. A decrease in relative weight was associated with a significant earlier age at menopause. Each 1% higher premenopausal Framingham risk score was associated with a decrease in menopausal age of 1.8 years (95% confidence interval -2.72 to -0.92).
Conclusions:
The findings support the view that heart disease risk determines age at menopause. This offers a novel explanation for the inconsistent findings on cardiovascular disease rate and its relationship to menopausal age and effects of hormone replacement therapy.
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