Effect of Early Menopause and Hormone Replacement Therapy on Aortic Stenosis Progression

Early menopause has been associated with several cardiovascular diseases. Its effect on the progression of aortic stenosis (AS) remains unknown. We conducted an analysis to examine the effect of early menopause without hormone replacement therapy (HRT) on the progression of AS in postmenopausal women with AS.

This subanalysis included 33 female patients with at least mild AS (mean age 65 ± 10 years) who were prospectively enrolled in the Metabolic Determinants of the Progression of Aortic Stenosis (PROGRESSA) study (NCT01679431). Anatomical assessment of AS was performed using multidetector computed tomography, whereas hemodynamic assessment of AS was performed using Doppler echocardiography.

Over a median follow-up of 2 (25th-75th percentiles, 1-4) years, early menopausal women without HRT showed faster progression of aortic valve calcification (AVC; median, 100 [25th-75th percentiles, 58-130] vs 23 [25th-75th percentiles, 2-71] arbitrary units per year; P = 0.03); mean pressure gradient (median, 2.37 [25th-75th percentiles, 0.82-3.61] vs 0.33 [25th-75th percentiles, 0.01-1.78] mm Hg per year; P = 0.04) and aortic valve area indexed to body surface area (median, -0.12 [25th-75th percentiles, -0.23 to 0.002] vs -0.004 [25th-75th percentile, -0.07 to 0.08] cm²/m²/y; P = 0.07). In multivariate analysis adjusted for several clinical, echocardiographic, and anatomic factors, early menopause without HRT remained independently associated with faster AVC progression (P = 0.003). Women who received HRT showed a slower progression of AVC compared with those who never received HRT (median, 62 [25th-75th percentile, 2-100] vs 20 [25th-75th percentile, 10-42] arbitrary units per year; P = 0.13). Multivariate analysis also showed that AVC progressed less rapidly in women who received HRT (P = 0.04).

In this study of postmenopausal women with AS, early menopause without HRT was associated with faster progression of AS, anatomically and hemodynamically. However, the use of HRT was associated with slower progression of AS.