Premature menopause was associated with an increased lifetime risk of coronary heart disease (CHD) in Black women and White women in the U.S., according to a population-based cohort study published March 18 in JAMA. These findings emphasize the importance of reproductive factors in cardiovascular disease risk assessment.

For this study, Priya Mehta Freaney, MD, et al., included individual-level data from postmenopausal women (aged 55-69 years) across six cohorts who identified their race as Black or White, with a total of 163,600 person-years of follow-up, from 1964 to 2018. Participants had a mean age of 60 years and no history of CHD, and they provided complete data on menopausal status and CHD outcomes. Participants who reported menopause due to surgical procedures were excluded.

Results showed that premature natural menopause occurred more frequently in Black women (545 of 3,522 women; 16%) than White women (313 of 6,514 women; 5%). Notably, Black women with premature menopause were more likely to have a history of diabetes, whereas White women were more likely to be current smokers.

Premature menopause was associated with an increased lifetime risk of 40% for developing CHD, defined as fatal and nonfatal myocardial infarction, in Black and White women.

Black women with premature menopause lived a mean of 18 years free of CHD, compared with 19 years among Black women without premature menopause. A similar pattern was observed in White women, although neither were statistically significant.

“…these data support the perimenopausal period as a unique window of opportunity to measure, monitor and modify [cardiovascular disease] risk in women,” write the authors. They note that their work also “raises the question whether the higher frequency of premature menopause observed in Black women may contribute in part to known disparities in CHD between Black and White women.”