Timing of Menopause Onset May Increase HF Risk

Postmenopausal women who reached menopause at an earlier age or who never gave birth may be at a higher risk for heart failure (HF), according to research published May 15 in the Journal of the American College of Cardiology.

Philip S. Hall, MD, and colleagues examined 28,516 postmenopausal women without cardiovascular disease from the Women's Health Initiative to test associations between total number of live births, age at first pregnancy lasting at least six months, and total reproductive duration (time from first menstruation to menopause) with incident HF.

During an average follow-up of 13.1 years, 5.2 percent of women were hospitalized for HF. Short total reproductive duration was associated with an increased risk of HF, which was found to be related to an earlier age at menopause and was more pronounced in women who experienced natural, rather than surgical, menopause. Women who never gave birth were found to be at an increased risk for diastolic HF. The authors did not find that this relationship was due to infertility. Further, they found that having more children was not associated with HF risk.

According to the authors, the finding that a shorter total reproductive duration was associated with a modestly increased risk of HF might be due to the increased coronary heart disease risk that accompanies early menopause. Moving forward, they note that ongoing evaluation of the potential cardioprotective mechanisms of sex hormone exposure in women is warranted.

In an accompanying editorial comment, Nandita S. Scott, MD, FACC, explains that while the mechanisms of these findings are unclear, their importance and potential impact on women's health is real. "There also remain many unresolved questions including the mechanisms of estrogen's cardioprotective effect, making this truly a work in progress," she said. "Altogether, these findings raise interesting questions about the cardiometabolic effects of sex hormone exposure over a woman's lifetime and continue to raise important questions for future research."

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Coronary Disease, Estrogens, Female, Follow-Up Studies, Gonadal Steroid Hormones, Heart Failure, Infertility, Live Birth, Menopause, Menopause, Premature, Menstruation, Postmenopause, Pregnancy, United States, Women's Health


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