Age of Menopause and Cardiovascular Outcomes

Study Questions:

Is the age at time of menopause and time since onset of menopause associated with cardiovascular disease (CVD) risk?

Methods:

Studies were identified through Medline, EMBASE, and Web of Science until March 2015. Studies were included if they were observational cohort, case-control, or cross-sectional and included information on age at onset of menopause and/or time since onset of menopause as exposures in addition to risk of cardiovascular outcomes and intermediate CVD endpoints in perimenopausal, menopausal, or postmenopausal women. Primary outcomes of interest included coronary heart disease (CHD), overall stroke, fatal stroke, fatal CHD, composite cardiovascular disease (CVD), and all-cause mortality.

Results:

A total of 32 studies were included in this meta-analysis. These studies included 310,329 women. Comparing women who experienced menopause at an age <45 years and those who experienced menopause at 45 years or older, there was an increased risk for CHD among the women who experienced menopause at a younger age (relative risk [RR], 1.50; 95 confidence interval [CI], 1.28-1.76). A similar association was observed for stroke (RR, 1.23; 95% CI, 0.98-1.53), fatal stroke (RR, 0.99; 95% CI, 0.92-1.07), CVD mortality (RR, 1.19; 95% CI, 1.08-1.31), and all-cause mortality (RR, 1.12; 95% CI, 1.03-1.21). When comparing women between 50 and 54 years of age (at time of menopause), the younger women had a decreased risk for fatal CHD (RR, 0.87; 95% CI, 0.80-0.96) compared with the older women. There was no difference in risk of stroke. Among the data from four observational studies that examined time since onset of menopause, the risk of CVD related to time since menopausal onset was inconsistent between studies.

Conclusions:

The investigators concluded that the findings of this review indicate a higher risk of CHD, CVD mortality, and overall mortality in women who experience premature or early-onset menopause.

Perspective:

This meta-analysis suggests that the earlier age of menopause rather than time since menopause may be associated with increased CVD risk. Whether women who transition through menopause at an earlier age have more CVD risk factors may be a factor in this finding.

Clinical Topics: Prevention

Keywords: Cardiovascular Diseases, Coronary Artery Disease, Menopause, Menopause, Premature, Perimenopause, Postmenopause, Primary Prevention, Risk Factors, Stroke, Women


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