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Age at Menopause and Risk of Heart Failure and Atrial Fibrillation
Quick Takes
- A history of premature menopause was associated with a higher risk of incident HF and AF, compared to those without such a history, after adjusting for the traditional cardiovascular risk factors.
- The association between premature menopause and the risk of HF was stronger in the group with age <65 years, never-smokers, and obese individuals compared to the other groups.
- Reproductive factors such as premature menopause and age at menopause should be considered in addition to traditional risk factors when evaluating the future risk of HF and AF.
Study Questions:
What is the association of premature menopause and age at menopause with the risk of heart failure (HF) and atrial fibrillation (AF)?
Methods:
The investigators included a total of 1,401,175 postmenopausal women, who had undergone a health examination provided by the Korean National Health Insurance Service, and their reproductive histories were collected. Multivariable Cox proportional hazard models were performed to determine the hazard ratios (HRs) and 95% confidence intervals (CIs) of incident HF and AF, according to the history of premature menopause and age at menopause.
Results:
At a mean follow-up of 9.1 years, there were 42,699 (3.0%) and 44,834 (3.2%) new cases of HF and AF, respectively. Women with a history of premature menopause had an increased risk of HF (HR, 1.33; 95% CI, 1.26–1.40) and AF (HR, 1.09; 95% CI, 1.02–1.16), compared to women without the history. Compared with women aged ≥50 years at menopause, those aged 45−49, 40−44, and <40 years at menopause showed a significantly increased trend in HRs for the incident risk of both HF and AF (p for trend < 0.001). The robustness of the results of a series of sensitivity analyses further strengthens the main findings.
Conclusions:
The authors reported that postmenopausal women with a history of premature menopause or early menopausal age may have an increased risk of HF and AF.
Perspective:
This study reports that history of premature menopause was associated with a higher risk of incident HF and AF, compared to those without such a history, after adjusting for the traditional cardiovascular risk factors. Furthermore, there were dose-responsive associations between earlier menopausal age and the risk of developing HF and AF. The association between premature menopause and the risk of HF was stronger in the group with age <65 years, never-smokers, and obese individuals compared to the other groups. Reproductive factors such as premature menopause and age at menopause should be considered in addition to traditional risk factors when evaluating the future risk of HF and AF, to prevent the disease and to establish therapeutic strategies in women with a history of premature menopause.
Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure
Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Heart Disease Risk Factors, Heart Failure, Menopause, Premature, Non-Smokers, Obesity, Postmenopause, Reproductive History, Risk Factors, Secondary Prevention, Vascular Diseases, Women
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