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Early Onset Menopause Linked To Increased Risk of Coronary Heart Disease

Health In Focus   - G J E 4
Highlights:
  • Menopause signals the end of menstruation in women, typically occurring between 49 to 52 years of age.
  • Cardiovascular disease is relatively uncommon in women before menopause.
  • Incidence of cardiovascular disease in women increases sharply after menopause.
  • Early onset of menopause occurring at less than 45 years of age may be associated with an increased risk of heart disease and overall mortality.

Early Onset of Menopause and Effect on Heart Disease

Early or premature age of onset of menopause and its effect on certain types of cardiovascular disease and overall mortality were analyzed in a recent study.
Early Onset Menopause Linked To Increased Risk of Coronary Heart Disease
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Taulant Muka, M.D., Ph.D., of Erasmus University Medical Center, Rotterdam, the Netherlands, and colleagues conducted a systematic review and meta-analysis of 32 studies (310,329 women) that satisfied the criteria for inclusion in their study.

‘Relief from periods finally, but increased the risk of heart disease.’
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Incidence of cardiovascular disease was compared between women who experienced menopause younger than 45 years of age and women who were 45 years or older at onset.

They found that overall, women who experienced premature or early-onset menopause at less than 45 years seemed to have a greater risk of coronary heart disease (CHD), cardiovascular disease (CVD) mortality, and an all-cause mortality but no significant relation to an increased risk of stroke. Women between the ages of 50 and 54 years at onset of menopause had a decreased risk of fatal CHD compared with women younger than 50 years at onset.

Women who begin menopause before age 46 or after 55 have an increased risk of developing type 2 diabetes.

The relationship between 'time since onset' of menopause and the risk of developing intermediate cardiovascular traits such as high blood pressure, diabetes, obesity and increased cholesterol levels or CVD outcomes were reported in 4 observational studies but showed inconsistent results.

"The findings of this review indicate a higher risk of CHD, cardiovascular mortality, and overall mortality in women who experience premature or early-onset menopause when younger than 45 years. However, this review also highlights important gaps in the existing literature and calls for further research to reliably establish whether cardiovascular risk varies in relation to the time since onset of menopause and the mechanisms leading early menopause to cardiovascular outcomes and mortality," the authors write.

About Menopause

Menopause signals the end of a woman's reproductive life and the cessation of menses. Typically it occurs between 49 to 52 years. By 58 years, majority of women (97%) have undergone menopause. It is a natural phenomenon, and not an illness. However, the physical and psychological changes that accompany menopause may be distressing for many women.

With onset of menopause, there is a decline in ovarian function. The ovaries produce lower amounts of the female sex hormones, namely estrogen and progesterone. Estrogen levels gradually decline over several years following the onset of menopause. The hormonal imbalances accompanying menopause are responsible for much of its features.

Symptoms and Signs of Menopause

Most women notice some changes during the years leading upto menopause. This period is referred to as perimenopause, and may last for 4 to 5 years. Common symptoms and signs during this period include
  • Irregular menses
  • Abnormal bleeding from the uterus
  • Hot flashes, including the flushing of the face and chest. These may be accompanied by palpitations, headaches and giddiness.
  • Night sweats
  • Vaginal dryness
  • Sleep disturbances
  • Migraines during periods
  • Bone weakness and osteoporosis
  • Mood changes, including depression, and tension (anxiety)
  • Increase in belly fat

Menopause and Its Risk For Development of Other Diseases

Post-menopausal women have an increased risk for development of the following diseases
  • Decreased bone density or osteoporosis
  • Increased intra ocular pressure (glaucoma)
  • Heart disease
  • Macular degeneration
  • Colon cancer
The increase in the incidence of heart disease following menopause is especially sharp, compared to its prevalence among women in the reproductive age group.

Why Menopause May Be Associated With Heart Disease?

Decreasing estrogen hormone levels occurring in menopause may contribute to the increased incidence of heart disease in post-menopausal women.

Other additional and equally important risk factors that are associated with increased risk of heart disease in general, that also need to be addressed or modified include
  • High blood pressure
  • Elevated blood cholesterol
  • Diabetes and glucose intolerance
  • Smoking
  • Obesity
  • Leading a sedentary life
  • Family history of early heart disease
  • History of very high blood pressure and fluid retention during pregnancy
  • Unhealthy dietary habits
  • Age (55 or older for women)

Measures to Reduce Incidence of Heart Disease In Menopause

Heart disease processes and risks start very early in life, although heart attacks and strokes happen later in life. Younger women are rarely targeted for preventive measures, since cardiovascular disease is believed to occur only in older women. Addressing the risk factors by women when they are still young may reduce or postpone occurrence of heart disease when they are older.
  • Reducing or stopping smoking
  • Weight loss
  • Exercising for at least 30 minutes per day more than three times per week. Exercising helps elevate mood, and reduces hot flashes. Weight bearing exercises help keep the bones strong.
  • Following a healthy and balanced diet. Reduce the intake of sugars and fatty foods.
  • Treatment of medical conditions such as diabetes, high cholesterol, and high blood
  • pressure which are known to increase the risk of heart disease.
  • Hormone replacement therapy may help, though they are associated with an increased risk of breast cancer and stroke.
Early menopause serves as a sentinel for elevated CVD risk, write JoAnn E. Manson, M.D., Dr.P.H., of Brigham and Women's Hospital, Harvard Medical School, Boston, and Teresa K. Woodruff, Ph.D., of Northwestern University, Chicago, in an accompanying commentary.

"The recognition that women with early reproductive decline constitute a population at increased vascular risk provides important opportunities for early intervention in terms of both risk factor modification and, when appropriate, hormonal treatment. Although additional research is needed to clarify the complex associations between accelerated reproductive aging and vascular health, applying current knowledge will help to reduce cardiovascular events in this high-risk patient population."

References:
  1. Menopause Introduction - (http://umm.edu/health/medical/altmed/condition/menopause)
  2. What is Menopause? - (https:en.wikipedia.org/wiki/Menopause)
  3. Sex, Age, Cardiovascular Risk Factors and Coronary Heart Disease - (http://circ.ahajournals.org/content/99/9/1165)
  4. Early menopause associated with increased risk of heart disease and stroke - (http://www.hopkinsmedicine.org/news/media/releases/early_menopause_associated
    _with_increased_risk_of_heart_disease_stroke)
Source: Medindia
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