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Early menopause linked to heart disease, stroke risk

Wednesday September 19, 2012
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Women who go into early menopause are twice as likely to suffer from coronary heart disease and stroke, according to a study.

The association holds true in patients from a variety of different ethnic backgrounds and is independent of traditional cardiovascular disease risk factors, the researchers said.

"If physicians know a patient has entered menopause before her 46th birthday, they can be extra vigilant in making recommendations and providing treatments to help prevent heart attacks and stroke," Dhananjay Vaidya, PhD, the study’s lead investigator and an assistant professor in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine, said in a news release. "Our results suggest it is also important to avoid early menopause if at all possible."

For example, Vaidya said, research has shown that smokers reach menopause an average of two years earlier than do nonsmokers, meaning quitting smoking may delay menopause.

Although the researchers said more investigation is needed, the findings about the negative impact of early menopause were similar whether the women reached menopause naturally or surgically. Often, Vaidya said, women who undergo hysterectomies have their ovaries removed, which precipitates rapid menopause. "Perhaps ovary removal can be avoided in more instances," he said.

Vaidya said previous studies have shown a link between early menopause and heart disease and stroke among white women, but similar associations had not been demonstrated in more diverse populations. Hispanic and African-American women, on average tend to go through menopause somewhat earlier than women of European descent, he said.

Methodology and data

Vaidya and his colleagues examined data from 2,509 women involved in the Multi-Ethnic Study of Atherosclerosis, a longitudinal, ethnically diverse cohort study of men and women ages 45 to 84, all enrolled between 2000 and 2002 and followed until 2008.

Of the women, 28% reported reaching menopause before age 46. Vaidya emphasized that although the risk of MI and stroke was doubled in these groups, the actual number of cardiac and stroke events recorded among study participants was small. Only 50 women in the study suffered heart events, while 37 had strokes.

Vaidya said some women are treated with hormone replacement therapy to control menopause symptoms such as profuse sweating and hot flashes, but its widespread long-term use has been limited after large clinical trials showed it increased the risk of myocardial infarction in some women. In Vaidya’s study, no role was detected for HRT in potentially modifying the impact of early menopause.

"Cardiovascular disease processes and risks start very early in life, even though the heart attacks and strokes happen later in life," Vaidya said. "Unfortunately, young women are often not targeted for prevention because cardiovascular disease is thought to be only attacking women in old age. What our study reaffirms is that managing risk factors when women are young will likely prevent or postpone heart attacks and strokes when they age."

The study is scheduled for publication in the October issue of the journal Menopause. The study abstract is available at http://bit.ly/NMR37P.

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