Women who experience premature menopause have a 40% greater risk for developing coronary heart disease (CHD), and this risk is the same for both Black and White women, according to an article published in JAMA Cardiology.

Reproductive milestones such as menopause can act as early signals from the cardiovascular system, said Priya M. Freaney, MD, lead author of the article and assistant professor of medicine in the Division of Cardiology at Northwestern University Feinberg School of Medicine in Chicago.

“These early signs are clues that can help clinicians identify risk sooner and take appropriate action before cardiovascular disease develops,” said Freaney, who also is director of the Women’s Heart Care Program at Northwestern Medicine Bluhm Cardiovascular Institute in Chicago. “Our findings reinforce that reproductive history is an important, and often underused, part of cardiovascular risk assessment.”

Researchers have known for some time that women who experience premature menopause, defined as cessation of menses beginning younger than age 40, have higher rates of heart disease. However, most studies have focused on short- and mid-term risk, Freaney pointed out.

Health Over ‘Course of a Woman’s Life’

“We wanted to understand what this would mean over the course of a woman’s life,” she said. “We also aimed to examine this question in a diverse and inclusive sample of women, which allowed us to better understand how these patterns may differ across populations.”

Freaney and colleagues conducted a prospective population-based cohort study consisting of 3522 Black women and 6514 White women, with mean ages at baseline of 61 years and 60 years, respectively. All participants were free of CHD at baseline, and data were collected and recorded on menopausal status and CHD outcomes.

The study team found that compared with White women, both premature menopause and incident CHD were greater in Black women. However, both Black and White participants who experienced premature menopause had a 40% higher lifetime risk for CHD.

“The 40% figure refers to how much premature menopause increased lifetime CHD risk within each group, and the increase is similar for both Black and White women,” Freaney said.

The researchers also noted that premature natural menopause occurs much more frequently in Black women (15.5%) vs White women (4.8%). “Separately, Black women have higher baseline rates of both premature menopause and CHD,” Freaney said. “Therefore, these conclusions are about two distinct findings. The effect of premature menopause is similar, but it is occurring on top of a higher underlying risk for Black women.”

Ask the Question

When consulting with female patients, many cardiologists are not inquiring about age at menopause, according to Srihari S. Naidu, MD, director of the Hypertrophic Cardiomyopathy Program at Westchester Medical Center in Valhalla, New York.

“As a result, they may miss a lot of patients who need to aggressively manage their risk for heart disease, especially if they have other risk factors such as hypertension, high cholesterol, and diabetes,” Naidu said. “Even if these other risk factors are borderline, premature menopause puts them in a higher risk category.”

For patients who have experienced premature menopause, he added, managing modifiable risk factors should begin right away.

“This may include prescribing statins or other cholesterol-lowering drugs, diabetes medications, and GLP-1 receptor agonists, which can help control obesity, hypertension, and diabetes,” Naidu said. “As cardiologists, we need to use all the tools available to us to help aggressively manage the risk for CHD in this population.”

Declining Estrogen

Freaney also advises high-risk patients about lifestyle changes. “In addition to the fundamentals of core heart health — nutrition, cardiovascular exercise, maintaining a healthy weight, and smoking cessation — I recommend strength training at least twice a week since declining estrogen accelerates muscle loss and visceral fat gain,” she said. “Maintaining muscle also helps regulate metabolism and counter adverse cardiovascular changes.”

She acknowledged that more research is needed to understand exactly why the relationship exists between premature menopause and CHD.

“Future studies should explore potential pathways such as hormonal changes, particularly the earlier loss of estrogen, as well as differences in metabolism, inflammation, and vascular health over time,” she said. “It’s also possible that some of the underlying factors that contribute to premature menopause may overlap with those that raise cardiovascular risk. Understanding these mechanisms will be an important next step for research.”

Freaney and Naidu reported having no financial disclosures.

Martta Kelly is a medical journalist who lives in the metropolitan New York area.