Key result
Each percentage point increase in premenopausal Framingham risk score links to ~1.8 years earlier menopause.
Why the study?
Women with early menopause have increased cardiovascular disease risk, but whether an increased premenopausal cardiovascular risk accelerates menopause required examination.
Does a higher premenopausal cardiovascular risk profile accelerate the age at natural menopause in women?
Cohort (n=695)
Does a higher premenopausal cardiovascular risk profile accelerate the age at natural menopause in women?
Mean Difference: -1.8 (95% CI -2.72–-0.92)
A higher premenopausal cardiovascular risk profile, including elevated Framingham risk score and cholesterol, is associated with an earlier age at natural menopause, suggesting heart disease risk determines menopausal age rather than the reverse.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The other possible explanation is that women with worse ASCVD risk factors – who are more overweight, have higher blood pressure, and have more diabetes and insulin resistance – are more likely to have earlier menopause.”
“If we look at the differences in the characteristics of women who have premature menopause, compared with those who didn't, there were slight differences in terms of higher blood pressure, higher body mass index, and slightly higher glucose. So maybe what we're seeing – and this is more speculative – is that risk factors are developing after early menopause, and the focus should be earlier in the patient's life course to try to prevent hypertension, diabetes, and obesity.”
“It remains unclear if the menopausal transition truly represents a more disease-permissible vascular environment, or whether those who experience premature menopause are the same individuals who already have a disease-permissible vascular environment where risk is unmasked and premature menopause is a marker.”
Higher premenopausal CV risk should not yet guide menopause counseling; leaves open causality and need for prospective confirmation.
OBJECTIVES: The purpose of this study was to investigate whether a harmful cardiovascular risk profile accelerates menopause. BACKGROUND: Women with an early menopause are at an increased risk of cardiovascular disease. Although increased cardiovascular risk has been proposed as consequence of menopause, the alternative hypothesis, that increased premenopausal cardiovascular risk promotes early menopause, needs to be examined. METHODS: We used data from the Framingham Heart Study cohort. This study started in 1948 and has followed up participants biennially since then. Women who were premenopausal at study entry and who reached natural menopause after at least two examination rounds were included in the study (n = 695). Premenopausal age-independent levels of serum total cholesterol, relative weight, blood pressure, and Framingham risk score were determined, as well as premenopausal changes in cholesterol, body weight, and blood pressure. RESULTS: A higher premenopausal serum total cholesterol level was statistically significantly associated with an earlier age at menopause, as were increases in total serum cholesterol, relative weight, and blood pressure in the premenopausal period. A decrease in total serum cholesterol during premenopause was statistically significantly associated with later age at menopause. Decreasing blood pressure was associated with a later menopausal age, but this association was not statistically significant. A decrease in relative weight was associated with a significant earlier age at menopause. Each 1% higher premenopausal Framingham risk score was associated with a decrease in menopausal age of 1.8 years (95% confidence interval -2.72 to -0.92). CONCLUSIONS: The findings support the view that heart disease risk determines age at menopause. This offers a novel explanation for the inconsistent findings on cardiovascular disease rate and its relationship to menopausal age and effects of hormone replacement therapy.
No takes yet. Share an insight, caveat, or question.
Kok et al. (2006) conducted a cohort in Cardiovascular risk and early menopause (n=695). Premenopausal cardiovascular risk (Framingham risk score) vs. Lower premenopausal cardiovascular risk was evaluated on Age at menopause (decrease of 1.8 years, 95% CI -2.72 to -0.92). Each 1% higher premenopausal Framingham risk score was associated with a 1.8-year decrease in menopausal age (95% CI -2.72 to -0.92), indicating that heart disease risk determines menopausal age.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: