Age at menopause as a risk factor for cardiovascular mortality

doi:10.1016/S0140-6736(96)90075-6

The Lancet

Volume 347, Issue 9003, 16 March 1996, Pages 714-718

https://doi.org/10.1016/S0140-6736(96)90075-6 Get rights and content

Abstract

Summary

Background Although an association of occurrence of menopause and subsequent oestrogen deficiency with increased cardiovascular disease has been postulated, studies on this association have not shown convincing results. We investigated whether age at menopause is associated with cardiovascular mortality risk.

Methods We studied a cohort of 12 115 postmenopausal women living in Utrecht, Netherlands, aged 50-65 years at enrolment in a breast cancer screening project. During follow-up of up to 20 years the women attended screening rounds at which we asked questions on menopausal status, age at menopause, medication use, cardiovascular risk factors, and ovarian function. Deaths were ascertained from the patient's family physicians. Life-table analysis and Cox regression analysis were used to investigate the association between age at menopause and cardiovascular mortality. All analyses were adjusted for biological age.

Findings 824 women died of cardiovascular causes. 1459 women had left the study area. The risk of cardiovascular mortality was higher for women with early menopauses than for those with late menopauses. The age-adjusted hazard ratio of age at menopause was 0·982 (95% Cl 0·968-0·996, p=0·01)—ie, for each year's delay in the menopause the cardiovascular mortality risk decreased by 2%. The extra risk of early menopause seemed to decrease with biological age (p for interaction 0·07); at biological age 60 the reduction of the annual hazard was 3%, but at age 80 there was no reduction. Adjustment for known cardiovascular risk factors and indicators of ovarian function did not significantly alter the risk estimate.

Interpretation These results support the hypothesis that longer exposure to endogenous oestrogens protects against cardiovascular diseases. The effect of an early menopause may be more important at younger biological ages.

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ArticleAge at menopause as a risk factor for cardiovascular mortality

Abstract

Am J Obstet Gynecol

J Chron Dis

J Chron Dis

Prev Med

Am J Obstet Gynecol

Menopause and the risk of cardiovascular disease: the Framingham study

Ann Intern Med

Menopause and coronary heart disease: the Framingham study

Ann Intern Med

Menopause and the risk of coronary heart disease in women

N Engl J Med

Increased incidence of coronary heart disease in women castrated prior to the menopause

Arch Intern Med

Estrogen and coronary heart disease in women

JAMA

The degree of coronary atherosclerosis in bilaterally oophorectomised women

Circulation

The incidence and severity of cornary atherosclerosis in estrogen-treated males, and in females with a hypoestrogenic or a hyperestrogenic state

Circulation

Number of pregnancies, use of oral contraceptives and menopausal age in women with ischaemic heart disease, compared to a population sample of women

Acta Med Scand

Article
Age at menopause as a risk factor for cardiovascular mortality