Women with premature menopause may be at higher risk of new-onset heart failure and atrial fibrillation, according to a study published in the European Heart Journal.

The study, which included more than 1.4 million women aged 30 years and older, found that the younger the age at menopause, the higher the risk of heart failure and atrial fibrillation.

Women were followed up over nine years

The researchers used data from women who completed the NHS health check-up in 2009. The participants were then followed up until the end of 2018.

Information was collected on demographics, health behaviours and reproductive factors including age at menopause and use of hormone replacement therapy (HRT). Age at menopause was categorised as below 40, 40 to 44, 45 to 49, and 50 years or older. Premature menopause was defined as having the final menstrual period before the age of 40 years.

In total, 28,111 (2%) participants had a history of premature menopause. In these women, the average age at menopause was 36.7 years. During an average follow up of 9.1 years, 42,699 (3.0%) developed heart failure and 44,834 (3.2%) developed atrial fibrillation.

The risk of incident heart failure increased as the age at menopause decreased

The researchers then analysed the association between history of premature menopause and incident heart failure and atrial fibrillation.

After adjusting for age, smoking, alcohol, physical activity, income, body mass index, hypertension, type 2 diabetes, dyslipidaemia, chronic kidney disease, coronary heart disease, HRT, and age at menarche, they found that women who experienced premature menopause had a 33% higher risk of heart failure 9% higher risk of atrial fibrillation compared to those who did not.

After adjusting for the same factors, the researchers also analysed the associations between age at menopause and incidence of heart failure and atrial fibrillation. The risk of incident heart failure increased as the age at menopause decreased.

Compared with women aged 50 years and above at menopause, those aged 45 to 49, 40 to 44, and below 40 years at menopause had 11%, 23%, and 39% greater risks of incident heart failure, respectively.

Similarly, the risk of incident atrial fibrillation increased as the age at menopause decreased, with 4%, 10%, and 11% higher risks for those aged 45 to 49, 40 to 44, and under 40 years at menopause, respectively, compared with women aged 50 years and above at menopause.

Women with premature menopause should improve lifestyle habits known to be linked with heart disease

The authors of the study say that that several factors may explain the associations between menopausal age, heart failure and atrial fibrillation, such as the drop in oestrogen level and changes in body fat distribution.

“The misconception that heart disease primarily affects men has meant that sex-specific risk factors have been largely ignored. Evidence is accumulating that undergoing menopause before the age of 40 may increase the likelihood of heart disease later in life. Our study indicates that reproductive history should be routinely considered in addition to traditional risk factors such as smoking when evaluating the future likelihood of heart failure and atrial fibrillation,” said study author Dr. Ga Eun Nam of Korea University College of Medicine, Seoul, Republic of Korea.

Dr Nam added that the findings should encourage women to improve lifestyle habits known to be linked with heart disease, such as quitting smoking and exercising.