Early menopause ups heart failure risk, especially for smokers

Women who go through menopause early—at ages 40 to 45—have a higher rate of heart failure, according to a new study published online today in Menopause, the journal of The North American Menopause Society (NAMS). Smoking, current or past, raises the rate even more.

Research already pointed to a relationship between and heart disease—usually atherosclerotic heart disease. But this study from the Karolinska Institute in Stockholm, Sweden, is the first to demonstrate a link with heart failure, the inability of the heart to pump enough blood to meet the body's needs. It is also the first large-scale (including more than 22,000 ) and long-term study linking early menopause and heart disease—made possible by the Swedish National Patient Register, which captures nearly all Sweden's hospitalization and outpatient diagnoses; Sweden's Cause of Death Register; and health surveys of some 90,000 women in the Swedish Mammography Cohort.

The authors' analysis of the data showed that women who went through menopause naturally at this early age had a rate of heart failure some 40% higher than women who went through menopause the usual age between 50 and 54. (The average is 51.) And for every one-year increase in age at menopause, the rate of heart failure was 2% lower.

Smokers are known to go through menopause an average of one year earlier than nonsmokers, but that didn't entirely explain the early menopause-heart failure connection, since women who had smoked earlier in their lives and quit also had an increased rate of heart failure with early menopause. What's more, who smoked, even if they had quit earlier, had a higher risk of heart failure if they went through menopause only somewhat early—at ages 46 to 49.

"Menopause, early or late, is always a good time to take more steps to reduce risk through exercise, a healthy diet, weight loss, and quitting smoking, says NAMS Executive Director Margery Gass, MD. "This thought-provoking study should encourage more research to find out how early menopause and heart failure are linked. Do the factors that cause also cause ovarian failure?"

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