Coronary heart disease occurs when arteries in the heart are partially or completely blocked by fatty deposits or plaques. For women, one of the main risk factors for coronary heart disease is premature menopause, or menopause before the age of 40. The American College of Cardiology/American Heart Association recognizes this risk in its Primary Prevention Guidelines.

Because women who experience premature menopause still have half their life expectancy ahead of them, researchers from the Northwestern University Feinberg School of Medicine, Boston University Chobanian and Avedisian School of Medicine wanted to get a clearer picture of the risk early menopause poses over time, so they followed more than 10,000 postmenopausal Black and White women over the age of 54 in a long-term study.

Hormonal changes during menopause, such as a decline in estrogen levels, can affect almost every system of the body, including the cardiovascular system.

The women were enrolled in six long-running U.S. studies: the Cardiovascular Risk Study, the Framingham Heart Study, the Framingham Offspring Study, the Multi-Ethnic Study of Atherosclerosis, the Women's Health Initiative and the Atherosclerosis Risk in Communities Study. Between 1964 and 2018, women in these six studies had more than 1,000 CHD events, including fatal and non-fatal heart attacks.

The team found that Black women who experienced early menopause had a 41 percent greater risk of cardiovascular disease; White women had 39 percent greater risk.

“Understanding their cumulative lifetime risk of blockage-related disease is critical,” Priya Freaney, lead author on the study, said in a statement. Most heart disease is preventable, she added, but people need to know they are at risk as early as possible because effective prevention takes decades.

If she knows her lifetime risk for CHD, a woman can be more proactive about reducing that risk. Women should see early menopause as a sign to take their heart health seriously and talk to their doctor about what they can do to protect their heart, Freaney, an assistant professor of medicine in the division of cardiology at Feinberg, added.

Women who experience early menopause should see it as an early warning sign to take their heart health seriously and talk to their doctors about what they can do to protect their hearts.

The findings highlight a gap in how menopause is discussed in medical care. The hormonal changes that occur during menopause, such as a decline in estrogen levels, can affect almost every system of the body, including the cardiovascular system. Menopause is often treated as a gynecologic issue, but it is also a factor in cardiovascular health, and cardiologists should routinely ask about menopause history when assessing long-term cardiovascular risk, the researchers said.

“All clinicians need to get comfortable asking about menopause, because we have estrogen receptors from our head to our toes,” said Freaney.

The study is published in JAMA Cardiology.