Is rapid transition through menopause linked to earlier onset of heart disease?

Preliminary study detects a possible connection between shorter menopause and faster progression of atherosclerosis, pointing to the need for more definitive research

LOS ANGELES, 29 jan 2009- An evaluation of 203 women as part of the multifaceted Los Angeles Atherosclerosis Study (LAAS) found that those who transitioned more quickly through menopause were at increased risk for a higher rate of progression of "preclinical atherosclerosis" – narrowing of arteries caused by the thickening of their walls.

Cardiologist C. Noel Bairey Merz, M.D., is principal investigator of the study. She is director of the Women's Heart Center and the Preventive and Rehabilitative Cardiac Center at the Cedars-Sinai Heart Institute. She serves as professor of medicine at Cedars-Sinai and holds the Women's Guild Endowed Chair in Women's Health.

This observational study included 203 women between ages 45 and 60 at the time they entered the study. Fifty-two were premenopausal, 20 were perimenopausal and 131 were postmenopausal. None of the women had been diagnosed with cardiovascular disease. They were evaluated when they entered the study and at two 18-month intervals, providing a snapshot over a three-year period of time.

Evaluations included carotid intimal-media thickness (cIMT) measurements and objective measures of menopausal status based on hormone levels and physiologic changes, not subjective factors, such as hot flashes and estimates of menstrual cycling.

Women who transitioned from being premenopausal to being fully postmenopausal within three years had more buildup of fatty plaque in their carotid arteries, suggesting that women who transition through menopause rapidly are at greater risk of early development of heart disease.

"We know that more fatty plaque accumulation predicts future heart attacks and strokes, but this is our first venture into this particular line of inquiry. This is an observational study, which doesn't provide specific recommendations for patient evaluation and treatment, but it does raise questions," Bairey Merz said.

"The findings suggest that we study this more definitively to possibly determine if women undergoing a more rapid menopause might benefit from early hormone replacement therapy," she said. "In the meantime, physicians could consider using carotid intimal-media thickness measurement or other cardiovascular screenings for women who are rapidly transitioning or who have certain risk factors, such as cigarette smoking or chemotherapy, which are known to accelerate transition through the menopause."

The study should not be used by patients to self-diagnose or presume they may be at higher risk because of symptoms.

"Women will say they're perimenopausal because they're having hot flashes or sleep disturbances or some cycle irregularity, but those are all symptoms. We use a very specific code of definitions to assess hormones and whether or not the ovaries are cycling," Bairey Merz said, adding that all women from the age of 21 should have annual checkups, which include blood pressure, cholesterol, height, weight and other measurements. Those at increased risk for cardiovascular disease may be referred by their physicians for additional screenings.

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Funding for this study was provided by a grant from the National Institutes of Health/National Heart, Lung, and Blood Institute.