Age at Natural Menopause and Risk of Cardiovascular Disease

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Abstract
EXOGENOUS estrogen use among postmenopausal women has consistently been associated with reduced risk of coronary heart disease (CHD),1 and surgical menopause in young women approximately doubles the risk of CHD if exogenous hormones are not taken.2 These observations suggest that early natural menopause might also increase CHD risk; however, few epidemiological studies have examined the relation of a broad range of ages at menopause with risk of cardiovascular disease. van der Schouw et al3 found a nonsignificant decreased risk of cardiovascular mortality among women with later age at natural menopause. Results of 2 other relatively small studies4,5 show a nonsignificant increase in risk of coronary death among women who had natural menopause before age 40 years. One limitation of these studies is that none examined the association among never smokers. Because smoking is a strong risk factor for early menopause6 and a strong independent risk factor for CHD, it may be such an important confounder that the issue may be best addressed among never smokers. In addition, few studies have adequately controlled for age. Rates of CHD approximately double between the ages of 50 and 55 years, and because age is so closely linked to menopause, adjustment by 5-year age categories—as done in some studies—may not adequately control for age.