Age of menopause, healthy lifestyle and cardiovascular disease in women: a prospective cohort study

Anushriya Pant; Alice A Gibson; Simone Marschner; Lee P Liao; Liliana Laranjo; Clara K Chow; Sarah Zaman

doi:10.1136/heartjnl-2024-324602

Age of menopause, healthy lifestyle and cardiovascular disease in women: a prospective cohort study

Heart. 2024 Dec 17:heartjnl-2024-324602. doi: 10.1136/heartjnl-2024-324602. Online ahead of print.

Authors

Anushriya Pant¹, Alice A Gibson^{2

3}, Simone Marschner¹, Lee P Liao¹, Liliana Laranjo¹, Clara K Chow^{1

4}, Sarah Zaman^{5

4}

Affiliations

¹ Faculty of Medicine and Health, The University of Sydney Westmead Applied Research Centre, Westmead, New South Wales, Australia.
² Menzies Centre for Health Policy and Economics, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
³ The University of Sydney Charles Perkins Centre, Sydney, New South Wales, Australia.
⁴ Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia.
⁵ Faculty of Medicine and Health, The University of Sydney Westmead Applied Research Centre, Westmead, New South Wales, Australia sarah.zaman@sydney.edu.au.

PMID: 39689929
DOI: 10.1136/heartjnl-2024-324602

Abstract

Background: Menopause is a timely opportunity to screen for cardiovascular disease (CVD) and intervene with healthier lifestyles. We investigated the association between premature/early menopause and the likelihood of CVD and whether a healthy lifestyle is associated with a lower likelihood of CVD in menopausal woman.

Methods: The Sax Institute's 45 and Up Study prospectively recruited participants aged ≥45 years (n=267 357) between 2005 and 2009 (New South Wales, Australia). Our study included women without prior CVD and reporting menopausal age at baseline. Primary outcome was new-onset CVD (self-reported heart disease/stroke) based on survey data at Wave 2 (2012-2015) and/or Wave 3 (2018-2020). Logistic regression models assessed the associations of premature (age <40 years) and early (age 40-44 years) menopause with CVD, compared with menopause between 50 and 52 years, adjusting for sociodemographic and clinical variables. Healthy lifestyle adherence was assessed using a score of five factors: smoking, physical activity, sitting, sleep and diet.

Results: We included 46 238 women (mean age 62.1±8.2 years), with 5416 (11.7%) cases of CVD over 15-year follow-up. After adjustment, the odds of CVD was higher in women with premature menopause (OR 1.36, 95% CIs 1.17 to 1.59; p<0.0001) and early menopause (OR 1.15, 95% CI 1.03 to 1.28; p=0.013) compared with menopause between 50 and 52 years. Among all women, high (score 9-10) versus low (score 0-5) healthy lifestyle adherence led to 23% lower odds of CVD (OR 0.77, 95% CI 0.68 to 0.86; p<0.0001), and in women with premature menopause, led to 52% lower odds of CVD (OR 0.48, 95% CI 0.30 to 0.77, p=0.0022). Lifestyle effect did not significantly differ between menopause categories (interaction, p=0.71).

Conclusion: Women with premature/early menopause are at higher likelihood for CVD. Lifestyle modification is associated with consistent reduction of the likelihood of CVD in women and should be encouraged across the life course.

Keywords: Cardiovascular Diseases; Cohort Studies; Risk Assessment; Risk Factors.