The Impact of Premature Menopause on Future Risk of Cardiovascular Disease

Abstract

Cardiovascular disease remains the leading cause of morbidity and mortality for women in the USA. Recent multi-society guideline updates endorse using a history of premature menopause, defined as occurring before age 40 years, as a risk-enhancing factor for atherosclerotic cardiovascular disease risk assessment in women. Here, we review recent literature on cardiovascular disease risk in women with premature menopause, possible mechanisms linking premature menopause to cardiovascular disease, and the role of menopausal hormone therapy in postmenopausal women. Large cohort studies and meta-analyses have demonstrated significant associations between premature menopause and development of diverse cardiovascular diseases. In addition to atherosclerotic cardiovascular disease, recent studies have noted accelerated development of valvular heart disease and venous thromboembolism. Surgical premature menopause may be associated with greater risk of cardiovascular disease compared with natural premature menopause; further research to clarify differential risk and relevant underlying mechanisms is needed. Although the cardiovascular risks of menopausal hormone therapy appear largely restricted to women over age 60 years and more than 10 years post-menopause, data do not demonstrate convincing cardiovascular protective benefit in any age group. Premature menopause is associated with elevated future risk of diverse cardiovascular diseases. Further studies are needed to further elucidate mechanisms and identify novel preventive strategies.