Obesity significantly increased heart failure risk among women who experienced late menopause at age 55 or older, according to new research published today in the Journal of the American Heart Association, open access, peer-reviewed journal of the American Heart Association. While women who enter menopause before the age of 45 are known to be at higher risk for heart failure, obesity significantly increased heart failure risk among women who experienced late menopause at age 55 or older, according to new research published today in the Journal of the American Heart Association, an open
According to the American Heart Association, following menopause, a woman’s body generates less estrogen and progesterone, which can raise the risk of cardiovascular disorders such as heart failure. Menopause usually happens between the ages of 45 and 55, however, according to some study, the average age for natural menopause has increased by 1.5 years in the last six decades.
Early menopause (before age 45) was 12.6 percent and late menopause (after age 55) was 14.2 percent in the National Health and Nutrition Examination Survey (NHANES) 1959-2018 surveys, which provided nationally representative estimates of the United States.
Early menopause has been linked to an increased risk of heart failure, according to a previous study. When the heart is unable to pump enough blood and oxygen to allow the body’s organs to function properly, heart failure is diagnosed.
“There is a gap in knowledge about the possible influence of late menopause occurring at age 55 or older on the incidence of heart failure,” according to lead study author Imo A. Ebong, M.D., M.S., an associate professor of medicine in the division of cardiovascular medicine at the University of California Davis, in Sacramento, California.
“We know that obesity increases the risk of developing heart failure, and the onset of menopause is associated with increased body fatness,” said Ebong. “In our study, we investigated if and how obesity affects the relationship between menopausal age and the future risk of developing heart failure.”
The Atherosclerosis Risk in Communities (ARIC) Study included roughly 4,500 postmenopausal women, and researchers analyzed their health data. ARIC is a long-term research project that began enrolling participants in 1987 with the goal of determining the relationships between known and suspected heart disease risk factors and the development of heart disease in adults in four different communities across the United States: Forsyth County, North Carolina; Jackson, Mississippi; Minneapolis suburbs; and Washington County, Maryland. By the end of 2019, six follow-up visits had been done.
A woman’s age when she enters menopause is an important factor, and women should share this information with their physicians to guide in estimating their risk of developing heart failure. Women with early menopause should be informed of their increased risk and counseled to adopt healthy lifestyle and behavioral changes. Women with late menopause should be particularly counseled to maintain a healthy body weight and prevent obesity to decrease their risk of future heart failure.
Imo A. Ebong
Participants were divided into four groups based on their age at the time of menopause: younger than 45 years, 45-49 years, 50-54 years, and 55 years and older. At the fourth visit, the average age of the research participants was 63.5 years.
Women who were diagnosed with heart failure before the fourth study visit were omitted from the analysis. At the fourth follow-up test, the women supplied their age at menopause and their weight was evaluated, among many other baseline measurements and assessments.
They were then divided into three groups based on their weight: normal weight (BMI between 18.5 and 24.9 kg/m2), overweight (BMI between 25.0 and 29.9 kg/m2), and obese (BMI 30 kg/m2 or more). Abdominal obesity was also defined as a waist circumference of 35 inches or more around the navel.
After adjusting for multiple other health and lifestyle risk factors for heart disease, such as Type 1 or Type 2 diabetes, hypertension (or high blood pressure), kidney function, inflammation, left ventricular hypertrophy, and prior heart attack, the heart failure risk potentially attributed to obesity as measured by BMI or waist circumference was calculated. Approximately 900 of the women experienced heart failure over the course of a 16.5-year follow-up, resulting in hospitalization or death.
The analysis found significant connections for menopausal age, BMI and waist circumference, and heart failure risk:
- The chance of having heart failure increased 39 percent for women in the menopause before age 45 group, 33 percent for those in the age 45-49 group, and twice (2.02 times higher) for women in the late menopause group with every six-point increase in BMI (age 55 or older). In women who experienced menopause between the ages of 50 and 54, a higher BMI was not linked to an increased risk of heart failure.
- The risk of having heart failure nearly quadrupled (2.93 times higher) for every 6-inch increase in waist circumference among women who reached menopause at age 55 or older.
- For women in any of the other menopausal age categories, waist circumference did not significantly increase the risk of heart failure.
“We had expected that the effect of obesity on heart failure risk would be greatest among women who had experienced early menopause. This was not so,” Ebong said. “The detrimental effects of obesity on heart failure risk was greatest among women who experienced late menopause.”
According to Ebong, the findings from the study could be useful for screening for heart failure and counseling postmenopausal women on heart failure prevention.
“A woman’s age when she enters menopause is an important factor, and women should share this information with their physicians to guide in estimating their risk of developing heart failure,” Ebong said.
“Women with early menopause should be informed of their increased risk and counseled to adopt healthy lifestyle and behavioral changes. Women with late menopause should be particularly counseled to maintain a healthy body weight and prevent obesity to decrease their risk of future heart failure.”
The current study has limitations because it did not include enough women to assess for different forms of heart failure individually.
“Our analysis should be repeated according to heart failure subtypes, preserved and reduced ejection fraction heart failure, to more clearly understand heart failure risk estimation and provide guidance on screening and prevention programs,” said Ebong.
Co-authors are Machelle D. Wilson, Ph.D.; Duke Appiah, Ph.D.; Erin D. Michos, M.D., M.S.; Susan B. Racette, Ph.D.; Amparo Villablanca, M.D.; Khadijah Breathett, M.D., M.S.; Pamela L. Lutsey, Ph.D., M.P.H.; Melissa Wellons, M.D.; Karol E. Watson, M.D., Ph.D.; Patricia Chang, M.D., M.H.S.; and Alain G. Bertoni, M.D., M.P.H.
The study was funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health.
