Aging, Not Menopause, Linked to Increased Risk of Heart Disease

Hormonal changes associated with menopause do not increase a woman’s risk for heart disease and heart disease mortality, according to new research published in BMJ. The work of Dr Dhananjay Vaidya, assistant professor of medicine at John Hopkins School of Medicine, and colleagues contradict the previously hypothesis that heart disease and heart attacks rise dramatically after menopause.

The authors looked at longitudinal mortality data across England, Wales, and the United States for three birth cohorts (1916 to 1925, 1926 to 1935, and 1936 to 1945). Vaidya and colleagues failed to find a sharp increase in slope or step increase in ischemic heart disease mortality among women at menopausal ages. Instead, they found that mortality steadily increased across all ages in adult women. In other words, their research indicates that absolute mortality increases at all ages with no abrupt rate change for risk at menopause. Because they used data across geographical areas and decades, the researchers believe the findings are true despite lifestyle and risk behaviors (e.g., smoking).

“Our data show there is no big shift toward higher fatal heart attack rates after menopause,” Vaidya explained in a statement to the press. “What we believe is going on is that the cells of the heart and arteries are aging like every other tissue in the body, and that is why we see more and more heart attacks every year as women age. Aging itself is an adequate explanation, and the arrival of menopause with its altered hormonal impact does not seem to play a role.”

Vaidya and colleagues also uncovered some interesting findings for men. According the mortality data, risk for heart disease in men may decrease as they age. The researchers found that the mortality curve for men under the age of 45 increases by 30% per year but slows to about 5% per year after that age. This rate is similar to the rate found in women throughout their lifetimes.

The decrease in risk among older men was not the only piece of good news that came from the study. Vaidya and colleagues found that each successive cohort had lower total and heart disease mortality than their previous cohort. Based on this data, the researchers believe better medications and treatments for heart disease as well as better nutrition, lifestyle and other prevention programs have made a positive impact on reducing heart disease mortality.

“Although we did not see any proportional acceleration of heart disease mortality at menopause, the absolute mortality still increases at all ages in women, including the postmenopausal period,” the authors explained. “Thus the current concern about cardiovascular disease among women in the ageing US population is fully justified, but with the focus on lifetime risk rather than primarily at menopause.”

Ultimately, the research serves as a reminder to clinicians treating female patients that heart disease screening should occur at all ages. Vaidya et al. concluded, “Efforts to improve cardiac health in women should focus on lifetime risk rather than risk only after menopause.”

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References:

Vaidya D, Becker DM, Bittner V, et al. Ageing, menopause, and ischaemic heart disease mortality in England, Wales, and the United States: modelling study of national mortality data. BMJ. 2011; Sep 6 [Epub].
Desmon S. No link between menopause, risk of heart attack. JHU Gazette. September 6, 2011.