The presence of obesity modifies the association between the age of menopause and the incidence of heart failure (HF), the risk of developing HF becoming significantly higher with worsening obesity. These findings were published in the Review of the American Heart Association.
The researchers assessed heterogeneity by obesity on the relationship between age at onset of menopause and incidence of HF. A total of 5,539 postmenopausal women who experienced natural or surgical menopause at the prospective Visit 4 of the Atherosclerosis Risk in Communities (ARIC) Study (1996 to 1998) were enrolled in the study. After exclusion for various reasons, the final sample size included 4441 postmenopausal women, including 3636 who had experienced natural menopause and 808 who had undergone surgical menopause. The hazard ratios (HR) of incident HF associated with age at menopause were estimated using Cox proportional hazards models.
Study participants were categorized by age at onset of menopause:
under 45, 45 to 49, 50 to 54 and 55 or older. Among 4441 postmenopausal women (mean age, 63.5 ± 5.5 years), a total of 903 incident HF events were reported over a mean follow-up of 16.5 ± 5.6 years. Heart failure incidence rates were 15.6/1000 person-years, 12.1/1000 person-years, 10.3/1000 person-years and 10.7/1000 person-years in people aged under 45, 45 to 49, 50 to 54, and 55 or older, respectively.
The study results show that the incidence rates of heart failure were highest in women with generalized or central obesity who had also experienced menopause at less than 45 years of age (21.3/1000 years -persons and 16.3/1000 person-years, respectively). However, the attributable risk of generalized obesity, overweight, and central obesity was highest in postmenopausal women at age 55 or older (11.09/1000 person-years, 4.56/1000 person-years and 7.38/1,000 person-years). -years, respectively).
The probability of CI-free survival during the follow-up period was lowest in women who experienced early menopause. A significant interaction was observed between age at menopause and body mass index (BMI) for the incidence of heart failure (Pinteraction =.02), thus justifying the presentation of current results based on menopausal age categories. A significant interaction was also reported between age at menopause and waist circumference (WC; Pinteraction =.001).
Adjusted RRs for incident CI associated with increased BMI were 1.39 (95% CI, 1.05-1.84), 1.33 (95% CI, 1.06-1 .67), 0.98 (95% CI, 0.73-1.31) and 2.02 (95% CI, 0.73-1.31). % CI, 1.41-2.89) for women aged less than 45, 45-49, 50-54, and 55 or older, respectively.
The adjusted RR of the incident CI for decreased waist circumference was high only in postmenopausal women aged 55 or older (2.93; 95% CI, 1.85-4.65). As BMI and waist circumference increased, adjusted incident CI RRs became higher in women who had experienced onset of menopause at age 55 or older compared to those in other age categories menopausal.
“Maintaining a healthy body weight and [WC] may protect against the development of HF, especially in women who have experienced late menopause,” the study authors noted. “These findings support a public health campaign advocating weight management in postmenopausal women, particularly those with late menopause.”
Disclosure: None of the study authors declared any affiliation with any biotechnology, pharmaceutical and/or device companies.
Ebong IA, Wilson MD, Appiah D, et al. Relationship between age at menopause, obesity and incident heart failure: the community atherosclerosis risk study. J Am Heart Association. Published online April 13, 2022. doi:10.1161/JAHA.121.024461