Premature menopause associated with increased lifetime risk of CHD

In a prospective population-based cohort study, premature menopause was associated with a 40% higher lifetime risk of CHD in Black women and White women.

This summary is based on the publication of Freaney PM, Ning H, Carnethon M, et al. - Premature Menopause and Lifetime Risk of Coronary Heart Disease. JAMA Cardiol. 2026 Mar 18:e260212. [Online ahead of print]. doi: 10.1001/jamacardio.2026.0212.

Introduction and methods

Background

Premature menopause (before age 40 years) is recognized as a risk-enhancing factor for ASCVD [1]. It is associated with an increased short-term risk of coronary heart disease (CHD) [2], but its association with lifetime risk of CHD and potential differences by race have not been well established.

Aim of the study

The aim of the study was to estimate the lifetime risk of CHD and the number of years lived free of CHD among women with and without premature menopause, stratified by self-identified race.

Methods

In this study, individual-level data from 6 US population-based prospective cohorts (1964–2018) from the Cardiovascular Disease Lifetime Risk Pooling Project were pooled. These cohort studies included: Atherosclerosis Risk in Communities Study, Cardiovascular Health Study, Framingham Heart Study, Framingham Offspring Study, Multi-Ethnic Study of Atherosclerosis, and Women’s Health Initiative. Postmenopausal women aged 55–69 years without CHD at baseline were included (n=3522 Black women and n=6514 White women). Premature menopause was defined as natural menopause before age 40 years. Follow-up was 163,660 person-years.

Outcomes

The primary outcome was CHD, defined as fatal or nonfatal MI or death due to CHD.

Main results

• Premature menopause was more common in Black women than in White women (15.5% vs. 4.8%).
• Premature menopause was associated with increased lifetime risk of CHD compared with no premature menopause in Black women (HR: 1.41; 95%CI: 1.04–1.90) and in White women (HR: 1.39; 95%CI: 1.03–1.87).
• Mean years lived free of CHD were similar between women with and without premature menopause in Black women (18.2 vs. 19.1 years; P=0.06) and in White women (22.5 vs. 24.1 years; P=0.07).

Conclusion

In this prospective population-based cohort study, premature menopause was associated with an increased lifetime risk of CHD in both Black and White women.

Find this article online at JAMA Cardiol.

References

1. Arnett DK,BlumenthalRS,AlbertMA,etal.2019 ACC/AHAguidelineontheprimarypreventionof cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task ForceonClinical Practice Guidelines. Circulation. 2019;140(11):e596-e646. doi:10.1161/CIR. 0000000000000678
2. HonigbergMC,ZekavatSM,AragamK,etal. Association of premature natural and surgical menopausewithincidentcardiovascular disease. JAMA.2019;322(24):2411-2421. doi:10.1001/jama. 2019.19191