Disclosures: Freaney reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
September 16, 2021
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Premature menopause associated with increased ASCVD risk

Disclosures: Freaney reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Premature menopause was associated with an increased risk for atherosclerotic CVD, according to new findings published in JAMA Cardiology.

“Conventional ASCVD risk calculators currently do not include premature menopause,” Priya M. Freaney, MD, third-year cardiology fellow in the department of preventive medicine at Northwestern University Feinberg School of Medicine, and colleagues wrote. “Thus, the extent to which premature menopause may quantitatively change risk prediction of ASCVD, beyond traditional risk factors such as diabetes, hyperlipidemia, hypertension and obesity, is unknown.”

Data were derived from Freaney PM, et al. JAMA Cardiol. 2021;doi:10.1001/jamacardio.2021.3490.

Researchers pooled participant data from 5,466 Black and 10,584 white postmenopausal women from seven U.S. population-based cohorts. Women with a history of ASCVD were excluded and premature menopause was defined as menopause at younger than 40 years. ASCVD was defined as fatal or nonfatal CHD or stroke.

To assess the Pooled Cohort Equations model performance in 10-year risk predictions of incident ASCVD among women with and without premature menopause, researchers used categorical net reclassification improvement based on a lipid-lowering therapy clinical threshold of 7.5%.

Premature menopause was more common among Black women than among white women (17.4% vs. 9.8%). Researchers found premature menopause was significantly associated with ASCVD independent of traditional risk factors for Black women (HR = 1.24; 95% CI, 1.03-1.49) and white women (HR = 1.28; 95% CI, 1.13-1.45).

However, there was no benefit in ASCVD risk prediction when adding premature menopause to the Pooled Cohort Equations, with a 0.0007 categorical net reclassification improvement value for Black women (P = .91) and a categorical net reclassification improvement value of 0.003 for white women (P = .37).

According to the researchers, these findings are similar to results of previous studies and extend upon prior knowledge of data supporting premature menopause as a risk-enhancing factor for ASCVD. Due to no benefit in ASCVD risk when premature menopause was included in the Pooled Cohort Equations, premature menopause appears mediated largely by traditional risk factors such as diabetes and hypertension, Freaney and colleagues wrote.

“Clinicians should aim to screen and identify women with a high risk for ASCVD and then offer early detection and treatment of these risk factors soon after the menopausal transition,” the researchers wrote.