Does Ovarian Function's Protective Power Extend to Heart Failure?

Summary and Comment |
May 15, 2017

Does Ovarian Function's Protective Power Extend to Heart Failure?

  1. Andrew M. Kaunitz, MD

Shorter reproductive duration was associated with higher risk for heart failure.

  1. Andrew M. Kaunitz, MD

Previous reports suggest that early menopause is associated with excess risk for cardiovascular disease (CVD). To evaluate associations between reproductive function and risk for heart failure (HF), investigators analyzed data from a subgroup of 28,516 women (54% non-Hispanic white, 31% black, 12% Hispanic) enrolled in the Women's Health Initiative (WHI). In this cohort, mean age at menarche was 13; at menopause, 47; and at enrollment, 63; no CVD was present at baseline. The analysis was adjusted for factors including body mass index, hypertension, and diabetes.

At a mean follow-up of 13 years, incident HF resulting in hospitalization had occurred in 1494 participants. Total reproductive duration was inversely associated with risk for incident HF (multivariable hazard ratio per year of reproductive function, 0.99; P=0.02). This association was more robust in women with natural (i.e., spontaneous) menopause than in those with surgical menopause. No significant effect modification was noted with race/ethnicity.

Comment

This modestly elevated risk for HF in women with shorter reproductive duration could reflect the excess risk for coronary heart disease (CHD) accompanying early menopause. This finding is also consistent with reports that bilateral oophorectomy raises CHD risk (BMJ 2017 Feb 6; 356:j372) — and with WHI clinical trial data showing lower incidence of CHD when hormone therapy was initiated in recently menopausal women (JAMA 2013; 310:1353). As the authors and editorialist note, more research is needed to fully understand the mechanisms underlying these findings (in particular, estrogen's cardioprotective effect).

Editor Disclosures at Time of Publication

  • Disclosures for Andrew M. Kaunitz, MD at time of publication Consultant / Advisory board Allergan; Bayer AG; Merck; Mithra; Pfizer; Shionogi Royalties UpToDate Grant / Research support Therapeutics MD; Bayer; Agile; Merck; Millendo; Mithra Editorial boards Contraception; Menopause; Contraceptive Technology Update; OBG Management; Medscape OB/GYN & Women’s Health Leadership positions in professional societies North American Menopause Society (Board of Trustees)

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