Early Age at Menopause Linked to Angina Post MI

From Medscape Medical News

Emma Hitt, PhD

August 24, 2010 — Women who have an early menopause, at 40 years or younger, are at higher risk for angina after a myocardial infarction (MI) vs women who experience menopause at 50 years or older, new research suggests.

Susmita Parashar, MD, with Emory University, in Atlanta, Georgia, and colleagues reported their findings in the July 21 online issue of Menopause: The Journal of The North American Menopause Society.

According to the researchers, women who experience early menopause may be at risk for cardiovascular disease morbidity and mortality because of a deprivation of estrogen after menopause; however, "no descriptions of its prognostic importance among women with known coronary heart disease have been reported," which may help in the risk stratification and management of this patient group.

In addition, the study authors note that angina symptom-driven care for women accounts for most costs associated with care in women with coronary heart disease.

In the current study, 493 women were interviewed by telephone 1 year after discharge from the hospital for MI on aspects of behavioral, treatment, and health status measures. Mean age at menopause (AAM) was 45.2 ± 7.8 years.

Participants were classified by AAM: 40 years or younger, 41 to 49 years, and 50 years or older. The researchers then determined whether age predicted 1-year post-MI angina and severity of angina while taking into account pre-MI angina, demographics, comorbidities, MI severity, and quality of care.

Of the women, 132 (26.8%) experienced early menopause at 40 years or younger. These women were more often smokers but otherwise had similar comorbidities and characteristics as women experiencing later menopause both before and after MI.

However, the rate of 1-year angina in women with an AAM of 40 years or younger (32.4%) was double that of women with an AAM of 50 years or older (12.2%) in a multivariable analysis (relative risk, 2.09; 95% confidence interval [CI], 1.38 - 3.17), as was the severity of angina (odds ratio, 2.65; 95% CI, 1.34 - 5.22 for a higher severity level).

"Early menopause is a significant predictor of angina at 1 year after MI, independent of comorbidities, MI severity, and quality of care," Dr. Parashar and colleagues conclude.

According to the researchers, deprivation of endogenous estrogen may increase the extent of vascular inflammation, endothelial and microvascular dysfunction, and coagulation abnormalities; and decrease arterial compliance, all of which could cause angina in the setting of coronary artery disease.

"A simple, inexpensive, and easily administered question regarding age at menopause may help identify high-risk women and guide efforts toward improving treatments and quality of life of post-MI women," they suggest.

Menopause. Published online July 21, 2010. Abstract