Menopause and risk of atherosclerotic cardiovascular disease: insights from a women's UK Biobank cohort

Abstract

Background

Menopause induces hormonal and metabolic changes that may increase the risk of atherosclerotic cardiovascular disease (ASCVD). However, the contribution of menopause to ASCVD risk, beyond aging, remains debated. This study investigated the association between menopause and ASCVD risk in a large population-based cohort.

Methods

We analyzed data from 222,007 women in the UK Biobank, excluding those with prior cardiovascular disease or uncertain menopausal status. ASCVD risk was estimated using pooled cohort equations. High ASCVD risk was defined as a 10-year risk ≥7.5 %. To address missing data, multiple imputations for the Area Deprivation Index (ADI) were performed using a fully conditional specification approach. Multivariable regression models were used to assess the association between menopause and ASCVD risk, adjusting for age as well as socioeconomic, lifestyle, metabolic, and clinical factors.

Results

Postmenopausal women (n = 158,572) had significantly higher estimated ASCVD risk than premenopausal women (n = 63,435) (3.75 % vs. 0.81 %; p < 0.001). The prevalence of high ASCVD risk was 9.65 % in postmenopausal women versus 0.41 % in premenopausal women (p < 0.001). After full adjustment, menopause was independently associated with a higher ASCVD risk (β = 0.56 %; 95 % CI 0.54–0.58) and an 18 % increased likelihood of high ASCVD risk (OR = 1.18; 95 % CI 1.01–1.37). The association was strongest among women aged under 60 years, with no significant association observed beyond 60 years.

Conclusion

Menopause is independently associated with increased ASCVD risk, particularly in women aged under 60 years. These findings highlight the importance of considering menopausal status in cardiovascular risk assessment and implementing targeted prevention strategies in midlife women.