Premature menopause and hypertension as combined risk factors for cardiovascular events in women: a nationwide cohort analysis.

Abstract

Objectives: To evaluate the independent and combined effects of premature menopause (PM, before age 40) and hypertension on the risk of cardiovascular disease (CVD) events in postmenopausal women using a nationwide Korean cohort.

Methods: This retrospective cohort study used data from the Korean National Health Insurance Service, including 1,168,791 postmenopausal women (aged ≥40 y) without prior myocardial infarction or stroke, followed from 2009 to 2022 (mean follow-up, 11.5 y). PM was self-reported; hypertension was defined as blood pressure ≥140/90 mmHg or antihypertensive medication use. The primary endpoint was incident myocardial infarction, stroke, or CVD mortality, identified using ICD-10 codes. Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) with 95% CIs.

Results: The prevalence of PM was 1.7%, whereas that of hypertension was 43.2%. During follow-up, 117,499 CVD events occurred (9.1 per 1,000 person-years). Compared with women with neither risk factor (6.0 per 1,000 person-years), adjusted HRs were 1.42 (95% CI: 1.40-1.44) for hypertension alone, 1.18 (95% CI: 1.12-1.24) for PM alone, and 1.64 (95% CI: 1.56-1.71; 18.4 per 1,000 person-years) for both. Risks were consistent for myocardial infarction (HR: 1.54), stroke (HR: 1.64), and CVD mortality (HR: 1.85), and across all clinical subgroups.

Conclusions: Coexisting PM and hypertension confer a markedly elevated risk of CVD beyond either factor alone. Menopausal age and hypertension should be integrated into CVD risk stratification and primary prevention strategies for postmenopausal women.