Early menopause criterion adds no value to CVD risk detection among multiethnic women

The addition of early menopause to current eligibility criteria for cardiovascular disease (CVD) risk screening does not appear to improve the detection of women at high risk of CVD in a multiethnic population, as shown in a study.

The analysis used data from the HELIUS study and included 4,512 women (median age 53 years) of Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish, and Moroccan ethnic origin.

Dutch women were more likely to have higher education than women in the other ethnic groups. South-Asian Surinamese women had the highest proportion of family history of premature CVD (55 percent) and prevalence of high CVD risk (26 percent). Meanwhile, obesity was most common among Turkish women (60 percent), and the proportion of smokers was lowest among Moroccan women (2 percent). The median estimated CVD risk was below 5 percent across all ethnic groups.

The overall age-adjusted prevalence of early menopause was 10 percent (95 percent confidence interval [CI] 9–11), ranging from 7 percent (95 percent CI, 4–12) among Moroccan women to 16 percent (95 percent CI, 3–60) among Ghanaian women.

When integrated into current eligibility criteria for CVD risk screening, early menopause improved the criteria’s performance but not significantly so. Specifically, the area under the curve (AUC) changed from 0.70 (95 percent CI, 0.69–0.72) to 0.71 (95 percent CI, 0.69–0.72) in the overall population of women aged between 45 and 70 years. When limited to women aged 45–50 years, the AUC changed from 0.66 (95 percent CI, 0.58–0.74) to 0.68 (95 percent CI, 0.59–0.74).

The results were consistent across ethnic groups.

Women at risk, especially in ethnic minority groups, may be missed using the current eligibility criteria for screening. However, the present data show that early menopause as an eligibility criterion may not be of value for screening.