Obesity modifies link between menopausal age and heart failure risk

The risk of developing heart failure (HF) appears to increase in proportion with the level of obesity, especially among women whose menopause occurred at ≥55 years of age, a study has found.

The study used data from the Atherosclerosis Risk in Communities Study Visit 4 and included 4,441 postmenopausal women (mean age 63.5 years, mean body mass index [BMI] 28.8 kg/m², mean waist circumference 100.8 cm). Researchers grouped these women according to menopausal age: <45 years (n=1,200), 45–49 years (n=1,515), 50–54 years (n=1,468), and ≥55 years (n=258).

Over a mean follow-up of 16.5 years, a total of 903 incident HF events were documented. The incidence rates per 1,000 person-years were 15.6, 12.1, 10.3, and 10.7 in the <45 years, 45–49 years, 50–54 years, and ≥55 years age groups, respectively.

On analysis, the highest attributable risk of generalized and central obesity for HF incidence was found among women who experienced menopause at age ≥55 years: 11.09 per 1,000 person‐years and 7.38 per 1,000 person‐years, respectively. There were significant interactions between menopausal age and body mass index and waist circumference for HF incidence (p=0.02 and p=0.001, respectively, for interaction).

Each standard-deviation increase in BMI was associated with a twofold increase in the risk of HF among women with menopausal age of ≥55 years (hazard ratio [HR], 2.02, 95 percent confidence interval [CI], 1.41–2.89) and around 30-percent risk increase among those with menopausal age of <45 years (HR, 1.39, 95 percent CI, 1.05–1.84) and 45–49 years (HR, 1.33, 95 percent CI, 1.06–1.67).

The risk of HF per one-SD increase in waist circumference was elevated only among women with menopausal age ≥55 years (HR, 2.93, 95 percent CI, 1.85–4.65).

The findings underscore the protective role of maintaining a healthy body weight and waist circumference against the risk of developing HF, particularly among women who have experienced late menopause.