here is no link between the
menopause and increased risk of fatal
heart attack, say Johns Hopkins
researchers who report their findings
in the 6 September online issue of the
British Medical Journal, BMJ. They
found that the increasing number of
deaths from heart attack as women
get older is not due to the
menopause but aging alone and not
hormonal changes. They were also
surprised to find evidence suggesting
that something biological happens to
young men up to the age of 45 that
raises their heart risk and propose we
should be paying more attention to
that.
Instead of the long-held belief that
cardiovascular risk in women spikes
just after the menopause, the Johns
Hopkins research points towards the
risk rising at a constant rate over the
whole lifespan.
Study leader Dr Dhananjay Vaidya, an
assistant professor of medicine at the
Johns Hopkins University School of
Medicine, told the press:
"Our data show there is no big shift
toward higher fatal heart attack rates
after menopause."
"What we believe is going on is that
the cells of the heart and arteries are
aging like every other tissue in the
body, and that is why we see more
and more heart attacks every year as
women age. Aging itself is an
adequate explanation and the arrival
of menopause with its altered
hormonal impact does not seem to
play a role," he added.
The implications are that perhaps
more attention should be paid to
women's heart health before the
menopause, since this study suggests
that is not negligible, as previously
thought.
The researchers are not saying that
menopause has no effect in the risks
of other diseases. For instance, the
rate of breast cancer deaths goes
down faster at menopause, probably
because of the changes in hormone
levels, said Vaidya.
For their study, the researchers
analyzed rates of death among
people born in England, Wales and
the USA between 1916 and 1945.
They followed the trends among
groups of similar people as they aged
and found that around the age of the
menopause in each group, there was
no rise in deaths among women over
and above the steady curve expected
from aging.
Vaidya said the death rate curve
increases annually in a similar way to
compound interest: the rate stays
steady at 8% a year, but the risk
accumulates, getting bigger as each
year goes by.
Absolute mortality, said Vaidya,
increases at all ages with no abrupt
change at the time of the menopause.
What the team also found surprising
were what they saw in the curves for
men. We have known for some time
that the risk of dying from heart
disease hits men earlier in life than
women, but what Vaidya and
colleagues found was that the
mortality curve for men under 45
years of age went up by 30% a year,
and only slowed down after the age
of 45 to around 5% a year.
Overall, this was similar to the rate
throughout the lifetime for women
(thus coming back to the compound
interest analogy, after around midlife,
assuming both invested the same
capital sum, both men and women
will have accrued the same amount of
interest, or risk, just women at a
steady rate of 8% and men at a fast
rate of 30% followed by 5% after the
age of 45).
This suggests something biological is
happening in younger men that could
be putting their hearts at risk.
"Instead of looking at menopause,
what we should be looking at is what
is happening biologically to men over
time," urged Vaidya, explaining that
they don't have an answer, it's just
that "good research always creates
more questions."
One possible explanation is there are
differences between men and women
in terms of what happens to their
telomeres. These are the ends of
chromosomes that protect important
genes (think of the hard plastic ends
of shoelaces that stop them fraying).
Every time DNA is copied, a bit of
telomere is lost. This happens each
time cells divide, until the point is
reached where genes get damaged,
and that is the damaging effect of
aging on cells.
We know that while male and female
babies have the same telomere
lengths, by the time the male babies
reach young adulthood, these will be
significantly shorter than that of their
female couterparts, but then later in
life, the rate of them getting shorter is
about the same in both sexes. The
researchers wonder if this might
account for the higher risk of death
from heart disease at younger ages
for men, and then both sexes having
similar heart disease mortality rates
later in life.
The data revealed some good news
too: comparing groups according to
the year they were born, each
successive group had lower total and
heart disease death rates over their
lifetime, which the researchers said
was most likely because of better
nutrition , better quality of life,
preventive medical care, drugs and
other treatments for heart disease.
Vaidya urged doctors to ensure that
they assess cardiovascular health in
their female patients from an early
age, and make sure they follow
healthy heart habits.
"Special attention should be paid to
heart health in women due to their
overall lifetime risk - not just after the
time of menopause," said Vaidya.
Written by Catharine Paddock PhD
menopause and increased risk of fatal
heart attack, say Johns Hopkins
researchers who report their findings
in the 6 September online issue of the
British Medical Journal, BMJ. They
found that the increasing number of
deaths from heart attack as women
get older is not due to the
menopause but aging alone and not
hormonal changes. They were also
surprised to find evidence suggesting
that something biological happens to
young men up to the age of 45 that
raises their heart risk and propose we
should be paying more attention to
that.
Instead of the long-held belief that
cardiovascular risk in women spikes
just after the menopause, the Johns
Hopkins research points towards the
risk rising at a constant rate over the
whole lifespan.
Study leader Dr Dhananjay Vaidya, an
assistant professor of medicine at the
Johns Hopkins University School of
Medicine, told the press:
"Our data show there is no big shift
toward higher fatal heart attack rates
after menopause."
"What we believe is going on is that
the cells of the heart and arteries are
aging like every other tissue in the
body, and that is why we see more
and more heart attacks every year as
women age. Aging itself is an
adequate explanation and the arrival
of menopause with its altered
hormonal impact does not seem to
play a role," he added.
The implications are that perhaps
more attention should be paid to
women's heart health before the
menopause, since this study suggests
that is not negligible, as previously
thought.
The researchers are not saying that
menopause has no effect in the risks
of other diseases. For instance, the
rate of breast cancer deaths goes
down faster at menopause, probably
because of the changes in hormone
levels, said Vaidya.
For their study, the researchers
analyzed rates of death among
people born in England, Wales and
the USA between 1916 and 1945.
They followed the trends among
groups of similar people as they aged
and found that around the age of the
menopause in each group, there was
no rise in deaths among women over
and above the steady curve expected
from aging.
Vaidya said the death rate curve
increases annually in a similar way to
compound interest: the rate stays
steady at 8% a year, but the risk
accumulates, getting bigger as each
year goes by.
Absolute mortality, said Vaidya,
increases at all ages with no abrupt
change at the time of the menopause.
What the team also found surprising
were what they saw in the curves for
men. We have known for some time
that the risk of dying from heart
disease hits men earlier in life than
women, but what Vaidya and
colleagues found was that the
mortality curve for men under 45
years of age went up by 30% a year,
and only slowed down after the age
of 45 to around 5% a year.
Overall, this was similar to the rate
throughout the lifetime for women
(thus coming back to the compound
interest analogy, after around midlife,
assuming both invested the same
capital sum, both men and women
will have accrued the same amount of
interest, or risk, just women at a
steady rate of 8% and men at a fast
rate of 30% followed by 5% after the
age of 45).
This suggests something biological is
happening in younger men that could
be putting their hearts at risk.
"Instead of looking at menopause,
what we should be looking at is what
is happening biologically to men over
time," urged Vaidya, explaining that
they don't have an answer, it's just
that "good research always creates
more questions."
One possible explanation is there are
differences between men and women
in terms of what happens to their
telomeres. These are the ends of
chromosomes that protect important
genes (think of the hard plastic ends
of shoelaces that stop them fraying).
Every time DNA is copied, a bit of
telomere is lost. This happens each
time cells divide, until the point is
reached where genes get damaged,
and that is the damaging effect of
aging on cells.
We know that while male and female
babies have the same telomere
lengths, by the time the male babies
reach young adulthood, these will be
significantly shorter than that of their
female couterparts, but then later in
life, the rate of them getting shorter is
about the same in both sexes. The
researchers wonder if this might
account for the higher risk of death
from heart disease at younger ages
for men, and then both sexes having
similar heart disease mortality rates
later in life.
The data revealed some good news
too: comparing groups according to
the year they were born, each
successive group had lower total and
heart disease death rates over their
lifetime, which the researchers said
was most likely because of better
nutrition , better quality of life,
preventive medical care, drugs and
other treatments for heart disease.
Vaidya urged doctors to ensure that
they assess cardiovascular health in
their female patients from an early
age, and make sure they follow
healthy heart habits.
"Special attention should be paid to
heart health in women due to their
overall lifetime risk - not just after the
time of menopause," said Vaidya.
Written by Catharine Paddock PhD
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