Worsening Obesity Linked to Risk for Heart Failure in Women With Late Menopause

Obese woman at doctor
A study was conducted to determine the relationship between obesity, age at menopause, and heart failure incidence.

The presence of obesity modifies the association of menopausal age and incidence of heart failure (HF), with the risk for development of HF becoming significantly higher with worsening obesity. These findings were published in the Journal of the American Heart Association.

Investigators evaluated heterogeneity by obesity on the relationship between age at onset of menopause and HF incidence. A total of 5539 postmenopausal women who experienced natural or surgical menopause at the prospective Atherosclerosis Risk in Communities Study (ARIC) Visit 4 (1996 to 1998) were enrolled in the study. Following exclusion for a variety of reasons, the final sample size comprised 4441 postmenopausal women, including 3636 who had experienced natural menopause and 808 who had undergone surgical menopause. Hazard ratios (HRs) of incident HF associated with menopausal age were estimated with the use of Cox proportional hazards models.

The study participants were categorized according to age at onset of menopause:

younger than 45 years, 45 to 49 years, 50 to 54 years, and 55 years or older. Among the 4441 postmenopausal women (mean age, 63.5±5.5 years), a total of 903 incident HF events were reported over a mean follow-up of 16.5±5.6 years. The incidence rates of HF were 15.6/1000 person-years, 12.1/1000 person-years, 10.3/1000 person-years, and 10.7/1000 person years in those aged younger than 45 years, 45 to 49 years, 50 to 54 years, and 55 years or older, respectively.

Results of the study show that incidence rates of HF were greatest among those women with generalized or central obesity who had also experienced menopause at younger than 45 years of age (21.3/1000 person-years and 16.3/1000 person-years, respectively). The attributable risk for generalized obesity, overweight, and central obesity, however, was greatest among those women who experienced menopause at 55 years of age or older (11.09/1000 person-years, 4.56/1000 person-years, and 7.38/1000 person-years, respectively).

The probability of HF-free survival during the follow-up period was lowest among women who experienced early menopause. A significant interaction was observed between menopausal age and body mass index (BMI) for HF incidence (Pinteraction =.02), thus substantiating the presentation of the current findings based on menopausal age categories. A significant interaction was also reported between menopausal age and waist circumference (WC; Pinteraction =.001).

The adjusted HRs for incident HF associated with an increase in BMI were 1.39 (95% CI, 1.05-1.84), 1.33 (95% CI, 1.06-1.67), 0.98 (95% CI, 0.73-1.31), and 2.02 (95% CI, 1.41-2.89) for women aged younger than 45 years, 45 to 49 years, 50 to 54 years, and 55 years or older, respectively.

The adjusted HR of incident HF for a decrease in WC was elevated only in those women with a menopausal age of 55 years or older (2.93; 95% CI, 1.85-4.65). As BMI and WC increased, the adjusted HRs of incident HF became greater in those women who had experienced onset of menopause at 55 years of age or older compared with those in the other menopausal age categories.

“Maintenance of a healthy body weight and [WC] may be protective against developing HF, particularly among women who have experienced late menopause,” the study authors noted. “These findings support a public health campaign advocating weight management in postmenopausal women, particularly among those with late menopause.”

Disclosure: None of the study authors has declared affiliations with biotech, pharmaceutical, and/or device companies.  


Ebong IA, Wilson MD, Appiah D, et al. Relationship between age at menopause, obesity, and incident heart failure: the Atherosclerosis Risk in Communities Study. J Am Heart Assoc. Published online April 13, 2022. doi:10.1161/JAHA.121.024461

This article originally appeared on The Cardiology Advisor