Thursday, September 20, 2012

Early menopause ups heart stroke risk

NEW DELHI: Early menopause — a rising trend among Indian women — has now been associated with increased risk of heart condition and stroke. An Indian doctor at the Johns Hopkins University School of Medicine in the US has found that women who go into early menopause are twice as likely to suffer from coronary heart disease and stroke. In an interview to TOI from the US, Dr Dhananjay Vaidya, an assistant professor in the department of general internal medicine at the Johns Hopkins University School of Medicine, said, "If physicians know a patient has entered menopause before her 46th birthday, they should be extra vigilant in making recommendations and providing treatments to help prevent heart attacks and stroke." Research has shown that smokers reach menopause, on average, two years earlier than non-smokers do, so quitting smoking may delay it. Worryingly, an average Indian female smoker puffs more cigarettes a day (7) than males (6.1). An average Indian woman is taking to smoking at 17.5 years as against 18.8 years among men.
Dr Vaidya said the association holds true in patients from a variety of different ethnic backgrounds and is independent of traditional cardiovascular disease risk factors. The study has been published in the October issue of the journal, Menopause. "Our results suggest it is also important to avoid early menopause if at all possible," he said. Notably, the researchers said, their findings about the negative impact of early menopause were similar whether the women reached it naturally or surgically like removal of reproductive organs. Often, Vaidya said, women who undergo hysterectomies have their ovaries removed and that precipitates rapid menopause. "Perhaps ovary removal can be avoided in more instances," he said. Vaidya examined data from 2,509 women aged between 45 and 84 — all enrolled between 2000 and 2002 and followed until 2008. The survey revealed 28% reported early menopause, or menopause that occurs before the age of 46. Vaidya emphasizes that although the risk of heart attack and stroke was doubled in these groups, the actual number of cardiac and stroke events recorded among study participants was small. Only 50 women in the study suffered heart events, while 37 had strokes. Menopause is a process during which a woman's reproductive and hormonal cycles slow down, her periods (menstruation) eventually stop, ovaries stop releasing eggs for fertilization and produce less estrogen and progesterone, and the possibility of pregnancy ends. A natural event, which takes place in most women in the 45-55 age group, of menopausal onsets and rates are influenced by a combination of factors, including heredity, smoking, diet and exercise. "Cardiovascular disease processes and risks start very early in life, even though the heart attacks and strokes happen later. Unfortunately, young women are often not targeted for prevention because cardiovascular disease is thought to be only attacking women in old age. What our study reaffirms is that managing risk factors when women are young will likely prevent or postpone heart attacks and strokes when they age," he said. Dr Vaidya said, "I found a survey of women visiting gynecology specialists in India published by Dr M Singh of Tanvir Hospital, Hyderabad. Approximately half of the women in their approx 1000 survey may have had menopause before 46 years." According to him, the main preventable reason for early menopause (in some countries and in some parts of the Indian population) is smoking. However, for the vast majority of women in developing countries, the reason for early menopause is poor nutrition during early life and young adulthood. Poor social/economic status women have early menopause. "If a woman is young (or parents of girls should pay attention), good nutrition is key because the women will have a longer reproductive life and also lesser heart disease and stroke in old age. For women who smoke: quitting will do both, give a longer reproductive life and also lesser heart disease and stroke in old age. For women who are already older, if they have had early menopause, they should be extra vigilant in improving their lifestyle, exercise before heart disease happens. Greater care should be taken in controlling high blood pressure and high cholesterol — so that those do not increase risk even more," he added.

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