Relationship Between Age at Menopause, Obesity, and Incident Heart Failure: The Atherosclerosis Risk in Communities Study

Imo A. Ebong, Machelle D. Wilson, Duke Appiah, Erin D. Michos, Susan B. Racette, Amparo Villablanca, Khadijah Breathett, Pamela L. Lutsey, Melissa Wellons, Karol E. Watson, Patricia Chang, Alain G. Bertoni

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Background The mechanisms linking menopausal age and heart failure (HF) incidence are controversial. We investigated for heterogeneity by obesity on the relationship between menopausal age and HF incidence. Methods and Results Using postmenopausal women who attended the Atherosclerosis Risk in Communities Study Visit 4, we estimated hazard ratios of incident HF associated with menopausal age using Cox proportional hazards models, testing for effect modification by obesity and adjusting for HF risk factors. Women were categorized by menopausal age: <45 years, 45 to 49 years, 50 to 54 years, and ≥55 years. Among 4441 postmenopausal women, aged 63.5±5.5 years, there were 903 incident HF events over a mean follow-up of 16.5 years. The attributable risk of generalized and central obesity for HF incidence was greatest among women who experienced menopause at age ≥55 years: 11.09/1000 person-years and 7.38/1000 person-years, respectively. There were significant interactions of menopausal age with body mass index and waist circumference for HF incidence, P interaction 0.02 and 0.001, respectively. The hazard ratios of incident HF for a SD increase in body mass index was elevated in women with menopausal age <45 years [1.39 (1.05-1.84)]; 45-49 years [1.33, (1.06-1.67)]; and ≥55 years [2.02, (1.41-2.89)]. The hazard ratio of incident HF for a SD increase in waist circumference was elevated only in women with menopausal age ≥55 years [2.93, (1.85-4.65)]. Conclusions As obesity worsened, the risk of developing HF became significantly greater when compared with women with lower body mass index and waist circumference, particularly among those who had experienced menopause at age ≥55 years.

Original languageEnglish (US)
Article numbere024461
JournalJournal of the American Heart Association
Issue number8
StatePublished - Apr 19 2022

Bibliographical note

Funding Information:
The ARIC (Atherosclerosis Risk in Communities) study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under Contract nos. (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, and HHSN268201700004I). Dr Ebong and Dr Racette are supported by NHLBI PRIDE subaward grant R25 HL105400. Dr Machelle Wilson is supported by the National Center for Advancing Translational Sciences, National Institutes of Health, grant UL1 TR001860. Dr Breathett has research funding from NHLBI K01HL142848, R25HL126146 subaward 11692sc and L30HL148881; and Women as One. Dr Villablanca is supported by the Frances Lazda Endowed Chair in Women’s Cardiovascular Medicine.

Publisher Copyright:
© 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.


  • heart failure
  • menopause
  • obesity
  • Body Mass Index
  • Humans
  • Menopause
  • Middle Aged
  • Risk Factors
  • Atherosclerosis/complications
  • Male
  • Incidence
  • Heart Failure/etiology
  • Obesity/complications
  • Female

PubMed: MeSH publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.
  • Journal Article
  • Research Support, N.I.H., Extramural


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