# Hidden Cardiovascular Risk: Early Menopause Triggering Acute Coronary Syndrome (ACS) in Young Patients

## TL;DR

Early menopause is linked to increased risk of heart problems in young women, including longer hospital stays and more complications.

## Contribution

This study identifies early menopause as a potential underrecognized cardiovascular risk factor in young women with acute coronary syndrome.

## Key findings

- Early menopause was found in 25.4% of young women with acute coronary syndrome.
- Women with early menopause had higher BMI, elevated FSH levels, and worse in-hospital outcomes like arrhythmias and heart failure.
- They also experienced longer hospital stays compared to non-menopausal women.

## Abstract

Introduction

Acute coronary syndrome (ACS) primarily affects individuals over 50 years of age. However, younger adults, particularly women experiencing early menopause, represent a unique demographic with significant implications for cardiovascular outcomes. Early menopause, characterized by cessation of menstruation before age 45, has been linked to increased metabolic and cardiovascular risks. This study explores the prevalence of early menopause and its associations with ACS among women aged 35-45 years.

Objective

This study aims to explore the occurrence of early menopause in young women presenting with ACS and examine its associations with cardiovascular risk factors, in-hospital outcomes (including arrhythmias, heart failure, and length of hospital stay), and hormonal parameters (follicle-stimulating hormone (FSH) levels).

Methods

This cross-sectional study was conducted at the Department of Cardiology at Mardan Medical Complex from March to September 2022. A total of 142 women aged 35-45 years with a confirmed diagnosis of ACS, classified as ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), or unstable angina based on clinical presentation, electrocardiographic changes, and cardiac troponin-I levels, were included. Early menopause was defined by ≥12 months of amenorrhea before age 45, corroborated by serum FSH levels >40 mIU/mL measured using standard immunoassay techniques. Women with diabetes mellitus, hypertension, smoking history, hormonal replacement therapy use, chronic systemic disease, or malignancy were excluded. Associations were evaluated using independent t-tests, chi-square tests, and multivariable logistic regression, adjusting for potential confounders.

Results

Early menopause was identified in 36 participants (25.4%). Women with early menopause had a significantly higher body mass index compared to non-menopausal women (mean difference: 1.6 kg/m²; p = 0.02). Mean FSH levels were markedly elevated in the early menopause group (67.8 ± 6.4 vs. 16.4 ± 4.3 mIU/mL; p < 0.01), with the highest levels observed among NSTEMI patients. Early menopausal women experienced longer hospital stays (mean difference: 0.8 days; p = 0.03) and higher odds of in-hospital arrhythmias and heart failure, indicating increased vulnerability to adverse short-term outcomes.

Conclusion

Early menopause is common among young women presenting with ACS and is associated with unfavorable clinical characteristics and in-hospital outcomes. These findings suggest that early menopause may act as an underrecognized cardiovascular risk enhancer in younger women. The absence of long-term follow-up represents a limitation and warrants future prospective studies to determine its impact on long-term cardiovascular outcomes.