Yang‐Hyun Kim

Background Mortality from cardiovascular diseases in Asian populations is considerable. Menopause is a risk‐enhancing factor for cardiovascular disease, but it is unclear whether menopause is an independent risk factor for cardiovascular disease and mortality in Asian women. Methods and Results A total of 1 159 405 postmenopausal women, who had participated in the health examinations of the Korean National Health Insurance Service in 2009, were analyzed, and their reproductive histories were taken. A multivariable Cox proportional hazard model assessed the hazard ratios (HRs) of myocardial infarction (MI), ischemic stroke, and all‐cause mortality, according to the history of premature menopause and age at menopause. After an average 10‐year follow‐up, there were 31 606, 45 052, and 77 680 new cases of MI, ischemic stroke, and all‐cause mortality, respectively. The women with premature menopause exhibited increased risks of MI (HR, 1.40 [95% CI, 1.31–1.50]), ischemic stroke (HR, 1.24 [95% CI, 1.17–1.31]), and all‐cause mortality (HR, 1.19 [95% CI, 1.14–1.24]) when compared with women with menopause aged ≥50 years. The highest risk was evident with menopause between the ages of 30 and 34 years (HR for MI, 1.52 [95% CI, 1.30–1.78]; HR for ischemic stroke, 1.29 [95% CI, 1.12–1.48]; HR for all‐cause mortality, 1.33 [95% CI, 1.20–1.47]) when compared with women with menopause aged ≥50 years. Conclusions Earlier age at menopause was associated with increased risks for MI, ischemic stroke, and all‐cause mortality. Future guidelines and risk assessment tools should consider menopause as an independent risk factor of cardiovascular disease in Korean women.