Premature menopause (PM), defined as natural menopause before 40 years, has been associated with elevated short-term cardiovascular risk, though long-term implications remain less clearly defined. A prospective population-based cohort study published in the JAMA Cardiology assessed lifetime risk of coronary heart disease (CHD) and years lived free of and with CHD, stratified by race and PM status. 

The analysis included postmenopausal women aged 55–69 years from six US cohorts, contributing 163,600 person-years of follow-up between 1964 and 2018. Eligible participants were free of CHD at baseline, had available data on menopausal status and CHD outcomes, and self-identified as Black or White; those with surgically induced menopause were excluded.

The primary outcome was incident CHD, defined as fatal or nonfatal myocardial infarction (MI). Lifetime risks were estimated using modified Kaplan-Meier methods, while adjusted competing Cox models evaluated joint cumulative risks of CHD and non-CHD death. Restricted mean survival time analysis quantified years lived free of and with CHD.

Among 3522 Black women and 6514 White women, PM prevalence was higher in Black women (15.5%) than White women (4.8%). PM was associated with increased lifetime CHD risk, with hazard ratios (HR) of 1.41 (95% CI, 1.04–1.90) in Black women and 1.39 (95% CI, 1.03–1.87) in White women. Mean years lived free of CHD were lower among women with PM compared with those without, though differences were not statistically significant. 

PM was associated with approximately 40% higher lifetime CHD risk across racial groups. These findings support consideration of PM as a risk-enhancing factor in CHD prevention strategies.