Atrial fibrillation and menopause: something else to worry about, or not?

Menopausal age is established as a strong marker of adverse cardiovascular risk. Earlier age of menopause has been related to increased myocardial infarction, stroke, heart failure and cardiovascular mortality. It would stand to reason, then, that menopausal age would similarly be associated with increased likelihood of atrial fibrillation (AF). AF is most commonly a disease of cardiovascular ageing, and multiple factors—cardiovascular events, increased inflammation and thrombosis and hormonal dysregulation—could be expected to link earlier onset of menopause with increased risk of AF. Several cohort studies have now examined the association of earlier menopausal age and AF. In their  Heart  manuscript, Wong et al have elucidated the relation between age of menopause and incident AF.1 In a cohort of over 30 000 women from the Women's Health Study—the largest cohort to examine this question to date—the authors followed cohort participants for a median of 20.5 years. The primary outcome was the onset of AF, self-reported and confirmed by physician review of medical records. In this cohort of 30 034 women, …