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Metabolic syndrome severity may increase before menopause
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Women, particularly black women, have a greater risk for metabolic syndrome and its five risk factors for CVD, stroke and diabetes before menopause rather than after menopause, according to new data published in the Journal of the American Heart Association.
“Previous research showed that, after menopause, women were at much greater risk for metabolic syndrome than before menopause began,” Mark DeBoer, MD, MSc, MCC, associate professor of pediatric endocrinology at the University of Virginia, Charlottesville, said in a press release. “This latest study indicated that the increased risk observed earlier may be related more to the changes happening as women go through menopause and less to the changes that take place after menopause.”
DeBoer and colleagues analyzed data from 1,470 women enrolled in the ARIC study to measure changes in the rate of progression of metabolic syndrome severity during the menopausal transition. Women were classified as premenopausal (menstrual period in last 2 years and no menopause), perimenopausal (menstrual period in last 2 years and in current menopause or uncertain of status) or postmenopausal (no menstrual period in last 2 years and no surgical removal of ovaries or uterus). Metabolic syndrome severity z scores were calculated during four visits over 10 years. Median follow-up was 9 years.
According to the results, women experienced a faster increase in metabolic syndrome severity during the premenopause and perimenopause periods compared with postmenopause (P < .05 for all). Black women had a greater rate of increase in severity during premenopause and perimenopause compared with white women (P < .001 and P = .036, respectively).
The rate of change in metabolic severity z scores per year was 0.057 for white premenopausal women and 0.061 for black postmenopausal women, while the rate of change was 0.057 and 0.115 for white and black premenopausal women, respectively.
Use of hormone-replacement therapy was not associated with metabolic syndrome severity during any menopause stage in this study. “We did not note differences in the rate of change in metabolic syndrome severity by current estrogen use —though we lacked data regarding dose and adherence to estrogen use, which may have further influenced any effect. Overall, however, hormone replacement did not appear to explain the racial differences in metabolic syndrome severity,” the researchers wrote.
When the researchers studied change in individual components of the metabolic syndrome, they found that black women had “more favorable” rates of change in waist circumference (P < .001), triglycerides (P < .01), HDL (P < .05) and fasting glucose (P < .05) during postmenopause compared with white women.
“We found that, both overall and particularly among [black] women in ARIC, the rate of increase in metabolic syndrome severity was rapid during the menopausal transition and decreased afterward. This most closely paralleled a rapid rise in triglyceride levels, as … had been noted in previous studies of women during menopause,” DeBoer and colleagues wrote in the study.
According to the researchers, while the mechanisms behind these findings are “unclear,” changes in estrogen levels and related action of hepatic function and adipocytes may be related.
These findings provide an opportunity to motivate women to make lifestyle changes to reduce their risk for metabolic syndrome and related diseases, DeBoer said.
“ … [T]he years transitioning to menopause may represent a ‘teachable moment,’ when patients are especially receptive to learning and putting into practice healthy habits that can make a difference in their [CVD] risk,” he said in the press release. – by Tracey Romero
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Katherine Sherif, MD
It should be no surprise that metabolic syndrome incidence and severity increase before menopause. A prevailing view of menopause is that women are premenopausal one day and one year after the last period they inhabit a different body. The metabolic syndrome is intimately linked to sex hormones, which begin to decline noticeably in the late 30s and early 40s. Most studies have not examined women in their late 30s or early 40s to document symptoms or physiologic changes. In fact, there is resistance to studying women at these ages because some consider it “low yield.” The perimenopausal transition, which spans many years, provides a rich opportunity to study aging.
I applaud the authors of this important study for examining the perimenopausal cohort and comparing them to postmenopausal women. I would like to see more researchers examine women in their late 30s and 40s. The study should spur change in clinical practice by raising awareness of the increase in risk factors before, not after menopause. One of the traditional risk factors for CVD is postmenopausal status, but not perimenopausal status. Perimenopause is invisible because there is not a clear delineation or definition of what constitutes hormone deficiency, in spite of the fact that women have many symptoms and metabolic parameters change. Furthermore, there is not a slow, steady decline in hormones, but there are some who exhibit very high spikes in serum estradiol in the years before menopause.
Some of the concerns I had with the study were the difference in hormone use between white women and black women, which was at least twice as much. The groups were also not balanced for income levels. However, it was very well-designed and applied a sophisticated statistical model to describe the rate of change.
Researchers need to focus on the perimenopausal population, doing so will help to clarify the role of sex hormones on metabolism and aging.
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