HDL not as cardioprotective in postmenopausal women

Women who were postmenopausal did not have the cardioprotective benefits typically seen with elevated HDL, according to an analysis published in Arteriosclerosis, Thrombosis, and Vascular Biology.

“The menopausal transition is a critical period of women’s lives when they are subjected to an increase in their bad cholesterol, shift in fat deposition from peripheral to central abdomen and changes in vascular health, and all can significantly increase women’s risk for CVD, the No. 1 killer for women,” Samar R. El Khoudary, PhD, MPH, BPharm, FAHA, associate professor of epidemiology at University of Pittsburgh, told Cardiology Today. “Women and their health care providers need to be aware of these risks for that early intervention strategies can be adopted before reaching menopause. This includes a heart-healthy lifestyle.”

MESA data

Researchers analyzed data from 1,380 women (mean age, 62 years) from the MESA study who either had natural menopause (n = 848; mean age, 65 years), surgical menopause (n = 290; mean age, 63 years) or perimenopause (n = 242; mean age, 48 years). Those with self-reported CVD, cancer, pregnancy or cognitive impairment at baseline were excluded from the study.

In this analysis, HDL ion-mobility data and a carotid artery scan were available from the baseline visit. Information on menopause status was collected at baseline by asking women whether they have gone through menopause and at what age. Other data that were analyzed include smoking status, race/ethnicity, physical activity, BMI, systolic BP, diabetes status, C-reactive protein levels and interleukin-6 measurements.

After adjusting for total HDL particles and HDL cholesterol, higher levels of HDL particles were associated with lower carotid intima-media thickness (P = .001) and a greater risk for the presence of carotid plaque (P = .04), although this was not seen for HDL cholesterol.

Time since menopause

The association of large HDL particles with carotid intima-media thickness was significantly modified by the time since menopause. This effect was not seen for small HDL particles. Higher levels of large HDL particles were linked to higher carotid intima-media thickness in women who were close to menopause and lower carotid intima-media thickness later in life.

Women who were more than 10 years postmenopausal had the strongest proatherogenic association between HDL cholesterol and carotid plaque.

“To better understand whether quality of HDL changes as women transverse menopause, a study that follows women over the menopausal transition and assesses other metrics of HDL function that can better reflect quality and functionality of HDL particles is needed,” El Khoudary said in an interview. “We also need to evaluate whether and how changes in HDL quality over the menopausal transition impact CVD risk later in life. Only longitudinal studies could address these gaps in our current knowledge.” – by Darlene Dobkowski

For more information:

Samar R. El Khoudary, PhD, MPH, BPharm, FAHA, can be reached at elkhoudarys@edc.pitt.edu.

Disclosures: The research was supported by Quest Diagnostics. El Khoudary reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.