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Some CHD risk factor changes related to menopausal transition period in addition to chronological aging
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Women in the transitional period surrounding menopause had a unique increases in lipids related to the transition, results from a new analysis of the SWAN study suggested.
The researchers evaluated 1,054 women who achieved a final menstrual period within nine years of follow-up in the SWAN study that was not due to hormone therapy or surgery. The researchers evaluated coronary heart disease risk factors in participants, including lipids, lipoproteins, C-reactive protein, BP, glucose, insulin and fibrinogen. The researchers then sought to determine if a linear model of risk factor assessment consistent with chronological aging or a piecemeal model consistent with ovarian aging were a better fit with observed risk factor changes over time in relation to the final menstrual period.
Accoridng to the study results, total cholesterol (P<.0001), LDL (P<.0001) and apolipoprotein B (P<.0001) levels increased within a one-year interval prior to and following the final menstrual period. Increases in HDL and apolipoprotein A-I levels were observed prior to the one-year interval surrounding the final menstrual period, but leveled off thereafter. Based on the interaction slopes generated from the piecemeal linear model, the researchers reported that all ethnic groups changed in a similar fashion. Linear and piecemeal models were of equivalent fit for systolic and diastolic BP, C-reactive protein trajectories and insulin levels.
“Our findings have potential clinical implications because identification of the modifiable risk factors and early intervention may reduce women’s increased risk of CHD after menopause,” the researchers wrote in their conclusion. “This study underscores the need to closely monitor lipid profiles of premenopausal and perimenopausal women, and the importance of emphasizing proven lifestyle measures and therapeutic interventions before the menopause transition to counter and possibly prevent this adverse chance in lipids associated with menopause itself.”
Commentary in an accompanying editorial from Vera Bittner, MD, a professor of medicine at the University of Alabama at Birmingham, suggested that the coinciding processes occurring during ovarian aging and chronological aging make for particularly challenging and complicated CHD risk factor assessment in women during the time interval surrounding menopause.
“The take-home point for the clinician is that risk factor levels do indeed change around the time of menopause, some related to chronologic aging and some related to the menopausal transition itself,” she wrote. “Women should be made aware that their CV risk is likely to increase during this period and should be counseled to emphasize therapeutic lifestyle changes to combat such increases. It may be prudent to increase the frequency of risk factor monitoring during this time to identify women in a timely fashion who may benefit from pharmacologic management of their risk factors beyond lifestyle modification.”
Matthews K. J Am Coll Cardiol. 2009;54:2366-2673.