Elevated HDL, total cholesterol increase heart failure after menopause
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Key takeaways:
- Postmenopausal women with high total or HDL cholesterol levels have increased risk for heart failure.
- Providers should monitor cholesterol as part of HF prevention.
Postmenopausal women with high total or HDL cholesterol have an increased risk for heart failure compared with women with normal cholesterol levels, according to a study published in Menopause.
“Menopause is a normal physiologic process in women, but the underlying hormonal changes may drive up the risk of cardiovascular disease,” Ahmed Arafa, MD, PhD, of the department of preventive cardiology at the National Cerebral and Cardiovascular Center in Osaka, Japan, and colleagues wrote. “Our study indicated a greater risk of heart failure (defined as brain natriuretic peptide 100 pg/mL) among postmenopausal Japanese women with total cholesterol of 240 mg/dL or greater. We could also notice a positive association between total cholesterol of less than 160 mg/dL and the risk of heart failure, yet it was not statistically significant, most probably due to the limited number of participants in this category.”
Researchers obtained data from 1,307 women aged 55 to 94 years who participated in a prospective cohort study investigating risk factors for CVD in Japan. Participants attended a visit at baseline and were asked to attend a follow-up every 2 years. Women were diagnosed with heart failure (HF) if they had a brain natriuretic peptide level of 100 pg/mL or greater during follow-up. Cholesterol levels were obtained from blood samples. Participants were stratified by American Heart Association cholesterol level cutoffs.
There were 153 women who developed HF over a median 8 years of follow-up. Women who had total cholesterol of at least 240 mg/dL were more likely to develop HF than those with total cholesterol between 160 mg/dL and 199 mg/dL (adjusted HR = 1.7; 95% CI, 1.04-2.77). Participants with HDL cholesterol of 100 mg/dL or higher had a higher risk for HF than women with HDL cholesterol of 50 mg/dL to 59 mg/dL (aHR = 2.7; 95% CI, 1.1-6.64). LDL cholesterol, non-HDL cholesterol and triglycerides were not associated with HF risk.
When participants were divided into quartiles by HDL cholesterol level, women in the quartile with the highest HDL cholesterol had a higher risk for HF than those in the lowest quartile (aHR = 1.66; 95% CI, 1.04-2.63). There were no associations when the study group was stratified by age, BMI, hypertension or lipid-lowering medication use. There was a higher risk for HF observed among women with total cholesterol of less than 160 mg/dL with no hypertension (aHR = 5.6; 95% CI, 2.02-15.56) and women with total cholesterol of 240 mg/dL or higher who used lipid-lowering medication (aHR = 3.15; 95% CI, 1.2-8.28) compared with women with total cholesterol of 160 mg/dL to 199 mg/dL.
“Monitoring total cholesterol and HDL cholesterol in postmenopausal women should be considered for HF prevention,” the researchers wrote. “The cardioprotective effects of HDL cholesterol should not be taken for granted at very high levels.”
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