Two new studies have addressed once again the issue of worsening of the cardiovascular risk profile in midlife, while focusing on the menopause transition and the role of menopause itself vis-à-vis aging as determinants of this physiological process. The first study investigated the SWAN cohort (Study of Women’s Health Across the Nation), a longitudinal, multi-site, community-based study of 3302 initially premenopausal and early perimenopausal women . Those healthy women had an annual examination, during which biochemical tests were performed to assess cardiovascular risk factors. Two longitudinal models for each risk factor were employed: (1) a linear model that assumes a constant slope across the following three time periods: more than 12 months before the final menstrual period (FMP), within 12 months before and after the FMP, and more than 12 months after the FMP; (2) a piecewise linear model that allows the slope to differ across the three segments. It was found that low density lipoprotein cholesterol and apolipoprotein B demonstrated an increase within 1 year around the time of the FMP, consistent with menopause-induced changes. However, changes in levels of other risk factors – glucose, insulin, triglycerides, lipoprotein(a), factor VIIc, systolic blood pressure, plasminogen activator inhibitor-1 – were attributed to aging rather than menopause. Diastolic blood pressure and levels of tissue plasminogen activator antigen, fibrinogen and C-reactive protein did not change during the follow-up period. All these alterations were similar among the various ethnic groups.
The second study addressed the alleged effects of estrogen deficiency on blood flow and the rate of development of atherosclerotic plaque . This was a cross-sectional study that included 120 early menopausal women (age range 42–55 years, <3 years in menopause) and 24 age-matched premenopausal women. Brachial artery flow-mediated dilation (FMD) and common carotid intima-media thickness (IMT) were studied. Estrogen receptor (ER)-α and ER-β polymorphisms were studied. FMD was significantly lower in early menopausal women compared with controls (5.43 ± 2.53 vs. 8.74 ± 3.17%, [i]p[/i] < 0.001), whereas IMT did not differ between groups ([i]p[/i] > 0.8). Severity of hot flushes was the most important independent predictor for FMD ([i]p[/i] < 0.001) in menopausal women. Women with moderate/severe/very severe hot flushes had impaired FMD in contrast to women with no/mild hot flushes or controls. Women with no/mild hot flushes did not differ compared with controls. Age and systolic blood pressure were the main determinants of IMT (both [i]p[/i] = 0.004). ER polymorphisms were not associated with vascular parameters.
Department of Medicine T, Ichilov Hospital, Tel-Aviv, Israel
Matthews KA, Crawford SL, Chae CU, et al. Are changes in cardiovascular disease risk factors in midlife women due to chronological aging or to the menopausal transition? J Am Coll Cardiol 2009;54:2366-73. Published December 15, 2009.
Bechlioulis A, Kalantaridou SN, Naka KK, et al. Endothelial function, but not carotid intima-media thickness, is affected early in menopause and is associated with severity of hot flushes. J Clin Endocrinol Metab 2010 Jan 15. Epub ahead of print.
Gambacciani M, Pepe A. Vasomotor symptoms and cardiovascular risk. Climacteric 2009;12(Suppl 1):32-5.